Lack of Resources May Result in a Crisis.

THE cost of emergency medical treatment is steadily climbing as the number of calls increases and it gets more difficult to find doctors and hospitals to handle those patients.

Thus far, local paramedic agencies have been able to modestly boost funding. But there is concern that such increases won't be enough to prevent an impending crisis in the region's emergency medical response system.

"In the city, we have set response criteria," said Emil Mack, chief of the planning section for the Los Angeles City Fire Department. "Our goal is to arrive on scene within five minutes and get paramedics on scene within eight minutes. There are some areas where we can't meet that consistently; in those areas we want to increase our resources even-further."

The city of Los Angeles, which has the county's largest paramedic staff, has increased funding at a fairly steady 4 percent annual clip, as the fire department has gradually shifted its focus from fire suppression to emergency response. The city's annual budget for paramedic services is now $73.2 million.

In the last several years, the city has added 14 ambulances and is in the midst of boosting paramedic personnel at certain fire stations, especially in the San Fernando Valley.

Meanwhile, the county, which provides paramedic services for unincorporated areas and dozens of contract cities, has increased its funding by about 15 percent a year since a pullback in the mid-1990s. But the county doesn't provide emergency transport services.

Instead, ambulance service is handled by private-sector carriers that charge fees to patients. As a result, the county's paramedic service budget of $13.6 million for the 1999-2000 fiscal year was considerably less than the city of L.A.

"Paramedic calls have increased about 17 percent over the last five years," said L.A. County Fire Chief Michael Freeman. "As a result, we have added additional units, including three paramedic squads in the last three years and one air squad."

Salary increases also have accounted for a significant portion of the increased costs, Freeman said.

Two major trends are converging that could put unprecedented pressure on a system that has already gone through periods of severe strain.

First is the increase in emergency calls. Causes cited by paramedic officials include overall population growth, especially among the elderly; more immigrants turning to the emergency system for health care; and rapid growth in the uninsured population that turns to the emergency system as a first resort.

Virginia Hastings, the county's emergency medical services coordinator, said the squeeze is especially felt on the treatment side. In the late '80s, 10 of the county's 23 hospitals with trauma centers shut down those facilities as funding to treat uninsured patients dried up. That has forced paramedic response teams to travel longer distances to get their patients the appropriate level of care.

"There is no trauma center in the entire San Gabriel Valley, and no pediatric critical care service in either the San Fernando or the San Gabriel valleys," said Hastings. "That means that all trauma and critical pediatric patients in those areas have to be airlifted, at tremendous additional cost."

Meanwhile, many specialty doctors who handle emergency cases have been reluctant to treat those patients because they claim health plans are not adequately reimbursing them. Whenever a doctor refuses to respond, paramedics are forced to find appropriate specialists at other hospitals that are usually farther away. In addition, paramedic units are tied up for longer periods.

To prevent a full-blown emergency treatment crisis, Hastings said steps might have to be taken to reduce the number of uninsured people and to fund the treatment of emergency patients at area hospitals.