The Great Ambulance Debate...

This is a bit outside my purview, but here's my two cents on who gets to provide emergency ambulance service to the LACoFD. For the last few years, American Medical Response has provided a majority of the 911 ambulance service for the County fire department.

Unlike LA City and (a few smaller municipalities) that use their own ALS and BLS ambulances to transport medical patients, the County sends two-man paramedic squads--just like in the 1970s show "Emergency!". Private ambulances respond to 911 calls but they're staffed with two EMTs who assist the fire medics with patient care. The fire-medic then hops onto the private ambulance and transports to the hospital with the EMTs.

This is a particularly stupid system for a variety of reasons. First, the fire department has to separately alert the ambulance dispatchers on any medical call. This causes a delay right from the start of the 911 process.

Second, the delay is compounded by the private companies finding the closest ambulance that's sitting on some street corner and then sending the ambulance to the call. Invariably, the fire station that is sending the engine and squad is closer to the call, often by miles. Once the ambulance has been dispatched from its street corner, then another ambulance is either dispatched to the original street corner, or will sit at its assigned location and wait for the next call, which could be any distance away.

In the ambulance industry, this is known as "system-status mangement." Not only is it a complicated system developed by mostly moronic people that work at big companies like AMR (and even more moronic people who work at smaller companies), but it makes for grumpy EMT's who are stuffed into the front of ambulances driving around aimlessly or sitting in the parking lots of 7-Eleven's.

Even the casual scanner listener will often hear LA County fire captains and medics requesting "AMR's ETA" over the radio. Partly, the Fire guys are pissed that they're on a medical call, but they're also pissed that sick people have to wait for an ambulance while they've been on scene for many minutes providing care.

While AMR and others take response times very seriously because they're financially and contractually obligated to respond to calls in a certain amount of time, individual EMTs have less incentive. Mostly because they're going to get on scene and likely be treated like total shit by both the medics and the firefighters. Also, they're EMT's, so medically, they can't do shit. Often, they're also pissed because 95% of them are trying to/have tried to get hired by a fire department and are either in the middle of the long, long, long process, or have already been rejected.

Then, they're gonna carry the patient around on the stretcher while the (extremely strong and fit) fire guys sit around or scurry back to the engine. Granted, LA City's system isn't flawless. Often, busy periods leave ambulances scrambling across town (especially in South LA and the Valley), but non-ambulance ALS resources can often be paired with a BLS transport unit and that solves the issue. LAFD has done a great job of flooding the districts with FIRE STATION-BASED ambulances and paramedics on engines allowing for great flexibility.

The LA County Board of Supervisors a few weeks ago broke AMR's monopoly on ambulance transport in the county. This is both good and bad:

Good = AMR is shitty company. Period. In LA County where they primarily do non-emergency transport work and BLS 911 operations, they suffer from the complacency as the industry leader. In other parts of the country--and even California--AMR paramedics are the primary 911 responders. There are highly competent and experienced paramedics within those operations that provide first rate care. The company, however at the managerial level, totally sucks. And the last thing I want to hear is a defense of AMR from anyone. They're a unit of a large and poorly performing public company. The bottom line is stock price and return on investment to the shareholder. That is their motivation. They treat their employees like shit, and are lucky to have exclusive 911 contracts in many markets that provide employment for some excellent EMS providers. Paramedics and EMTs in a number of locations are even LUCKIER to have strong unions that deal extremely well with AMR.

In LA County, however, since top-line care is mostly provided by the fire departments, AMR cannot hide behind the good medicine and competence of its paramedics. It's all about the dollars in LA County. As for the smaller companies like Schaefer, Care and Westmed, it's a mixed bag. They now get wider leeway to play with the big boys, but suffer the same evils from barely competent EMTs, greedy executives and the system status issue.

The County should either begin staffing its own transporting ambulances or make their squads truly first assestment and treatment units and allow the private ambulances to use medics for 911 responses and transports. Holding the monopoly on ALS care while depending on the privates for response and transport via BLS units is stupid beyond the pale.

Thank God no one reads the site, or I'd have a hundred idiot EMTs and even more idiot firefighters bitching at me in ungrammatical sentences with dozens of misspellings.

Living in Beverly Hills....

So after years of rolling in the modified Chevy Tahoe's/Suburban's, the Beverly Hills PD last summer starting phasing in the Crown Vic's for the first time in a long time. I remember the old 1980s Crown Vics and the Chevy Impala's the department used to have (a la Beverly Hills Cop), but for the longest time they've been rolling in the SUVs.

Good things about the SUV = easy to spot the cops when driving through the city.

Bad things about the SUV = light bar scheme sucked--way too low profile and almost impossible to see from the rear. To alleviate the issue, they installed blue and yellow flashers in the upper part of the rear windows. Good idea on the lights. Bad idea on tinting those windows making the lights nearly invisible during the day.

But the new Crown Vics are sweet. Decent paint scheme, nice new LED low-pro light bars, tricked out strobe packages. Awesome flat-screen MDTs and some sort of crazy touch screen MDT or mini computer mounted to the facing the driver. Dont exactly know what it is.

Biggest problem: Cops are now tough to spot in traffic.

No good BHPD calls recently that I've heard.

As for the BHFD, as I've mentioned before, the new frontline engines in the fleet are sweet. And the new USAR is so over the top, it's ridiculous. Now, they just need to replace the aged Freightliner ambulances with the UGLY slanting patient compartments. Culver City has some sweet new Freightliner's that would be good for BH. Also, BH should number the rescues on the exterior like every other FD in the country.

That's what it's like, living in Beverly Hills.

No Excuses

I'm just not going to make any excuses for my extended absences anymore. Life's busy. I'm lazy. Ta-da.

But there's been some decent scanning lately.

--Turned on the Bearcat296D a few weeks ago at the tail-end of the LA Marathon to hear LAFD units going on what turned out to be a retired LAPD detective who had a sudden cardiac arrest at Mile 22 of the marathon. They had a rescue, the golf-cartesque "Gator" and a bunch of other units on scene. I think the LAFD's medical director (a self-important doctor that plays paramedic whenever he can) might have actually been first on scene. Either way, sudden cardiac arrest is never good, especially during a marathon. Patient was transported but was pretty much DRT (dead right there). Kinda crazy to turn on the scanner at the exact moment the call went down!

--Heard bits and pieces of the major LAFD deployment a few weekends ago for the immigration protests downtown. A few hundred thousand folks showed up (which is about a few hundred thousand more than anyone figured) and the LAFD was scrambling all afternoon for a ton of total bullshit calls. But things did get sorta hairy down there at one point and it sounded like the LAPD was going to have a riot on their hands. But a few more men in blue with riot gear seemed to quell the masses.

--Yesterday, LAFD had a good swiftwater call when two teenage girls in the Valley got swept down a flood control channel. The most amazing (and impressive) thing about the LAFD is its ability to swarm incidents with resources. LACoFD has a ton of units but they're so spread out that the density and rapid response of units always takes longer than the City's. Heard the huge Valley dispatch go out, but by the time units got rolling, it sounded like Light Force 89 may have completed the rescue. Didn't hear the details on the scanner, but judging by the congratulations all around, sounds pretty spectacular. LAFD is VERY good at swiftwater stuff.