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California County Expands Role of Private Ambulances

Expanding the role of private ambulances in Orange County's health-care system, a county official announced last week that companies will soon be able to use paramedics on some non-emergency calls.

The policy change will reduce the waiting times for people who need to be moved between health care facilities, officials say. But the move raised the ire of local firefighters union leaders, who say the unilateral decision should be reviewed by the Board of Supervisors.

Emergency Medical Services Director Dr. Sam Stratton decided to implement the new policy during a committee meeting, effectively ending months of debate.

"We are now able to provide the same service as other surrounding counties, and that will benefit the health and safety of the community," Stratton said after the Emergency Medical Care Committee meeting.

Scheduled to take effect Oct. 1, the change will allow private ambulance companies - which are now limited to emergency medical technicians or critical-care nurses - to use paramedics for transporting patients between health care facilities. Other counties statewide have a similar policy.

Paramedics fall between EMTs and nurses in their level of training and pay. They can perform advanced life support - administering intravenous drugs, cardiac defibrillation and other special procedures - while most EMTs are relegated to basic care.

An example of an advanced life support transfer: A patient arrives at a hospital with bleeding in her brain. After stabilizing her in the intensive-care unit, doctors realize she needs surgery - but they don't perform neurosurgery at that facility. They have to send her to another hospital under intense monitoring.

Today in Orange County, the only people who can perform such advanced life support while transferring patients are critical-care nurses or public fire department paramedics. Because fire departments make emergency calls a priority, nurses are typically left to make the advanced transfers.

But the state has a nursing shortage, and Stratton says that leads to long waits at hospitals - up to three hours in some cases - until a qualified nurse is available. That, in turn, can clog up bed space in hospitals and lead to longer waits for incoming emergency patients.

"Is this the kind of care I would want my mom or my dad to receive?" said Jon Gilwee, the director of government affairs at UC Irvine Health and a committee member. "I would want the doctor who was taking care of her to have this option to get her there as quickly as possible."

Union leaders criticized the policy as an ideologically driven move intended to enrich ambulance companies at the expense of patient well-being. They pointed to a death during a pilot study, when private paramedics handed off a nursing home patient to 911 responders, and she later died.

"This has nothing to do with public safety," said Joe Kerr, spokesman for the Orange County Professional Firefighters Association. "It has everything to do with political philosophy."

But Stratton said it was not the paramedics' skill or inherent problems with private paramedics which led to the death. Rather, he made a "political decision" in the beginning of the pilot study that 911 should be called in any instances of life-threatening emergencies - leading to a delay in care.

"If anything, the death rests on me," Stratton said.

The pilot study tested 215 calls this spring to make sure they were dispatched and handled correctly. The county reports that 97 percent of calls were dispatched appropriately. Lynch Ambulance Service of Anaheim was the provider for the pilot study.

Firefighter union officials requested the District Attorney's Office to investigate alleged conflicts of interest between committee members and Lynch, Kerr said.

Also, they want the Board of Supervisors to be the ultimate arbiter of policy, but Stratton says he has the legal authority to make the change.
Under a new county decision, paramedics working for private ambulance services will be allowed to transport patients in some critical but nonemergency situations.


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