A unit of Baltimore City’s Fire Department, IAFF Local 734, is speaking out against the department’s recent move to downgrade four Advanced Life Support Units to Basic Life Support Units starting in July.

ALS units, staffed by paramedics, work to stabilize patients in critical condition in a pre-hospital setting, such as those who are experiencing cardiac arrest or a stroke, according to the American Red Cross. Alternatively, BLS units focus on giving immediate care. The ALS units can deliver more advanced care, such as administering medicine and airway management, which BLS units are not equipped to do.

The city’s decision to downgrade four ALS units puts more strain on staff to meet the high demand of EMS calls in Baltimore City, said Matthew Coster, the president of IAFF Local 734.

After the units get downgraded, 17 ALS units will remain for Baltimore City, a BCFD official confirmed.

Washington, D.C., has 133,979 more residents than Baltimore City, per 2024 census data. Washington also operates 17 ALS units alongside 22 BLS units. Milwaukee’s population has 4,740 fewer people than Baltimore, and its fire department operates 13 paramedic units.

“I’m always worried whenever we have units that are either downgraded or shut down,” Coster told The Baltimore Sun. “I’m always worried that lives are at risk.”

According to a statement from the department, the change is part of a larger strategy meant to address staffing pressures, rising amounts of overtime and the “changing landscape of emergency medical care.” BCFD is trying to modernize its operations and take a data-driven approach to balance resources against demands, which this change reflects, the statement said.

Baltimore paramedic staff shortages have led to a huge uptick in overtime pay, The Sun previously reported.

Despite the financial benefits overtime offers medics, it can also cause burnout, stress and employment turnover, according to a 2019 study from the National Institutes of Health. EMS workers “frequently” work beyond a standard 40-hour work week, the study found.

In the last fiscal year, a BCFD paramedic was the highest-paid employee in the city. Paramedic David Lunsford made $358,586, with 68% of that coming from overtime work.

“If we didn’t have those employees working those extreme overtime hours, we would be closing down units on a daily basis,” Coster previously told The Sun.

Additionally, the city’s call volume is extremely high for its size, which further strains BCFD staff, Coster said.

Because of the limited staff and high call volume, reclassifying the ALS units will increase EMS response wait times and cause more delays in getting care, Coster added.

In Baltimore, it’s not unusual for wait times to be 45 minutes or more, a former BCFD paramedic Kyle Lovell told The Sun in March.

“If you have a high acuity ALS call, and we have four or less ALS units on the street, you’re going to be waiting a little bit longer,” Coster said.

Acuity refers to the level of care a patient may need. High-acuity calls typically involve people in critical condition that might be experiencing a life-threatening event. Alternatively, low-acuity calls mean the patient’s condition has a low probability of becoming critical.

According to the BCFD statement, the department uses telemedicine to connect low-acuity callers with physicians for virtual consultations, which eases the demand on units. The department reaffirmed its commitment to delivering high-quality, rapid care to city residents.

Coster reassured community members who may be worried about the reduction in ALS units.

“My members are dedicated,” he said. “They’re going to try as hard as they can to assist anyone who has a life-threatening emergency.”

In addition to the reduction in ALS units, the city allocated over $5.2 million in its budget to hire private EMS contractors — a move that the union “believes deserves closer public scrutiny,” according to a news release shared on social media.

Coster would have liked to see those funds go toward the department for equipment and to hire and train its paramedics, rather than outside contractors.

“We’re asking City Hall and the public to take a hard look at these choices and consider reinvesting in our frontline emergency medical workforce,” the news release said.

Have a news tip? Contact Irit Skulnik at iskulnik@baltsun.com or on X as @irit_skulnik