Turf war brewing between OCFA and county over medical calls, grand jury says

Distrust and poor communications are fueling a heated turf war over medical responses involving Orange County’s Fire Authority, Fire Chiefs Association and Emergency Medical Services, a grand jury investigation has found.

“Although their mandated responsibilities are clear, there is a mutual reluctance to acknowledge their respective spheres of authority, in particular the critical role of Orange County Emergency Medical Services as an independent regulatory body,” the Orange County Grand Jury said in a 22-page report issued Friday, May 20.

The grand jury examined the efficiency of the Orange County Fire Authority and various municipal fire agencies in responding to emergency medical calls.

The grand jury recommend that fire departments implement a universal tiered response system to dispatch ambulances to most medical calls rather than deploying larger fire engines as a standard response.

‘Dangerous and costly’

“Current protocol requires sending multiple vehicles to the scene, which involves not only additional personnel but also expensive fire equipment,” the report says. “This is the case even when an ambulance or rescue squad vehicle could provide all the necessary medical supplies and personnel. Sending a 36,000- to 60,000-pound fire engine or aerial ladder truck down residential streets for strictly medical calls is not only dangerous and costly, but it also results in unnecessary wear and tear on our streets.”

The OCFA is reviewing the recommendations, spokesman Matt Olson said Friday. “We received the Orange County Grand Jury report and appreciate the work that went into it. We look forward to commenting further after a thorough review of the report and its recommendations,” he said.

The Orange County Health Care Agency, which manages the OCEMS, and the Orange County Fire Chiefs Association did not respond to requests for comment.

Appropriate level of response

The goal of a tiered dispatch system is to match the emergency with the appropriate level of response in terms of urgency, personnel and equipment.

As part of its investigation, the grand jury reviewed records, memorandums and other documents. It also interviewed OCFA and OCEMS officials, private ambulance company executives and firefighter union representatives.

The OCFA has 77 fire stations in Orange County and contracts its services to several cities. Municipalities with their own fire departments are Anaheim, Brea/Fullerton, Costa Mesa, Fountain Valley, Huntington Beach, Laguna Beach, Newport Beach, Orange and Placentia.

OCEMS has established a minimum requirement that one paramedic and one emergency medical technician respond to emergency medical calls. However, it is left up to the individual fire departments to determine how to deploy personnel and whether to exceed these minimum staff requirements, according to the grand jury report.

At the OCFA, regardless of the preliminary assessment of the medical emergency, a fire engine or truck staffed with four personnel — at least two of whom are paramedic/firefighters — are sent to the scene. A transport ambulance with two EMT trained attendants also is dispatched.

Ambulance use causing friction

The use of ambulances is causing friction between the OCES, the OCFA and the Orange County Fire Chiefs Association, the grand jury said.

The report noted that that Fire Chiefs Association wrote a seemingly contradictory letter to the OCEMS, describing the agency’s implementation of policy changes without prior notice or collaboration as “offensive.”

“This complaint was made despite the fire chiefs’ specific acknowledgment in the same letter that a joint advisory committee had been formed and had been discussing the issues,” the report says.

Despite the fire chiefs’ complaint about OCEMS overstepping its authority, the only example provided was an emergency action taken by OCEMS in 2021 when hospitals were backed up, causing long wait times for first responders.

In response, OCEMS introduced an emergency measure that allowed emergency medical technicians and paramedics to leave patients in the hands of the hospital on a portable cot, according to the grand jury.

“Although OCEMS could possibly have provided better notice to OCFA and the independent fire chiefs, the OCEMS appeared to be working in the best interest of all parties involved,” said the report. “This was a fact that was, at best, only begrudgingly acknowledged by a few OCFA union representatives and other fire agency personnel.”

Tensions have been exacerbated by the COVID-19 pandemic and the demand placed on ambulances, which have been struggling to respond to calls in a timely manner, prompting the OCFA to take matters into its own hands, the grand jury noted.

‘Code 3’ responses

In December 2021, the OCFA directed that all emergency medical services responses be classified as “Code 3” — requiring vehicles to use emergency lights and sirens — to speed up ambulance response times, according to the report.

“Code 3 responses have been shown to pose a significantly greater danger to the public and emergency personnel,” said the report. “The Orange County Grand Jury is concerned that this OCFA directive and the power struggles existing between the fire chiefs association and OCEMS may be viewed as self-serving rather than serving the best interests of the public.”

The report recommends that the OCFA immediately stop the practice of requesting Code 3 responses on all non-life-threatening calls. “Code 3 response is over-utilized by OCFA, unnecessarily putting the responders and public at risk,” the grand jury said.

The grand jury also recommended:

• By 2024, all Orange County fire agencies utilize criteria-based dispatch protocols and send a single unit response to those incidents triaged as non-life-threatening. Additionally, the OCFA should station a paramedic squad vehicle, which is more nimble and less costly to operate, in place of a second engine in stations with high volumes of medical calls.
• That OCEMS should recognize how certain policy changes may pose operational challenges to emergency responders in the field, and fire leadership should recognize and respect the independent oversight authority and expertise of OCEMS.
• Departments with publicly owned ambulances should allow OCEMS to inspect their ambulances for compliance with state emergency medical services guidelines and adopt OCEMS recommendations.

“Despite fire departments throughout Orange County having evolved into emergency medical departments, most have not updated their emergency response protocols accordingly, but have simply absorbed emergency medical responses into their existing fire response models,” the grand jury concluded.

Source: Orange County Register