1. 1 San Francisco Fire Department San Francisco Fire Commission EMS Configuration Project Report October 14, 2004 Chief of Department, Joanne Hayes-White

2. 2 Goals of the merger Rapid paramedic response to reduce response times Assure adequate transport resources Capitalize on economies of scale: Infrastructure Training Administration

3. 3 A little background Emergency Medical Technicians (EMT) 120 hours of training The ability to: Provide basic trauma care CPR and Defibrillate with AEDs Basic patient assessment and history Administer oxygen and oral glucose paste 24 hours of Continuing Education / 2 yrs

4. 4 More background Emergency Medical Technician – Paramedic 1200 hours of training The ability to: Defibrillate / Pace slow heart rates / Cardiovert fast heart rates Intubate / Cricothyroidotomies IV lines and over 40 drug therapies including: Cardiac arrest drugs Asthma Pain management Anti-seizure meds 48 hours of Continuing Education / 2 yrs

5. 5 Critical Findings of Study Transition off 24 hour ambulance shifts Promotes fatigue / untenable work-loads Transition to 10 hr – “short shift” staffing Allows for peak period staffing Transition to dynamically deployment Allows for quick response / best possible coverage 42 Paramedic Engine Companies Providing high level of service to all neighborhoods Eliminating the “triple dispatch”

6. 6 Critical Findings of Study Better job satisfaction for H3 FF/PMs Focusing on diversity in recruitment / retention Retaining ambulances for training / retention of PM skills Redeployment of H2 FF/EMTs and H3 FF/PMs from ambulance to suppression

7. 7 What does that look like?

8. 8 What we have now Nineteen ambulances quartered in Fire Stations– 24/7 Staffed with 1 FF/PM and 1 FF/EMT Two Dual H1 ambulances 1 0600 – 1400 / 1 1400 - 0200 42 Engine Companies 25 Paramedic Engine Companies 17 Basic (EMT) Level Engine Companies

9. 9 SFFD TODAY 25 Paramedic Engine Co.s / 17 EMT Level Engine Co.s

10. 10 The Goal 42 ALS Engine Companies AND 24 peak-period / 16 off-peak ambulances Staffed w/ 1 SF PM & 1 SF EMT All 10 hr / dynamically deployed ambulances OR 20 peak-period / 14 off-peak ambulances Staffed w/ 1 dedicated PM & dedicated EMT All 10 hr / dynamically deployed ambulances 4 24 hour ambulances quartered in fire stations Assess call volume / feasibility during transition

11. 11 SFFD The Goal: 42 Paramedic Engine Co.s

12. 12 Why peak period staffing? Predictable and dramatic rises in call volume Time of day / day of week Allows the Department to be responsive to requests for service

13. 13

14. 14 Why dynamic deployment? Real time redeployment of resources in response to call volume Constant “chess game” Requires aggressive fleet management at ECD Most efficient mechanism of resource utilization

15. 15 How do get there and how long? Accelerate Hiring of Dedicated Paramedics and Dedicated EMTs Defer hiring of H2 Firefighters Match hiring to retirements Over 12-18 months transition our 24 hour units to 10 hour units Move FF/PM & FF/EMTs to suppression assignments

16. 16 Reinforcing our commitment to EMS Ads 160-200 dedicated EMS professionals to SFFD (overall increase of 29 FTEs) Creates 70 paramedic response platforms 42 Engines/24 ambulances/4 Rescue Captains 40% increase in paramedic units deployed Provides career opportunities for dedicated function paramedics and EMTs

17. 17 Proposed Timeline 1. Outreach & applications for Paramedics / EMTs – 1/05 (rolling applications) 2. Testing beings – 3/05 3. First class enters academy (2 x 33) – 5/05  Three / four week academy 4. Deployment of 1 st SF ambulances – 6/05 5. Second class enters academy – 10/05 6. Final class enters academy – 4/06 7. Total deployment of system – 6/06

18. 18 Critical Link-Project Management Project Manager Operations Logistics / Admin Human Resources Training ECD Liaison EMSA Liaison

19. 19 Operations

20. 20 Logistics / Administration

21. 21 Human resources

22. 22 Training

23. 23 Liaison to ECD

24. 24 Liaison from EMS Section

25. 25 Oversight Committee Committee of eight members Reports to Fire Commission Members from: Emergency Physicians Association

26. 26 The numbers game -#1 Current staffing: 243 H3 Firefighter/paramedics Nine (9) currently assigned to SFO 20 H1 Fire Rescue paramedics 14 currently working

27. 27 The numbers game -#2 What it takes for 42 / 20: 42 Paramedic Engine Co. – 189 H3 FTEs 42 X 4.5* Ambulance staff is projected on 20 / 24 hour units – 200 (100 PMs / 100 EMTs) 2 X 20 X 5** * 48.7 hr. work week relief factor ** 40 hr. work week relief factor

28. 28 The numbers game -#3 What it takes for 42 / 20: 42 Paramedic Engine Co. – 189 H3 FTEs 42 X 4.5* Four 24 hour dual H3 Fire station ambulances – 36 FTEs 2 X 4 X 4.5* Total 225 H3 FTEs Dynamic Ambulance staff projected on 16 / 24 hour units – 160 FTEs (80 PMs / 80 EMTs) 2 X 16 X 5**

29. 29 Why a cushion of H3s? Training Continue ongoing truck training Absorb attrition from promotional exams

30. 30 FAQs “Will this be an entry level rank into the Fire Department?” “I’m in EMT or PM school now. Will I be able to apply?” “Is their opportunity to be a career paramedic or EMT?” “Are there promotional opportunities for these new ranks?” “Who will represent these new ranks?”

31. 31 FAQs “Isn’t there a need for additional infrastructure with this new ambulance corps?” “Can H3s and new paramedics / EMTs work together?” “Will these PMs and EMTs be second class citizens?”

32. 32 Thanks for your attention and ongoing support