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"MOBILE INTENSIVE CARE PARAMEDIC" PROGRAM
LOS ANGELES COUNTY FIRE DEPARTMENT


One of the most successful programs in the nation in the continuing battle to save lives is the Los Angeles County Fire Department's paramedic operation.

"Para" means "by the side of" or to "assist" -- hence, the term paramedic. He's assisting the physician.

Although the highly-trained squads of firemen are specially geared to treat heart attack victims, they also handle life -threatening and serious situations involving vehicle accidents, seizures, drug overdoses, respiratory problems, burns and child birth.

The paramedic at the scene is actually the eyes and hands of the physicians at the base hospital. The paramedic uses high-frequency radio and telemetry to transmit vital signs and other important patient information.

There are two training centers for paramedics -- Harbor General Hospital and Los Angeles County - USC Medical Center, both part of the County Department of Health Services Paramedic Training Unit.

In these facilities, the firemen are assigned for two months to doctors, making daily patient visits, checking vital signs, taking blood pressure, reading electrocardiograms.

Training also involves classroom work, briefing by medical doctors, lectures, demonstrations and the teaching of terms such as sinus tachycardia, Wekenbach phenomenon and multiple unifocal PVCs. They then spend another month training with the base hospital which is to serve as their "headquarters hospital" when they are operational. Another two months is spent working with certified paramedics on an existing squad.

In order to receive the white nameplate of "Paramedic", the firemen must undergo a total of 990 hours. If he successfully passes his test, he is certified to administer intravenous medication, perform cardio-pulmonary resuscitation and defibrillation and other tasks upon order of the physician or nurse.

To keep abreast of changes in medical procedures and to retain his certification, he must spend a specified number of hours each month at his base hospital or with the Paramedic Training Unit's staff nurses.

Meanwhile, he still is a firefighter and spends much of his on-duty time in fire suppression. His rescue squad truck also carries the necessary tools to fight fires and perform salvage work.

The vehicle has been modified to allow transport of sophisticated medical equipment -- two-way radio and telemetry, oscilloscope, defibrillator, IV solution, drugs, splints, resuscitators 9caried on all fire trucks) and even pre-loaded syringes. Cost of the additional equipment: $10,000.

Each year, the Los Angeles County Fire Department responds to about 55,000 calls -- half of which are rescues, underscoring the need for paramedics.

Fire Chief Richard H. Houts reports that 65 per cent of those who die from heart attacks do so within the first hour. 

"This ominous fact points up the necessity for fast responses by specially-trained, thoroughly-equipped paramedics," he adds, saying that by early 1974, all of the County's 27 rescue squads will be converted to paramedic units.

A non-paramedic fire crew stationed closer to the scene of an emergency also will be dispatched and will administer first-aid and prepare the patient for the paramedics. By this procedure, precious minutes are saved because the paramedics may then start immediate, specialized treatment -- thanks to preliminary work by their fellow firemen.

On arrival, the paramedics attach small metal leads to the patient, then radio his heart rhythm (electrocardiograph) to the base hospital's doctor or nurse. Other pertinent data (blood pressure, pulse) is also transmitted to evaluate the victim's condition.

From the hospital, the doctor relays directions: give medication, increase oxygen, administer life-saving electric shock. During their training, the firemen learn to read complicated EKGs and have a portable scope to give them a "read out" at the scene. In some cases, where topography or other obstacles have prohibited direct radio telemetry and transmission, the firemen have used a telephone to contact their base hospital. Their evaluation of the EKG is given to the doctor, who then prescribes treatment. A radio-phone relay system utilizing the Department's fire dispatch radio frequencies also has been used in some emergencies when telemetry was impossible.

Currently, there are 11 base hospitals -- Harbor General, L.A. County-USC Medical Center, South Bay (Redondo Beach), Little Company of Mary (Torrance), St. Mary's (Long Beach), Santa Teresita (Duarte), Huntington Memorial (Pasadena), UCLA Medical Center, Antelope Valley Hospital (Lancaster), Queen of the Valley (West Corvina) and Daniel Freeman (Inglewood).

The paramedics are the operational end of what is essentially a hospital program. Once the victim is treated at the scene, he is transported to the hospital by ambulance, with a paramedic usually accompanying him. He takes all his battery operated equipment in the ambulance and continues treatment.

There is no charge by the Fire Department for paramedic service. The hospital can bill the patient for supplies and medication after he is admitted at the facility.

Indeed, the program has been successful.

Since the middle of 1970 (when the paramedics went into action in the field), the morality rate in cardiac cases has been reduced from 80 percent to 20 percent. And, more than 200 persons in the County who were clinically "dead", have been saved by the program. The figure does not include victims of accidents who have been saved.

Also, the paramedics and hospital staffs haven't lost a trauma case because of shock -- the major contributor to death in serious burn and accident incidents.

The program was made possible by state passage in 1969 of the Wedworth-Townsend Act, which delegated power and authority to the County to initiate paramedic training.

It was decided that the Fire Department was best suited to provide this emergency care. Fire stations, staffed 24-hours a day, are located strategically throughout residential, commercial and industrial areas so as to provide a minimum response time. The Fire Department traditionally provided rescue service, with fire equipment carrying some life-saving equipment and the fire fighters trained in advance first aid and cardiopulmonary resuscitation. 

The "mobile intensive care paramedic" program then, is an extension of existing resources, with the addition of specialized equipment to rescue trucks already in use, and the additional training of the firefighter.

After the first paramedic class was graduated, staff doctors announced that firemen, by nature of their experience in responding and working under adverse emergency conditions, performed extremely well in medical field emergencies as well.

Under the Act, the paramedic is authorized to; Render rescue, first-aid and resuscitation services; administer medication under the direct supervision of a physician or registered nurse; and perform cardiopulmonary resuscitation and defibrillation.

The American Heart Association recently reported that of the more than 725,000 Americans who died of heart disease in 1972, at least one-third died outside the hospital. Up to 37 percent of the latter might have been saved had they been treated at the scene by paramedics, the Association added.

The County's concept of "take the hospital to the patient" is reducing the heart death rate and will continue to do so, thanks to the cooperative efforts of hospitals and firemen paramedics.

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