NEIGHBORHOOD POLITICS-A prior article looked at some of the fire suppression and firefighter training aspects of the Los Angeles Fire Department/LAFD.
It is more than just fires and provides first response, technical rescue, paramedic services, and ambulance transport. In conjunction with other departments, it also protects Angelenos through strategic planning initiatives, disaster response and counterterrorism.
Additionally, it works with neighborhoods on public education, evacuation plans (everybody should check out Ready, Set, Go! and a variety of community service projects.
EMS
In spite of the Mayor’s call to rein in costs in the economic aftermath of the pandemic, the City needs to expand its force of advanced units to help control future costs. Currently, 81% of the calls to the Department are medical, and that is only rising.
The Fire Department is already extending its budget through the support and public-private funding from Cedars Sinai, Kaiser Permanente, Providence Health & Services Southern California, and the Los Angeles Fire Department Foundation for its Advanced Provider Response Unit (APRU) program.
APRUs consist of two firefighters and one nurse practitioner who can solve many medical issues on site. These responders have specialized training to provide advanced on-scene medical care to patients who may not require immediate transportation to the emergency room.
They can redirect mental health and intoxicated patients to more appropriate facilities, provide skilled assessment of 911 super-users, and address the needs of other vulnerable Angelenos who might be better assisted by non-emergency care and services. This reduces the time and costs for what comprises the majority of 911 calls and frees up first responders to handle real emergencies.
Adding units to cover much of the hardest worked portions of the City would help lower departmental overtime.
Homelessness
Another area that needs adjustments, not only for fiscal reasons but to pivot with the realities of the City in recent decades, has to do with the homelessness crisis.
The Fire Department receives too many calls ranging from fires at encampments to medical conditions that arise from living on the street to the spread of infectious diseases. These calls use valuable resources.
At the time the Budget Advocates met with the Department last October, the City did not have the ability to accurately track the cost of funds used to handle issues related to homelessness. Over 80% of calls to Skid Row’s Station 9 have a homelessness component so the 311 Call Center should be able to aggregate calls to determine what percentage of LAFD resources are being used as compared to fire and emergency medical services.
Mobile triage units, named for their Fast Response Vehicles, include a social worker and a nurse practitioner and are now working effectively in downtown’s Skid Row and South Central’s Watts areas.
Since these are always on the street, the units can respond more quickly than the normal fire engine and ambulance duo, reducing the demand on departmental resources and hospital emergency rooms, handling low-need calls on the street as well as giving emergency first aid to people where minutes can mean the difference between life and death.
With the wide dispersal of the homeless across the City and in our parks and canyons, rapidly expanding this program to service the areas where those who need them live should add up to savings in manpower and equipment.
The addition of Sober Units to transfer intoxicated people to centers specializing in their needs has further reduced the demand on the personnel and equipment-intensive traditional response.
The City needs all these programs. It needs more of them. And they need to be staffed 24/7.
Equipment and more
The cutbacks of the Great Recession extended equipment beyond their normal lifecycles. This means the department is constantly scrambling to replace failing systems and update others. This impacts technology, dispatch, incident command and field communications as well as fleet upgrades and maintenance.
Maybe these don’t seem urgent compared to balancing the City’s budget, but they can mean the difference between life and death. This is so apparent at times of crisis such as during wildfires and now with the COVID-19 pandemic.
Suggested Solutions
Again, zero-balance budgeting in a City with problematic health issues, compounded now by a worldwide pandemic, is a penny wise but dollar foolish approach. A long-term policy needs to be implemented to take all of Los Angeles from what we have today into a future where these problems have been resolved.
This kind of holistic approach should include:
- Pushing for a statewide Single Payer medical care system which would improve the health of all Angelenos, provide earlier intervention and better results, and take a huge weight off the LAFD. They could, in fact, integrate their resources and expertise into this new approach to healthcare and generate income for the City.
- Bumping up Fire Department hiring across the board now needs to be a priority; it needs to be viewed as an investment that will reduce costs and improve results over time.
- Expanding nurse practitioner units to relieve pressure on the department and Los Angeles hospitals; again, this is an investment with the potential for considerable savings for the City when all ramifications are factored in.
- Identifying and mitigating situations which might lead to lawsuits, both from the public and internally.
- Improving efficiency including by more effective staffing to significantly reduce overtime costs.
- By addressing the above, free up resources to incorporate technological innovations and respond to new mandates required by agencies of the Federal, State, and County governments.
- Finding other sources of income that won’t harm others or take time away from the Fire Department’s traditional (and any new) objectives.
Balancing costs could also include finding more appropriate ways to charge for ambulance transport to medical facilities in a City where the cost exceeds two weeks gross pay for a minimum-wage worker and where far too many have the bare minimum coverage under Obamacare. The insurance deductibles for most of the cheaper health insurance plans are outsize so the insurance companies don’t have to pay out - perhaps super-sized?
This balancing of costs must include all the factors, but especially quality of life issues for department personnel and the Angelenos they serve.
Support groups and adopt-a-fire station help extend the LAFD’s budget. While providing food during the current, hopefully once-in-a-lifetime, event is a courtesy to our first responders, any department which depends on outside assistance for operational funding opens themselves to political persuasion from those donors. Big money benefactors tend to act in their own interests, not those of the people.
(The Budget Advocates are an elected, all volunteer, independent advisory body charged with making constructive recommendations to the Mayor and the City Council regarding the Budget, and to City Departments on ways to improve their operations, and with obtaining input, updating and educating all Angelenos on the City’s fiscal management.) Edited for CityWatch by Linda Abrams.
The issue I raise is that no department should depend on donations for basic budget needs. Perhaps:
