DOUBLE DUTY, AND MORE SHORT STAFFING HAS L.A. PARAMEDICS WORKING LONG WEEKS.

Byline: Jordan Smith Staff Writer

VAN NUYS - Los Angeles has so few city paramedics that Capt. Steven Lilienthal had to work an extra 24-hour shift last week - again.

And his Van Nuys station had to borrow a paramedic from elsewhere to fill a vacancy, leaving him to work 48 hours straight. Shortages across the city forced three engine companies and an ambulance out of operation.

For Lilienthal and other paramedics, the problem has grown critical, hampering emergency medical service in the city.

``You are up all night some times and you might not even get back to the station all night long,'' he said last week, nine hours into his second 24-hour shift in three days. ``You just get worn down, and when you have a shortage like we do - it gets worse.''

``We need more people and it's going to take more time to get more people,'' he said.

Currently, the department has 51 vacancies for paramedics, but critics said 350 more are needed to ensure solid patient care, cut overtime and lower the resident-to-paramedic ratio to national levels.

The department's resident-to-paramedic ratio of 8,000-to-1 is double the national average of 4,000-to-1.

<Overtime necessary

Lilienthal's expectation of working overtime is not unusual. One paramedic worked seven days last week - making for a 168-hour week, he said.

Department officials have acknowledged it is common for paramedics to work 120-hour weeks.

LAFD Chief of Staff John Ware declined to comment about the shortages.

However, fire officials have said the city's focus on police has taken away money needed for paramedics. And recruiting paramedics is difficult because of a requirement that they also train as firefighters, they said.

For the paramedics, the staffing shortages and excessive amounts of overtime have raised a critical question: Is it possible for them to work that many hours in a row, with little to no sleep, and still be effective without raising a risk to public safety?

``Effective? That's an issue. Having a partner helps, but only to a point,'' Lilienthal said. ``They're up all night and they go home exhausted. And now we're having the effects of people burning out and not wanting to be paramedics.''

Indeed, last year alone 22 paramedics dropped their medical certification completely, according to the paramedic association.

``We should never have been in this situation, because it's one we could have avoided,'' said Rob Linnell, president of the Los Angeles Paramedic Association. ``This is the result of poor EMS planning. That's what's so despicable about it.''

<Equipment shortages

While the department's dispatch center downtown strives to keep the city covered, staffing shortages have added strain to operations. One day last week, 13 pieces of equipment were removed from service across the Valley - including seven fire engines - due to staff training or mechanical problems.

Paramedics contend that sometimes ambulances are not close by.

``Sometimes they just can't fill the resources fast enough, and there'll be a delay, and sometimes that delay is that you have resources coming from long distances,'' Lilienthal said. ``It's a real juggling act downtown.''

Yet on the streets, professionalism reigns.

One day last week about 5:47 p.m., the alarm sounded, and Lilienthal moved across the garage at a fast clip, getting into his captain's car. The paramedics were already on the ambulance, the garage door opened and the sirens wailed.

Checking the mobile data terminal in his car, Lilienthal knew he was going to see an 82-year-old woman complaining of difficulty breathing. He also knew, as did the paramedics in the engine, that she has a history of cardiac problems.

``So at this point they are already thinking about what equipment they'll need at the scene, and what sort of problems they might encounter,'' he said.

By 5:52 p.m., the ambulance from station No. 100 had arrived to find a paramedic assessment engine from station No. 83 from Encino already there.

Paramedics from No. 100 acted quickly and quietly. Amid the hustle of Ventura Boulevard, they were an anomaly: stealthy and calm.

``That's part of the job,'' Lilienthal said. ``If we're not in control, we lose control.''

The four paramedics work in unison: gathering medical history, soothing the patient, checking the nearest hospital for bed availability. Within seven minutes they had the patient on the gurney and were moving her to the ambulance. Luckily, there was a hospital close by with beds available, which isn't always the case.

``Sometimes they simply don't have the room, and then that ties up the ambulance, takes it out of the picture until they can free up a bed,'' he said.

According to Fire Department statistics, there are nearly two times more engines than ambulances, but paramedics spend twice as much time handling calls.

``So two people on the ambulances are doing twice the work of four people on the engines,'' Linnell said. ``You can see who is doing a majority of the work. This is a real problem.''

CAPTION(S):

2 photos

Photo:

(1) Michael Henley, a Los Angeles Fire Department paramedic, uses the time between emergency medical calls to wash down the ambulance at his fire station in Van Nuys.

(2 -- color) LAFD Capt. Steven Lilienthal takes a rare break from answering emergency paramedic calls to reflect on staff shortages that have put a strain on him and his colleagues.

David R. Crane/Staff Photographer