1. Knighton Award Presentation to ALGA November 19, 2013

2. 2 This audit is important because: 1. It has the potential to save lives. 2. The issues we encountered are relevant to many other audits:  Processes have not been streamlined or reexamined for a long time  Shortcomings in reporting result in poor information for management decision-making Introduction

3. 3 1. Determine the efficiency and effectiveness of the receipt and handling of calls and dispatching of response units. 2. Assess the adequacy and completeness of dispatch performance reporting to the City Administration and the City Council. Audit Objectives

4. 4 San Diego uses two channels to deliver EMS: 1.A vendor, Rural/Metro, operates ambulances EMS Delivery in San Diego

5. 5 San Diego uses two channels to deliver EMS: 2.The City’s own Fire-Rescue Department operates other rescue units

6. 6 The city is legally obligated to provide two paramedics to serious medical emergencies (Priority 1)  An ambulance is typically staffed by one Emergency Medical Technician (EMT) and one paramedic  A Fire-Rescue unit is typically crewed by four people, all of whom are EMTs and at least one of whom is a paramedic EMS Delivery in San Diego

7. 7 In fiscal year 2011, the FCC processed over 118,000 incidents in the city  Note: There are often multiple calls associated with each incident. These incidents resulted in more than 97,00o dispatches, 83,000 of which were for medical emergencies Approximately 82 percent of medical calls result in the dispatch of a Fire-Rescue unit Level of Activity

8. 8 1. Emergency calls (911) are received by Police Dispatch 2. Police Dispatch routes fire or medical emergency calls to the Fire Communication Center (FCC) 3. The FCC assigns an ambulance to all medical calls as soon as an incident address is obtained 4. An FCC call taker asks a series of questions to determine the severity of the medical incident 5. The FCC assigns a Fire-Rescue unit to high priority calls, providing a second paramedic Medical Dispatch Process Overview

9. 9 Response time is divided into three segments: Dispatch Time, Turnout Time, and Travel Time To reduce the impact of outliers, response time is reported as percentage of calls falling within a period of time  For example, Travel Time for 90 percent of dispatches was met within seven minutes Response Time Measurement

10. 10 The Fire-Rescue Department was struggling to meet National Fire Protection Agency (NFPA) response time standards.  The City hired a consultant to study its response time performance, and subsequently adopted its own standards  The Fire-Rescue Department still struggled to meet the City’s adopted standards Performance Standards

11. 11 City vs. NFPA Response Time Standards Time Interval City Standard NFPA Standard Dispatch Time: Starts at the phone pickup and ends when emergency units are notified of the incident. 1 minute Turnout Time: The interval between notification and departure to the scene of an incident. 1 minute 30 seconds 1 minute 20 seconds Travel Time: Begins when the unit departs to the scene and ends when it arrives at the scene. 5 minutes4 minutes Overall Time: Total of the above. Time from phone pickup to arrival on scene. 7 minutes 30 seconds 6 minutes 20 seconds

12. 12 City Response Time Performance Time Interval City Standard Percentage of Dispatches Meeting Standard Time Within Which 90% of Calls Were Met Dispatch Time: Starts at the phone pickup and ends when emergency units are notified of the incident. 1 minute12% 3 minutes 1 second Turnout Time: The interval between notification and departure to the scene of an incident. 1 minute 30 seconds 90% 1 minute 28 seconds Travel Time: Begins when the unit departs to the scene and ends when it arrives at the scene. 5 minutes76% 6 minutes 13 seconds Overall Time: Time from phone pickup to arrival on scene. 7 minutes 30 seconds 69% 9 minutes 27 seconds

13. 13 There are two ways to improve response times: 1. Provide more resources  Build additional fire stations  Hire more firefighters  Contract for more ambulances  Upgrade dispatch systems Improving Performance (1)

14. 14 2. Examine current practices  We diagramed the entire process from the time that someone places an emergency call to the time a Fire-Rescue unit arrives on scene  We compared the difference between the way that Rural/Metro ambulances and Fire-Rescue units were being dispatched  We calculated response performance for the three segments of the process Improving Performance (2)

15. 15 Finding 1 Changes to Fire-Rescue Dispatch Procedures Can Reduce Response Time by up to One Minute

16. 16 We presented two options to the Fire-Rescue Department 1.Assigning and deploying Fire-Rescue units to all emergency medical calls when an ambulance is assigned 2.Implementing a pre-notification and deployment order process for Fire-Rescue units We recommended option 2:  The Fire-Rescue Department should implement the pre- notification and deployment order option (option two) to reduce the overall response time for medical calls Recommendation 1

17. 17 Projected Results MeasureCity Standard Percentage of Dispatches Meeting the Standard Time Within Which 90% of San Diego Calls Would Be Met Dispatch Time: Time from Pickup to First-Responder Unit Assigned Current Performance 1 minute 12%3 minutes 1 second Projected Performance59%1 minute 44 seconds Overall Time: Time from Phone Pickup to Arrival On Scene Current Performance 7 minutes 30 seconds 69%9 minutes 27 seconds Projected Performance82%8 minutes 22 seconds

18. 18 Finding 2 Fire-Rescue Can Improve the Measurement and Reporting of Emergency Response Times

19. 19 We discussed ways for improving reporting by measuring:  The percentage of emergency calls processed within one minute  The percentage of emergency calls processed within one and a half minutes for a first-responder  Turnout time  The total response time from phone pickup to the arrival on scene time Finding 2

20. 20 The Fire-Rescue Department should strengthen its monthly measurement and reporting of dispatch data, analyze data to identify trends, and utilize the results of the analysis to identify opportunities to streamline and improve overall performance Recommendation 2

21. 21 The Fire-Rescue Department agreed with both recommendations The Department chose to implement option 1 and will assign and deploy Fire-Rescue units to emergency medical calls when an ambulance is assigned Department Response

22. 22 For most medical calls, our recommendations will have minimal impact. For medical incidents involving traumatic injuries or bleeding, the audit may save someone’s life. For heart attacks, a rapid response increases the chance of survival by 10%-20% per minute within the first few minutes. Achieving these results would have otherwise cost San Diego millions for building new fire stations and hiring new personnel. What is a person’s life worth? Our work is ultimately about serving our residents. Gauging the Audit’s Impact

23. 23 Questions? For more information, contact: Eduardo Luna, San Diego City Auditor EduardoL@sandiego.gov EduardoL@sandiego.gov Toufic Tabshouri, Senior Performance Auditor ttabshouri@sandiego.gov ttabshouri@sandiego.gov Questions / Contact