Burn Out

rescuing 911: Overworked paramedics could soon see their jobs re-examined thanks to a lawsuit.
Photo By: Michael T. Regan

The city could soon owe its paramedics big bucks.

by Mike Newall

Last Monday, the first truly hot day of the year, the city ran out of ambulances for almost the entire morning and afternoon, a dearth of resources that left fire engines and ladder trucks to respond to emergency medical calls.

This is dangerous, considering the fact that firemen can only provide the most basic medical treatment and are not capable or officially permitted by the department to transport patients to the hospital. Even worse: It's not all that unusual an occurrence.

In a recent City Paper cover story ["Emergency Breakdown," Mike Newall, May 12, 2005], dozens of paramedics, emergency dispatchers and firemen detailed how the Philadelphia Fire Department has taken woefully ineffective steps to deal with skyrocketing EMS calls. (EMS calls have increased 73 percent in Philadelphia from 1994 to 2004.) They said the city routinely, sometimes even daily, runs out of available squads, leaving firemen to wait 20 to 30 minutes at the scene of a medical emergency before an ambulance arrives. Firemen have even coined a phrase for standing over a dying person while waiting for an ambulance: "The Circle of Death."

While the city plans to add eight additional ambulances to its fleet sometime this summer, many paramedics equate that approach to putting a "Band-Aid on a hemorrhaging wound." But while Philadelphia has been slow to embrace the progressive measures other cities have utilized to modernize their EMS systems, they may no longer have a choice but to do so.

A federal lawsuit currently playing out in the James A. Byrne Courthouse at Sixth and Market streets may soon force the department to completely re-examine how they deliver emergency medical service.

Two hundred and fifty fire-service paramedics are suing the city under the Federal Fair Labor Standards Act (FLSA). They contend the city violated labor laws by not properly paying them overtime. Firemen and police officers are not covered by the FLSA and have to work up to 53 hours a week before becoming eligible for overtime. Philadelphia paramedics routinely work 48-hour weeks and argue that since they do not fight fires, they are owed unpaid overtime compensation.

Final arguments were completed in May and a decision could come down as early as this summer. Attorneys for the paramedics have yet to calculate an exact monetary figure. If they win, paramedics will be awarded up to three years of overtime compensation.

Paramedics in other major cities, including San Francisco and Los Angeles, have won similar suits and received multimillion dollar payouts. In some cases, federal judges have forced fire departments to adopt dually trained, fully integrated EMS systems, an inexpensive step many paramedics believe would greatly improve EMS service and cut back longer response times. In dually trained systems, paramedics can be rotated onto fire engines ensuring that advanced life support personnel arrive on the scene in less than five minutes. It would also give paramedics a break from the constant grind of emergency runs, decrease paramedic burnout and turnover, and allow paramedics more career advancements; there are dozens more officer positions available for firefighters than there are for paramedics.

"If you were to deploy these medics on engine companies, you've now distributed your advanced life support personnel over a wider playing field," says Lori Moore, a national EMS consultant and an assistant to the president of the Washington, D.C.-based International Association of Firefighters. "You've got fire engines sitting out there that can get to patients within four to five minutes. It's just a tremendous way to take advantage of the resources you have. It would be a win for the city."

Philadelphia, though, refuses to train paramedics in fire suppression and will not rotate them onto fire engines. If a paramedic wants to become a firemen he or she must take the test like any other civilian. (They are awarded 10 bonus points on the test.) The issue came up frequently during the tenure of former Fire Commissioner Harold Hairston — who retired in 2004 after 12 years at the helm — when burnt-out paramedics requested transfers to fire companies. Hairston repeatedly denied the requests, which violated a labor agreement that dictated paramedics could transfer to become fire cadets after five years of service.

"Two different jobs altogether," Hairston explained during a 2004 City Council budget hearing. "One deals with the medical aspects of a constituent's problems, and the other deals with the extinguishment of fire. I personally like the idea of keeping them separate."

The issue went before an arbitrator who ruled in favor of the city.

"Many medics felt betrayed by the commissioner," says paramedic Dave Kearney, who is also a fire union representative. "It was a major impetus of the lawsuit being filed."

The new commissioner, Lloyd Ayers, has also refused all paramedic transfer requests. But now, to avoid forking over millions in back pay, the city is arguing that paramedics are "trained in fire suppression" and "have the legal authority and responsibility to engage in fire suppression," in accordance with FLSA mandate. The argument completely contradicts the department's previous stance.

Philadelphia firefighters receive 16 weeks of fire-suppression training. Paramedics, in contrast, receive a week to 10 days of fire-orientation training to help them better understand the dangers of a fire scene. They are not issued the Essentials of Firefighting textbook and engage in little hands-on training. They're not even taught how to handle a hose.

"We never put water to fire," says Kearney. "I don't know how good a firemen I can be if I never put water to a fire."

"I know as much about fire fighting as you do," says another paramedic.

According to the lawsuit, Hairston admitted the difference between paramedic "orientation" and the proper "training" firefighters receive.

In "training, you actually participate in some way," said Hairston. "You put your hands on the hose. You put your hands on a fire truck. You drag bodies out. You do the kinds of things … that happen under real fire ground situations."

Once on the job, paramedics handle only medical emergencies. On rare occasions, a paramedic may inject themselves into fire-suppression activities — picking up a hose or running into a burning house — but they can be punished for it.

For a person to understand the "whole idea of structure fire fighting," said Ayers during an interview in May, seemingly contradicting the city's contention that paramedics are authorized to fight fires, "you need to go through the Fire Academy, you need the whole 16 weeks of training."

Even the job-description page of Philadelphia's city government Web site (www.phila.gov) lists the paramedics under professions eligible for overtime.

Representatives of the fire commissioner's office did not return repeated calls for this article. Attorneys for the city also refused comment. But as clear a win as the case seems on paper, the firefighter's union refused to support the paramedic lawsuit, fueling anger among paramedics who already describe themselves as the "redheaded stepchildren" of the department dominated by fire fighting, not EMS, tradition.

"We felt there was a big chance the city might rearrange everybody's work schedule — firemen included — so they wouldn't have to pay the paramedics overtime," says Tom O'Drain, president of Fire Fighters Union Local 22.

The city does have the authority to change firefighters' and paramedics' work schedules without bargaining with the union. That approach, however, won't sit well with the rank-and-file workers.

"If they change our schedules," predicts paramedic Lou Rosmini, "more good paramedics will become fed up and burnt out and probably quit."