By Tony Saavedra
The Orange County Register
ORANGE COUNTY, Calif. 鈥� Orange County fire chiefs are seeking the removal of one of the county鈥檚 top Emergency Medical Services directors, accusing him of endangering 911 patients by blocking paramedics from using innovative medical treatments already employed statewide.
The Orange County Fire Chiefs Association, in an Aug. 20 letter to the Orange County Health Care Agency, called EMS Medical Director Carl Schultz 鈥渁brasive,鈥� saying he has damaged the morale of paramedics as well as the county鈥檚 reputation among EMS professionals throughout California.
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鈥淔or too long, Dr. Schultz鈥檚 decisions and actions have insulted our first responders, alienated our statewide partners and impeded our ability to heal, serve and save the sick and injured of Orange County,鈥� said the letter, signed by association president and Laguna Beach Fire Chief Niko King.
鈥淪imply put, it is time for an immediate change, and nothing short of the removal of Dr. Schultz will resolve the issues at hand,鈥� King wrote.
Schultz, a medical doctor, has helped run the agency that regulates the county鈥檚 emergency medical care system for about six years.
OCHCA Director Veronica Kelley and Schultz declined to comment through an agency spokesperson, saying, 鈥淲e don鈥檛 speak to issues related to personnel.鈥�
The four-page letter ticks through a number of complaints. For instance, Schultz has steadfastly fought against performing blood transfusions in the field, despite the federal government offering billions of dollars in grants to pay for them.
During a regional question-and-answer session hosted by the Los Angeles County EMS Authority, Schultz insulted the panel and remarked, 鈥淚 don鈥檛 have any idea if this stuff works,鈥� the letter said. This despite evidence that hundred of thousands of people have been saved by prehospital transfusions, King said. Ventura, Los Angeles, Riverside and San Bernardino counties already conduct such blood transfusions, according to the letter.
King also wrote that during a conference on prenatal and postpartum seizures, Schultz rejected the use of magnesium by paramedics even though it is already in use nationally. Schultz remarked to the conference that the proposal wasn鈥檛 worth the training time, and Orange County paramedics still can鈥檛 get the dose right on another seizure medication, according to the letter.
King said the insult against the paramedics came without proof.
Schultz also rejected another proposal to stem false 911 calls, saying, 鈥淵ou need high-quality paramedics to do this,鈥� the letter said.
King wrote that Schultz also declined to apply for a state grant of up to $400,000 to test the use of the drug buprenorphine to combat opioid use disorder. According to King, Schultz said the grant might cost more to administer than the funds received.
Schultz also slow-walked the trial use of the fast-acting anesthetic ketamine by paramedics, who were able to administer only four doses in six months under his stewardship.
鈥淚n other words, while other counties widely and successfully use ketamine as the evidence-based and state-authorized drug that it is, Orange County has only run a 鈥榯rial鈥� with a sample size of four,鈥� King complained.
The prehospital use of ketamine to ease pain has already been endorsed by the American College of Surgeons, the American College of Emergency Physicians and the National Association of EMS Physicians, said the letter.
But, according to King, Schultz has said, 鈥淚f we give ketamine to someone and they die, there is a possibility of litigation or even criminal investigation, whether or not ketamine was the culprit.鈥�
Lastly, Schultz last month prohibited fire department medical directors from advising paramedics in the field, said the letter. By denying the use of EMS physicians, Schultz is putting emergency patients at risk, King wrote.
鈥淭his policy strips the Orange County EMS system, and its residents, of its most qualified physicians at the exact moments when their expertise is most critical,鈥� the letter said.
King wrote the new policy contradicts national recommendations, conflicts with neighboring agencies and results in an unnecessary loss of 鈥渓ife-expertise.鈥�
The situation has gotten so bad, King wrote, that EMS agencies across the state strategize around anticipated opposition from Schultz and Orange County Emergency Medical Services.
He wrote, 鈥淭his culture of obstruction, lack of innovation and non-collaborative decision-making is adversely affecting our EMS services and our collective reputation as a county.鈥�
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