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What Nobody Is Saying About Sunnyvale’s Paramedic Shortage

While the recent restoration of paramedic services to Sunnyvale was a victory for residents, it still doesn’t address the larger issue.

Late last year, the Public Safety Officers’ union raised the alarm bell that a paramedic shortage was causing delayed response times, putting lives at risk. Sunnyvale is a bit of an oddity: its officers are essentially cops, firefighters and emergency medical technicians (EMTs). But they aren’t paramedics.

That means sometimes EMTs would have to wait for long stretches until a paramedic arrived on scene. EMTs can perform basic life support such as CPR, treat broken bones, administer an automated external defibrillator (AED) and provide basic patient care. They cannot, however, inject medication or perform higher-level care.

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“Minutes can mean the difference between life and death and whether an injury gets better or worse,” said Devon Klein, president of the Sunnyvale Public Safety Officers’ union. “With that gap in coverage comes additional pain and suffering. It could mean death if we don’t get a paramedic on scene…I really felt that we couldn’t stand by and do and say nothing. I didn’t think it was ethical. I didn’t think it was right.”

Sunnyvale uses what Sunnyvale Police Chief Phan Ngo called “quick response vehicles” (QRVs) to field calls where a paramedic is needed but ambulance transport is not. Sunnyvale used to have two QRVs, but last year, the city lost one.

Then, earlier this year, the emergency services provider that contracts with Santa Clara County for paramedic services, American Medical Response (AMR), ponied up the money to reinstate the second QRV, returning two dedicated paramedics to Sunnyvale.

So, it would appear that all is well. The problem is, while having two dedicated paramedics is a win, it is really a return to normalcy, not a solution. The return of the QRV does not address the overall paramedic shortage plaguing, not just Sunnyvale, but all of the Bay Area.

What’s really troubling is that nobody seems to be taking any responsibility for it.

Evasions

Ngo was quick to say, “This is not a dire situation.”

The problem is not unique to Sunnyvale or even Santa Clara County, Ngo said. It is a national shortage. It is not just a paramedic shortage but a shortage of many medical professionals, he said, calling it a “sort of ecosystem that has problems in different areas.”

Ngo cautioned that anyone offering a magic bullet to solve this problem is likely not looking at the entire picture. A multi-pronged approach is needed, he added.

Although asked several times whether restoring the QRV solved the issue, at least in Sunnyvale, Ngo said, “Yes and no.” When asked for clarification, he elaborated.

“Not having a paramedic does not hamper our ability to assist,” he said. “That doesn’t necessarily mean there are no challenges.”

Ngo never answered the question.

And he isn’t alone in failing to offer a clear answer. Sources contacted for this story shirked even the most basic inquiries.

An email response from Santa Clara County’s Office of Communication asking for an interview was reluctant to even acknowledge that the county funds ambulance services. The email notes that the county “contracts for emergency ambulance services” but does not provide any “direct funding.” The writer didn’t even sign the email.

The county’s website lists three employees in the Office of Communication: María Leticia Gómez, director of communications and public affairs, Laurel Anderson and Quan Vu, both assistant director of communications and public affairs.

Similarly, an unsigned response to a request for an interview said sources at AMR were “unable” — i.e., unwilling — to provide one. A “statement” from AMR read that “[t]he main obstacle contributing to this has been fewer people entering training programs resulting in a smaller pool of qualified candidates to hire from.”

In other words, the paramedic shortage is being caused by…a paramedic shortage.

Spread Too Thin

There is a psychological phenomenon called the Bystander Effect. The theory holds that at least one of the reasons people often don’t help in dire situations is a sense of diffused responsibility. Because each person feels that they are but one of many people responsible for solving a problem, nobody does anything, because each person’s share of the responsibility is so small.

Klein said a “systemwide fix” is needed to address the crux of the problem, adding that the union “did a substantial amount of heavy lifting” in getting the QRV reinstated.

“Clearly, we felt there was a shortfall in emergency medical care,” Klein said. “Educating is the best course of action. Doing nothing would eventually result in a lack of service and even death.

It just wasn’t something we could stand idly by and allow a slow process to take place.”

However, he said, the union’s role is more as an advocate. Going public with how the paramedic shortage is affecting Sunnyvale was not about pointing fingers or assigning blame, he added. Klein said he hopes other stakeholders “pick up the ball from here.”

But those at the county and AMR seem to share Ngo’s sensibility about acknowledging there is even a problem.

If each agency simply continues to kick the can down the road without actually providing concrete solutions, the Bay Area could find itself in a situation similar to Multnomah County in Oregon.

In Portland, AMR got into hot water, racking up nearly $2 million in fines, for repeated delayed response times. A shortage of paramedics was at the heart of the issue there too. Although AMR offered a solution of having one paramedic and an EMT aboard ambulances — as opposed to two paramedics, which is customary in Multnomah County — one county official said last month that she is having none of it.

That Multnomah County commissioner wasn’t buying what AMR was selling, which was that the only way to provide adequate patient care is to reduce the number of paramedics on a rig. Pushback from the commissioner seems to be because she is fed up with AMR claiming that, what she sees is compromising care, is the only solution.

Here in Santa Clara County, until someone holds each agency responsible for its role in the shortage, agencies are just rolling the dice that things don’t get to that point.

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5 Comments
  1. Benjamin Ram 2 months ago
    Reply

    This is a useful article. How can citizens get involved and with whom to make this better?

  2. David Alexander 2 months ago
    Reply

    Mr. Ram,

    I suggest if you want to get involved, attend a county supervisors meeting and make your opinions known. Thanks for reading.

  3. m wendell 2 months ago
    Reply

    I wish the article included information about the training, certification, licensing process for the paramedics. How long does it take? What institutions offer the programs? Do the graduates find jobs in the Bay area or do they go elsewhere? What is the salary and compensation difference for paramedic versus EMTs? Are there not enough people entering the training pipeline? Are there not enough seats in the programs to fill the need? OR?….

    • CSC 2 months ago
      Reply

      Wendell… Paramedic training can be obtained at the South Bay Regional Public Safety Training Academy. See this URL for complete description. https://theacademy.ca.gov/paramedic-program-1/
      .
      Salary estimates below assume 40-hour work week 52 weeks year…
      • Paramedic: $80,000 https://www.salary.com/job/santa-clara-county-ca/paramedic/j202303080239183600626
      • LVN/LPN: $89,000 https://transparentcalifornia.com/salaries/search/?q=licensed+vocational+nurse&a=santa-clara-county&y=2022&s=base
      • EMT: $70,000 https://www.indeed.com/career/emergency-medical-technician/salaries/Santa-Clara-Valley–CA

  4. CSC 2 months ago
    Reply

    Sunnyvale’s population is 20% larger than Santa Clara’s, square miles to cover is 25% larger, and 2022’s EMS response needs were 10% greater than Santa Clara’s. On average, EMS services respond to ~21 calls for service per day in each of these two cities.
    .
    Minimum response time for Code 3 EMS is 7-minutes 59-seconds (7:59) and cities must meet at least 90% of all such calls in that time or less. In 2022, EMS services had a 94.5% success rate in Sunnyvale and 98.5% in Santa Clara. https://emsagency.sccgov.org/sites/g/files/exjcpb266/files/general/Annual%20Report%202022.pdf
    .
    In 2010-2011, the Santa Clara Civil Grand Jury conducted an in-depth investigation and released a study titled “Fighting Fire or Fighting Change?” In their summary titled, “Managing Human Resources Effectively,” the Grand Jury notes “In their responses to Grand Jury questions regarding firefighter staffing and salary levels, some interviewees described firefighting as ‘the best part-time job in America,’ conceding these well-rewarded firefighters wear ‘golden handcuffs.’ Others acknowledged that firefighters are paid for ‘23 hours of sitting around for one hour of work’ because that is how ‘insurance’ works. But if cities are paying for insurance in the form of idle staff, why not effect change to maximize that insurance “premium?” https://www.scscourt.org/court_divisions/civil/cgj/2011/FDResponse.pdf
    .
    Two of the recent controversies in San Jose was the construction of a new fire station in Willow Glen and ‘pilot’ of a “48/96 Kelly Schedule” which is now permanent. The Willow Glen fire station is controversial because for decades residential fires have significantly declined due to (1) better construction materials and (2) the City had not secured budget to staff the new fire pad with firefighters. The 48/96 switched firefighter schedules from having to work 4 days of 10-hour shift to 2 days of 24-hour shifts with 4 days off in a row. As detailed in the 2011 Civil Grand Jury report, firefighters are now doing less as they sleep most of that 24-hour shift. Many residents in the area and their then-Councilmember tried to push for expanded EMS/Paramedic services instead but unions through more money at the good ol’ boys club. City of Santa Clara firefighters also enjoy the same 2-days on, 4-days off schedule.
    .
    In a 2016 article for Firehouse Magazine, 42-year experienced firefighting executive Gary Ludwig cautions on having cities and firefighters choosing between deploying to a medical call in a QRV versus a fire-fighting apparatus: https://www.firehouse.com/home/article/12197168/ems-another-perspective-on-qrvs
    .
    Sunnyvale and Santa Clara both experience low crimes and building fires, it does not take multiple police officers and firefighters responding to a call for medical assistance. According to a current Santa Clara County job posting, a 5-year experienced Paramedic can earn up to $38.62/hr. or approximately $80k/yr with service contractor ProTransport-1. That is significantly less than the $118k a City of Santa Clara Firefigher-1, with three years experience and much less medical care capability earns.
    • https://www.salary.com/job/santa-clara-county-ca/paramedic/j202303080239183600626
    • https://www.joinscfd.org/salary-benefits
    .
    The solution is clear: residents would benefit more from expanded medical response services from an independent provider. Both cities of Santa Clara and Sunnyvale should ditch the fire station based QRV idea and contract with a certified provider to have dedicated ambulances with both a Paramedic and EMT/driver aboard. In regard to a shortage of Paramedics, both cities should pay future Paramedics a much higher wage than the county currently pays. For comparison, a LVN/LPN goes through 1 year of training and doesn’t perform medical proceedures but is paid an average of $88k/yr in SCC. Paramedics
    .
    The problem is evident: Like the 2010/11 Santa Clara County Grand Jury Recommendation, the resolution to this problem will be kicked down the road by Current City Councils in favor of union endorsement money.

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