City unveils controversial plan to redeploy paramedics

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. ••

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