New Orleans Mayor LaToya Cantrell is apparently considering merging the New Orleans Fire Department and Emergency Medical Services into a single city department, she announced at a public meeting last week.
“It is something that my team and I have been focused on,” she said. “We’ve started to take steps toward that.”
The merger is being pushed by the New Orleans Fire Fighters Association, the city firefighters union that has advocated for the idea on and off for more than a decade, and which recently met with the administration to discuss it. However it appears that so far, EMS hasn’t been involved in the planning. A spokesperson for the department said it was “shocking” to learn, from The Lens, that the idea was under consideration.
“Honestly this is the first I’m hearing of this,” EMS spokesman Jonathon Fourcade told The Lens in an interview. “Just for the record, we really don’t have any knowledge of EMS and Fire consolidating.”
The Cantrell administration didn’t respond to several requests for additional information. The Fire Department’s communication team also didn’t respond.
Cantrell’s statements came last week during a meeting of the city’s Revenue Estimating Conference, a board responsible for forecasting the city’s future revenues. The meeting was only supposed to be about the revenue forecast, but the potential merger was brought up during public comment by Aaron Mischler, president of the New Orleans Fire Fighters Association.
“I believe it’s time we really take a hard look at trying to integrate EMS and the Fire Department together,” he said. “I believe utilizing the manpower from the fire department and combining the two departments would lower the budget for both departments and remove redundancies.”
Cantrell said that she agreed with Mischler that it is now the “national standard” to merge those services. She said that the administration was still looking for a model that would work best for New Orleans, but she was ultimately enthusiastic about the idea.
“You have made my day,” Cantrell said. “Any time you get Fire advocating at this level and for something we know is a best practice and is a standard, and is right for the city of New Orleans, you’re making it easier for us to get there. And you’ve started that this morning.”
However, Cantrell also said that the administration was stepping lightly into the idea, hinting at potential tensions that could arise with the effort, especially from EMS.
“We’ve taken a very conservative approach on the front end,” Cantrell said. “The men and women that are attached to those agencies are accustomed to doing things in a certain way.”
Mischler is specifically advocating for a consolidation in which the Fire Department would absorb the EMS budget and mission. He said that EMS opposition was likely.
“You’ll get pushback from EMS,” he said.
Fourcade didn’t explicitly say that EMS was opposed to the idea. But he seemed much less enthusiastic than Mischler and Cantrell, and argued that although other cities have combined these departments, New Orleans residents are well served by having a seperate EMS service.
“New Orleans is unique to have EMS as a true third service,” Fourcade said. “And we’re a great group of EMTs and paramedics that are highly trained. Some of the best medics in the country. New Orleans has a lot of sick people and a lot of violence, so we see a lot of trauma.”
Nonetheless Mischler seemed optimistic the merger would get done. He said he’d already discussed the idea wth Chief Administrative Officer Gilbert Montaño.
“Everyone’s on board,” Mischler said. “But again, it’s just been talk for a long time. And since we’ve been in this budget crunch for the past two years, I just think it’s time to stop talking about it and get it done. It seems like it would be a best practice to fold them into our ranks.”
‘Huge savings on the back end’
Currently, New Orleans’ EMS budget is a subset of the broader Health Department budget, although in terms of operational chain of command, it falls under the Office of Homeland Security and Emergency Preparedness, according to the city’s website.
In an interview, Mischler said it made most sense for EMS to fall under the command and budgetary control of the Fire Department. To start, he said that the Fire Department is already responding to roughly 90 percent of calls EMS responds to. And the Fire Department usually gets to the scene first because it has more fire houses and vehicles stationed throughout the city.
“You’ll have three or four firefighters on the scene for a medical call waiting for two or three people from EMS,” he said. “Sometimes they’re waiting 45 minutes to an hour.”
Mischler said that since the 1990s, newly-hired firefighters in New Orleans have been required to get Emergency Medical Responder, or EMR, certifications. And he said many also have their more advanced Emergency Medical Technician, or EMT, certifications. He added that in the New Orleans region, the protocols for EMRs and EMTs are very similar.
“There are very few things an EMT can do in the city of New Orleans that an EMR can’t do,” he said.
He said that many current EMS workers are full-fledged paramedics — more advanced than EMT or EMR certifications. Those paramedics will continue to be necessary on the most serious calls, for things like heart attacks, gunshot wounds or strokes. But, he said, EMTs and EMRs can handle less serious medical transports.
Mischler said that under a potential merger, the EMR and EMT certified fire-fighters could handle many of those medical transports, thereby freeing up paramedics to quickly respond to the more serious cases using the most advanced type of ambulance, called Advanced Life Support, or ALS, vehicles.
Mischer said that to do that, the Fire Department would have to buy more basic “ambulets” or sprinter vans to respond to these less serious calls, as well as hire more certified firefighters to operate them. He said his initial goal was to add ten of these smaller ambulances.
“It lessens the amount of resources sent to a single call,” he said.
And, he said, that would allow the city to start collecting transport fees that currently go to privately-owned medical transport companies, such as Acadian Ambulance.
He said that two potential obstacles to his plan were pushback from private medical transport companies and the upfront cost to buy new vehicles and hire new firefighters.
“Money is gonna be one of the biggest, because there’s gonna be initial upfront costs to buy new equipment to have the non-emergency transports. That’s one big hurdle.”
But, he said, “there’s huge savings on the back end.”
Mischler emphasized that the details of the plan were still very much up in the air. He said he was consulting with his parent union — the International Association of Fire Fighters — to collect different merger models that have been deployed throughout the country to see what would work here and present those options to Cantrell’s administration.
When asked why the union is advocating for the merger, Mischler said a big benefit would be “boosting our ranks.” Absorbing EMS’ responsibilities and budget would mean a bigger staff for the fire department, which would mean more dues-paying union members and a better negotiating position when dealing with the city.
And he said that because his plan involves hiring more staff, it would mean more time off for existing firefighters and EMS workers.
“You would increase the numbers by adding more firefighters rather than adding someone who’s strictly EMS, and have a lot of fire/EMS crossover,” he said. “It will allow us to hire more people, which will allow for more time off.”
He said that would help the mental state of the workforce, which could stop rampant turnover, and having more highly trained workers on the job.
“It’s a grueling job on both ends,” Mischler said. “That’s the two biggest benefits right there: allowing more time off for mental recovery and stopping turnover.”
After hearing the broad outline of Mischler’s plan, Fourcade said that starting in 2020, EMS was already buying more “ambulets” operated by EMTs, rather than full-fledged paramedics, to respond to less serious calls. He said that resource-saving change, as well as hiring more firefighters and EMTs, could be achieved without a merger.
While Mischler stressed how much the departments share in terms of protocols and supplies, Fourcade stressed how little the two departments currently share.
“We have the same medical director. And we do some of the training for fire. But other than that, we’ve always been two separate municipal departments. Yeah, I mean, I would say try to see with the Mayor’s Office exactly what they’re referring to because, like I said, this isn’t something that we know of at EMS.”