By Kevin Cole
Omaha World - Herald
Copyright 2007 Omaha World - Herald
OMAHA, Neb. — Whenever an ambulance, fire engine or aerial truck answers an emergency call in Omaha, a fire captain is onboard.
A consultant studying the Fire Department said recently that the city could save thousands of dollars if it did not use captains to staff ambulances.
The California-based Matrix Consulting Group said medical units are not routinely staffed by captains in any of the 20 other cities it has studied in the past two years. Milwaukee, which is among the cities studied by Matrix, requires a paramedic of at least lieutenant rank on each run.
Numerous other cities, however, do not include officers on ambulances. Sacramento, Calif., for example, said it does not put officers on ambulances because of budget constraints.
Omaha Fire Chief Robert Dahlquist and Battalion Chief Mike McDonnell said the use of captains as on-duty paramedics helps ensure that Omahans receive excellent emergency medical services.
The Fire Department, which is authorized to employ 679 sworn members, includes 182 captains.
“We believe that our system of having an officer in charge (of each unit) is in the best interest of the citizens of Omaha during medical emergencies,” said McDonnell, past president of the Omaha Firefighters Union. “We think it makes the most sense to have a clear chain of command at all emergencies.”
At the scene of any Omaha emergency, the paramedic captain directs the care of patients, whether it’s a car accident, a fire or a call to the home of a person who is ill.
“There are any number of scenarios that can occur,” said Battalion Chief Joe Mancuso.
The fire engine captain manages the scene. At a car accident, for example, that could include directing the cleanup of spilled fluids and directing traffic until police arrive.
The Matrix report estimated that Omaha could save about $381,000 per year on wages by replacing the 45 captain paramedics with firefighter paramedics.
The report concluded that the department could save much more — about $5 million a year — by reducing the number of firefighters from four to three on each pump and ladder truck.
Mayor Mike Fahey has opposed that proposal, saying he puts a premium on public safety and won’t advocate reducing the number of firefighters.
His chief of staff, Paul Landow, said the mayor also opposes changing the way ambulances are staffed.
“The mayor believes somebody has to be in charge in a medical emergency,” Landow said. “He believes there has to be a captain paramedic.”
Richard Brady, president of Matrix and author of the report, said his company has not worked for another city where captains are routinely used to staff ambulances.
“They may have someone acting as a captain or lieutenant, but most of the time they are just going to have a paramedic firefighter,” he said.
That’s the case in Sacramento, where both paramedics on an ambulance are firefighters.
Sacramento Fire Capt. Jim Doucette said the paramedics are under the command of the fire engine captain when they respond to calls.
“The captain on the fire engine is technically in charge during the call,” Doucette said. “The paramedic reports are later reviewed by their supervisor.”
He said that not having a captain among the paramedics doesn’t seem to have any negative effect on emergency medical services, other than the crews must get used to the way each engine captain goes about his job.
“There are little differences among the different captains,” Doucette said. “So the paramedics might have to get used to that, but we don’t think that has cost any lives.”
Sacramento discussed changing its system to have a paramedic captain or lieutenant on each call, but that would mean a budget increase as a number of firefighters are promoted and thus paid more.
Ambulance crews do spend a lot of time transporting patients without direct supervision, he said, “and that is a concern.”
“Trust me, if we could do it, we would love to do it. It’s just a matter of money,” Doucette said.
Milwaukee uses lieutenants and sometimes captains on its ambulances.
Fire Capt. Mary Horsman said Milwaukee changed its paramedic program in 1985 to include a lieutenant or captain for each ambulance.
“We did that because our paramedics really have a huge responsibility and need to be in complete charge of all medical decisions,” Horsman said.
Dahlquist said Omaha’s Fire Department came to the same conclusions.
He said having captains on both fire engines and ambulances also gives the department flexibility to rotate staff as needed. “Cross-training ensures that our captains stay ready for any duties we ask of them,” he said.
Dahlquist said he is considering the report’s recommendations, but staffing medical units with captains “fits our organizational structure.” He doesn’t think it will be changed any time soon.