Philadelphia’s Civil Service Commission has paved the way for a Nutter administration plan to halve the number of paramedics serving on each of the fire department’s 50 medic units, despite vehement objections from leaders of the city’s firefighters and paramedics union.
The administration unveiled the plan on March 25 during a City Hall news conference. Traditionally, the fire department has staffed each of its ambulances with two paramedics. Under the new protocol, each unit will be staffed by one paramedic and one emergency medical technician. By definition, EMTs receive less medical training than paramedics and are not certified to perform certain advanced life support functions such as administering medication and reading electrocardiograms.
While the administration maintains that the redeployment will allow the fire department to put more ambulances on the street at any given time, the union argues that the new system could compromise the level of emergency medical care provided by the department.
“This places a greater burden on already overworked medic units,” said Joe Schulle, president of Local 22 of the International Association of Fire Fighters.
On March 26, the commission approved the creation of a new job classification within the fire department to accommodate the new deployment scheme. Previously, the department’s complement of EMTs consisted entirely of firefighters. Now, the department will be able to hire EMTs who will not fight fires.
Deputy Fire Commissioner David Gallagher, who oversees emergency medical services, said the redeployment is part of a sweeping overhaul that the department hopes will make more efficient and appropriate use of its EMS resources. The department also will implement a new “tele-triage” call-taking system that will allow 911 operators to better-assess the severity of medical emergencies over the telephone.
“We want to address the fact that currently in our deployment today, we are sending two EMTs in cases where they may end up on a critical call. (And) we are sending two paramedics on a basic call that maybe neither of them are needed on,” Gallagher said.
In 2013, the fire department responded to about 100,000 calls for advanced life support, but only about 65,000 of those cases actually required paramedic-level treatment. Even for legitimate ALS calls, state standards require only one paramedic and one EMT, according to the city’s director of public safety, Michael Resnick.
In support of the new single-paramedic units, the fire department plans to have five roving supervisor-level paramedics on the street. They will travel in SUVs and serve as the second paramedic on ALS cases. Gallagher claims that the new deployment will allow the fire department to have as many as eight additional ambulances in service on certain days of the week. In a typical daytime shift, there may be 45 to 48 working ambulances.
Schulle believes that the new plan is largely about the budget. New EMTs will earn about 30 percent less than paramedics do. The fire department does not train paramedics, who obtain paramedic certification on their own before entering the fire academy. The department employs about 230 paramedics and has 30 to 40 vacant paramedic positions, according to the union leader.
“They should just hire more [paramedics],” Schulle said. “Right now, they have a [candidate] list of 71.”
The union leader also notes that ALS standards established by the National Fire Protection Association call for two paramedics on each ALS call. Often, ALS units need one paramedic to administer treatment while another maintains contact with emergency room physicians. Also, having two paramedics with a patient affords them the opportunity to consult with one-another over treatment options. In such a stressful job, two paramedics are needed to share the workload, Schulle contends. ••