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Off Deadline: Palo Alto paramedics service prompted by exposure of ambulance deficiencies

 

Palo Alto's hyper-busy paramedics service is celebrating its 40th anniversary Sunday, with a show-off of its equipment and a family-oriented schedule of events.

Many of those who will check out the birthday-party health fair weren't even born when the program's van rolled on its first official callout in 1975. The event will be from 11 a.m. to 2 p.m. at the Mitchell Park Bowl, 600 E. Meadow Drive, in south Palo Alto. Ice cream, chili and demonstrations are planned, along with a "kids corner" of games. The City Council will commemorate the anniversary at its meeting Monday night.

Creation of the paramedics program didn't happen by accident. Few such things do. It was prompted by the revelation of serious problems and life-threatening deficiencies of the ambulance companies 40 years ago, documented in a five-part series published in the erstwhile Palo Alto Times in October 1971. The problems would have remained if it hadn't been for the persistent lobbying, based on the series, of a determined resident: the late Joseph "Joe" Carleton, long active in Palo Alto's Sister City organization.

There is simply no way to estimate how many lives have been saved or serious injuries prevented over the years by the trained paramedics, compared to often untrained or poorly trained ambulance crews of earlier decades, when private ambulance firms dominated the emergency-response world.

One estimate at the time was that such a program would save at least eight lives per year in Palo Alto, not counting the severe injuries (such as paralysis) caused by accident victims being treated by untrained or poorly trained ambulance crews.

Current Palo Alto Fire Chief Eric Nickel said he thinks eight lives may be a conservative estimate, as the Fire Department evolves toward being more of an emergency-medical-response service than a "fire department" in the classic sense, based on the relative number of fire versus emergency calls.

Some cities followed Palo Alto's lead, but others kept the private-ambulance model as training and services improved dramatically with the return of trained military medics from the Vietnam War. And fire departments generally upgraded emergency training of regular firefighters.

Because Palo Alto created its paramedics service as early as it did, it is one of the few services in the state allowed to transport patients to the hospital. Others were prohibited by a state law, leaving the field to ambulance firms.

As a reporter for the Palo Alto Times, just turned age 30, I covered as part of my beat a series of weekend demonstrations in downtown Palo Alto, some of them antiwar but others to protest a sound curfew on bands, an "anti-commune" ordinance and other counterculture issues -- some just to smash some windows and block traffic.

A young man I met at one of them called me one day in early 1971 and said his older brother worked for an ambulance company and was deeply concerned about the quality of the service and lack of training of attendants. We met, and his revelations were astounding. I launched six months of interviews and checking, on which the series was based. I interviewed ambulance company officials, physicians, firefighters and patients, double-sourcing anecdotes about ambulance "races" to pick up patients and an actual case of one ambulance crew who hid a competing crew's ambulance keys in the gutter -- reminiscent of the comedy movie, "Mother, Jugs and Speed" of that era.

To appreciate fully what the paramedics mean to a community, or region, one should be aware of what preceded them.

In a nutshell, the introductory article summed it up: "Despite recent significant steps to improve, the business appears to lag seriously behind other medical callings in regard to pay, training, working conditions and professionalism." That was putting it mildly, even though Santa Clara and San Mateo counties ranked second and sixth highest in quality among the state's 58 counties.

Dr. Lee Farr, then head of the state Department of Health's Bureau of Emergency Medical Service, created in 1970, said bad incidents were "not infrequent," and that he had started an "adverse incident" file to keep track of them.

The head of Stanford Hospital's Emergency Department cited serious problems with patients arriving in ambulances, from lack of proper treatment en route to cases of paralysis from being improperly lifted or handled.

Palo Alto fire trucks regularly dropped firefighters off at intersections so they could guide inexperienced or lost ambulance crews to the scene of an emergency.

One source was particularly close to me -- Marge Speidel, then editor of the business pages at the Times, who sat next to me. One weekend she fell from her horse along Alpine Road and broke a hip. En route to Stanford Hospital, she noted the ambulance had turned the wrong way on Junipero Serra and was heading south, not toward the hospital, and directed them from the back of the ambulance.

The core of the problem was low pay, long hours and inadequate state laws covering minimum training requirements. One law only required an ambulance crew member to obtain an advanced First Aid certificate within three months of starting work for an ambulance firm.

But a frequent occurrence was that instead of getting the required certificate, the individual would simply quit before the three months was up and go to work for another ambulance firm -- a kind of "musical-chairs" pattern among the typically younger, single men in the crews.

The series concluded with articles on the changing role of ambulances and calls for better integration of care. Ambulance companies were changing priorities, from just getting patients to a hospital as fast as possible to becoming increasingly high-tech "emergency rooms on wheels," traveling slower but stabilizing and even treating patients en route.

Yet paramedics filled a desperate need for better trained, more stable emergency responders to become a literally life-saving service.

Former Weekly Editor Jay Thorwaldson can be emailed at jthorwaldson@paweekly.com and/or jaythor@well.com. He also writes periodic blogs at PaloAltoOnline.com.

Comments

Like this comment
Posted by CW
a resident of Crescent Park
on May 16, 2015 at 6:06 pm

Here's the other narrative I've heard. Fire departments had to fight fewer and fewer fires because of improving building standards (requirements for sprinklers, etc.). As the unions for firefighters contemplated their future, they decided to move into the ambulance business, and push out the private sector operators. City Councils were only too happy to have firefighters take over ambulance service. Local politicians are owned by the unions. An "investigative" series like this in the Palo Alto Times simply gave the unions political cover for the takeover.


Like this comment
Posted by Bob Wenzlau
a resident of Crescent Park
on May 17, 2015 at 5:31 am

Well said Jay! Palo Alto is fortunate to have these paramedics, and obviously their greatest fans are those who have benefited from their help. Joe Carlton left his mark in many ways. Within our Sister City program Neighbors Abroad he started a program of donating surplus fire vehicles to Oaxaca Mexico, one of our sister cities. After not being allowed by state standards to be used further in the US, these vehicles (including paramedic vans) see long service in Oaxaca. We were remembering Joe as Neighbors Abroad with the support of civic groups like Kiwanis and Rotary are again working to raise the funding to send another round of surplussed vehicles to Oaxaca. Great to have coverage of "good" news!


6 people like this
Posted by Alphonso
a resident of Los Altos Hills
on May 17, 2015 at 9:06 am

Alphonso is a registered user.

CW - Actually PA Fire stated the ambulance program because the firefighters were tired of watching people die while waiting for ambulance service. Rural Metro is the Santa Clara County ambulance provider - they cover the entire county and they need to make money for shareholders. In order to provide service to the rural areas they need to set rates high enough to cover service to the remote areas. As a result, the more populated areas are forced to subsidize (through rates) the service to people in more remote areas. Additionally, the Rural Metro manpower model is one EMT and one Paramedic per truck and they require their men and women to work long hours (longer than a typical fighter) to satisfy the bottom line. PA Fire also charges people for ambulance services (mostly paid by insurance and generally lower than Rural Metro), but the difference is that all of the ambulance revenue goes back to PA. The PA ambulance service money not only covers the cost providing the ambulance service but it also subsidizes much of the "regular" fire service. Of course it makes sense to provide and needed service that more than pays for itself. The PA Fire ambulances have two paramedics on board (instead of one), they know Palo Alto and they provide faster services than Rural Metro could possibly offer - people in trouble have a better chance of surviving because of the service provided in PA.


Like this comment
Posted by Tim
a resident of Crescent Park
on May 17, 2015 at 1:19 pm

To Alphonso, yes your are right that the ambulance service pretty much pays for its self, but all money that the city collects goes into the general fund, not the department that collected it.


Like this comment
Posted by Curmudgeon
a resident of Downtown North
on May 17, 2015 at 10:32 pm

@ CW, @ Tim

Have you mentioned your concerns to the people whose lives were saved by unionized PA paramedics? Were they impressed by your argument and properly contrite over their missed opportunity for self sacrifice to the noble fiscal cause?

Will you yourselves obey your principles when you can't breathe and your chest feels like it's supporting a herd of elephants?

Oh no you won't.


Like this comment
Posted by Joe
a resident of Another Palo Alto neighborhood
on May 17, 2015 at 10:55 pm

> Actually PA Fire stated the ambulance program because the firefighters were
> tired of watching people die while waiting for ambulance service.

What evidence is there that "people" (dozens? hundreds?) were actally dying here in Palo Alto waiting for ambulance service before the Palo Alto Fire Department decided to slice off a very lucrative chunk of the market for itself?

This sort of information is very hard to come by, and claims like this are too often made without being challenged.

> Dr. Lee Farr, then head of the state Department of Health's Bureau of
> Emergency Medical Service, created in 1970, said bad incidents were
> "not infrequent," and that he had started an "adverse incident" file to
> keep track of them.

So--where is this "file"? Was it ever published? Or did it remain a part of some mythical basis for increasing the size and cost of the fire department?


Like this comment
Posted by Joe
a resident of Another Palo Alto neighborhood
on May 17, 2015 at 11:11 pm

> Will you yourselves obey your principles when you can't breathe and your
> chest feels like it's supporting a herd of elephants?

Suggesting that people will die unless they have Palo Alto Fire Department EMS is so distored that it really must be ignored. People all over the US have EMS service from both private and public sector sources. There is no evidence that people die routinely when attended by private sector EMS, but are always saved by public sector EMS.

Palo Alto is a small, 25 sq. mile, town. It's very hard to drive at 40-50 mph and not get to anywhere in town in a few minutes. Comparing PA response times to private sector services having to deal with a county-wide population distribution shows a complete lack of intellectual honesty.

Moreover, PA does not do a very good job of actually providing the public with data that documents how it performs--at least not on a yearly basis.



6 people like this
Posted by Fire Chief Eric Nickel
a resident of Another Palo Alto neighborhood
on May 18, 2015 at 8:52 am

@ Joe, please take a look at the Fire Department's Quarterly Performance Report: Web Link

The report is designed to share key performance data with the community. Also included is the EMS customer service survey that is conducted by an independent outside agency. The Fire Department strives to be transparent and accountable.

I would also suggest downloading the PulsePoint smartphone app as it allows you to monitor in real time all calls for service in Palo Alto. Hear sirens and wonder what’s going on, press PulsePoint and find out. If you are trained in CPR and help is needed nearby, PulsePoint will alert you and if you want to get involved, you can help before the emergency crews arrive.


Like this comment
Posted by curmudgeon
a resident of Downtown North
on May 18, 2015 at 9:58 am

"Suggesting that people will die unless they have Palo Alto Fire Department EMS is so distored that it really must be ignored."

Only a distorted reading of my posting for a distorted purpose would justify that statement.

When you feel those elephants roosting on your chest, you will skip the philosophizing and call 911. Trust me.


Like this comment
Posted by Art
a resident of Barron Park
on May 18, 2015 at 11:06 am

At the Mitchell Park event, I was extremely impressed by the number of volunteers in the community, of all ages but especially young people, who contribute time and effort and are learing the techiques and technology of EMS. They were there to show what they know and what they can do. Being an EMS is NOT an easy task and their participation and dedication is an inspiration. If anyone needed to know about community spirit in Palo Alto, you just needed to talk with one or more of these young people. Thank you.


Like this comment
Posted by Joe
a resident of Another Palo Alto neighborhood
on May 18, 2015 at 3:16 pm

@Fire Chief Eric NickelLL: Thank you for pointing out this link. However, the comment still stands--since the Fire Department has been around since the early days of the City's creation. Offering up one quarter's information is helpful, but when trying to look at the long term performance of any organization--at least ten years worth of data would be needed.

Moreover, is there a committment to provide this data in perpetuity? Or will this report disappear in a few quarters? It might be pointed out that the data could be in .xls format on the City's open data web-site--so that long term reviews of the data would be possible in the future.

As to your suggestion about using a smartphone APP, not everyone in the City uses smartphones--so, unless the same capability is provided for WEB users too, then this bias towards cell phones is not as helpful to everyone as full service data access would be.



Like this comment
Posted by Joe
a resident of Another Palo Alto neighborhood
on May 18, 2015 at 3:18 pm

> When you feel those elephants roosting on your chest, you will skip
> the philosophizing and call 911.

Nationally, 2/3rds of the 911 Fire/EMS responders are volunteers. They do a pretty good job, too!


Like this comment
Posted by Joe
a resident of Another Palo Alto neighborhood
on May 18, 2015 at 3:26 pm

Here is an example of the Santa Clara County data for EMS activities:

Santa Clara County EMS Performance Report--

Web Link

There are some different data in the Santa Clara County report, so it's not possible to compare the two directly. Response times are always an issue, particularly since how the response time is measured can be different in different fire districts.

The point being that SCC, which is serviced by a private provider, has been offering the public performance information for a while now. Palo Alto has not.


2 people like this
Posted by Peter Carpenter
a resident of Atherton
on May 18, 2015 at 4:12 pm

Peter Carpenter is a registered user.

Palo Alto is extremely fortunate to have its own well staffed and well trained ambulances. Decades ago the State Legislature gave the exclusive responsibility for providing ambulance service to the counties. The only exceptions were for those communities that were already providing their own ambulance service - Palo Alto was on of the few such grandfathered agencies. And if Palo Alto were to give up its ambulance service that grandfather exemption would disappear.

There are many communities who would love to have the quality and the speed of Palo Alto's ambulance service but are prohibited by State law from doing so.


2 people like this
Posted by Alphonso
a resident of Los Altos Hills
on May 18, 2015 at 4:12 pm

Alphonso is a registered user.

Joe

If you want to propose Rural Metro is a competitive alternative to what PA already has you might mention that they have not lived up to the Santa Clara contract, they have required two bail outs from Santa Clara to avoid bankruptcy and Santa Clara will likely pick another service provider when the current contract expires.


2 people like this
Posted by Peter Carpenter
a resident of Atherton
on May 18, 2015 at 4:28 pm

Peter Carpenter is a registered user.

There are frequently times when none of the San Mateo County private contractor's ambulance are in Menlo Park, East Palo Alto or Atherton. On at least one occasion a fire responder, who was prohibited by State law from transporting any patients, use Stanford Life Flight to get a badly burned child from East Palo Alto to Stanford because no County ambulance was available.

Palo Alto - count your blessings; there is always an ambulance within your city.


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