The State Health Commissioner has given the Fire Department permission to study a new type of medical emergency response involving non-transport command cars, THE CHIEF-LEADER has learned.

The FDNY recently approached the two unions that represent Emergency Medical Technicians and Paramedics to discuss implementing a pilot program involving up to six field teams comprised of a Paramedic officer and an EMT.

Used for On-Site Care

When ambulances are scarce or caught in heavy traffic, the teams could be dispatched in department sport-utility vehicles to provide more immediate medical care until a transport vehicle arrives, said Emergency Medical Service Bureau Chief John J. Peruggia.

The teams, also known as Advanced Life Support (ALS) responders, would drive command cars that are unable to move patients. Most of the time the teams would be engaged in the regular EMS supervisory work they're currently assigned now, said Chief Peruggia. The FDNY has between 30 and 40 supervisor teams in the field daily.

But, since the officers are also trained Paramedics, they could also be sent to ALS calls when ambulances are in short supply.

"It's a more-efficient use of our resources. ALS responders will not be primary responder units; their primary role is EMS supervision," stressed Chief Peruggia. "But sometimes we have Paramedics responding from a greater distance than we would like. We want to see if we can use these units to get there quicker -- but they aren't going to scenes by themselves. An ambulance will always be just minutes behind them."

Unions: Let's Talk

Patrick J. Bahnken, president of District Council 37's Uniformed Emergency Medical Technicians and Paramedics Local 2507, and Thomas Eppinger, president of DC 37 Local 3621, representing EMS Officers, said they were willing to discuss potential changes to how the work force is utilized. But they added that any increase in responsibilities and duties would require collective bargaining.

"We're not obstructionist," said Mr. Eppinger. "We are always happy to talk and listen. But any increase in productivity that creates savings for the city should result in fair compensation for our members."

The pilot program will rely heavily on the FDNY's Global Positioning System, implemented this summer in all its vehicles. Commanders at MetroTech now have real-time information about where all EMS resources are deployed during each eight-hour shift -- they know which ambulances are stuck in traffic on the Brooklyn-Queens Expressway, which ones are headed in to re-stock and clean up, and which ones are already engaged with a call.

'Seconds Count'

The GPS software is complemented by feedback from the FDNY's medical 911 system, which breaks up calls by type of emergency and automatically bumps life-threatening situations like cardiac arrest that require an ALS response to the top of the queue.

Now, when urgent calls start to stack up, EMS dispatchers send a Basic Life Support team -- two EMTs in an ambulance -- to the scene to get some medical intervention started. The theory is that any medical care is better than no medical care, explained Chief Peruggia, so the closest BLS ambulance is often sent to an emergency even when an ALS team is en route and only minutes away.

"Seconds are everything in medical response," he said. "So we send a BLS and an ALS, even though that takes two ambulances out of commission."

What the FDNY hopes to learn from the pilot program is how well ALS responders in command cars can help alleviate crunch periods when calls stack up.

Quicker Turnarounds

If dispatchers can send a Paramedic officer and EMT to a scene in advance of the ALS ambulance that's further away, and -- thanks to the officers' enhanced medical training -- that team can provide more sophisticated medical care that stabilizes patients faster and allows them to be transported immediately when an ambulance arrives, precious EMS resources could be freed to answer more calls.

"Ultimately we need more Paramedic units, but for that you need more Paramedics, and nationwide there's a shortage of them," Chief Peruggia said. "It's hard to recruit because they are in short supply and high demand, so we train in-house. We train more than 100 Paramedics a year, but they get promoted, they retire, they get injured, and it takes nine months to turn an EMT into a Paramedic."

The FDNY's need for more skilled EMS workers reflects the demand the city's increased population has placed on the bureau. Each year its 911 call volume goes up, and as lifespans extend, more calls are for cardiac care or cardiac complications, respiratory problems and other conditions that plague the aging.

'Can Do More Now'

"There's also a lot more that Paramedics can do today than they could 10 years ago -- there's more equipment, more education, more technology and a broader sense of medical protocols than ever before," the EMS Chief said. "We've got to keep pace as the demographics of the population change."

The FDNY has begun screening 100 EMTs for Paramedic training in March. Seven new Captains just completed training and were assigned to the field Dec. 10, and 25 Lieutenants are slated for promotion Jan. 5. They'll start a four-week training course three days later.

The EMS unions have expressed concerns that the bureau's employees, already strained by high attrition and turnover rates due to injuries and retirements, might not be able to juggle additional workloads.

Over Union's Objection

The non-transport command car request is part of a proposal submitted by the FDNY two years ago to the Regional Emergency Medical Services Council that oversees medical response procedures.

It was given a green-light by REMSCO, but then appealed by Local 2507. Ultimately, the REMSCO and the State Health Commissioner approved the project.

The FDNY also proposed splitting its Paramedics ambulance teams by pairing them with EMTs, thereby doubling the number of Paramedics on every shift and increasing the number of ALS transport calls that can be handled. REMSCO hasn't approved that proposal yet, and an FDNY spokesman said there were no plans to implement that at this time.

Both unions are cautiously eyeing the possibility, however, that the FDNY will take that step once it gathers more information about how the non-transport command cars function in the field.

Additional Worry

Traditionally, REMSCO and the unions have resisted sending Paramedics to life-threatening calls paired with an EMT because of concerns it would hurt critical care. It forces the Paramedic to focus not only on his or her actions, but also to monitor what their EMT partner is doing.

In addition, Paramedic teams often simultaneously perform ALS tasks -- like intubating a patient and starting a line to administer medicine. Without two pairs of equally trained hands available, critics worry, Paramedics will be burdened with the responsibility of making crucial decisions alone, and face even greater pressure to move fast.

The FDNY also must assess the potential impact of recommendations made three weeks ago by the Berger Commission on how to fix the state's health-care system. The report suggested closing five local hospitals.

"We are evaluating the proposed Berger report and have already developed components of a plan to insure no EMS delivery impact," said FDNY spokesman Francis X. Gribbon Dec. 7. He noted that if the recommendations are accepted, no changes would have to be in place until June 2008.

'We Can Step Up'

Mr. Bahnken said that in the past, EMS members have risen to the occasion when hospitals

closed.

"There's no doubt in my mind that we would do it again," he said. "My members will do whatever it takes to maintain the blanket of security that city residents rely on us for, and as the professionals that they are, EMS workers will always be willing to step up and address any issues related to that."

At the same time, he cautioned, "it should not come as a surprise to anybody that if our members are called upon to assume greater responsibilities and tasks, we are absolutely committed to the idea that they be properly compensated for that additional work."

Mr. Eppinger expressed similar sentiments, adding that staffing among Paramedic officers was desperately shy of what was needed. Already many of his members had hit their overtime cap for 2006, he noted, and the FDNY hadn't responded to his request to lift it for the last three weeks of the year.

"Good faith discussions" were always welcome, he said. "But I'd like to see the department get a little more proactive instead of always being reactive when it comes to staffing."