1. 1 San Francisco Fire Department San Francisco Fire Commission EMS Configuration Project Report September 9, 2004 Chief of Department Joanne Hayes-White

2. 2 2004 Reconfiguration Project Workgroup convened By Chief Hayes-White in March 2004 Open Process Organizations and individuals invited and encouraged to participate Develop multiple models for EMS in San Francisco

3. 3 Why the need for a workgroup? Refocus on the goals of the merger Rapid paramedic response Adequate transport resources Patient Care Issues Increase in Unusual Occurrences (UOs) Increased exposure to litigation Recent focus on Department Budget Analyst, Controller, Grand Jury, Media Crisis of morale H3 FF/PM attrition 8 times higher than H2 Firefighter

4. 4 And it could get worse Many Departments aggressively recruiting paramedics San Jose, Sacramento, San Diego, LA County, Milpitas ($$), and more 24 SFFD FF/PM are in process testing Expense to City from Litigation Increased expense of system Salaries / benefits (sp / dp)

5. 5 Participants Department Organizations Other City Organizations / Individuals Community Organizations Local 798 -Including H3 committee Local 790 FF / Paramedic Association EMS Officers Association Black Firefighters Association Asian Firefighters Association Los Bomberos United Fire Service Women SF Fire Chiefs Association Individual FF and FF/PM DPH EMSEOS (co-chair) Office of the Controller Emergency Communications Department SF Emergency Physicians Association* SF Hospital Council

6. 6 What we have now Nineteen statically deployed ambulances – 24/7 Staffed with 1 FF/PM and 1 FF/EMT Two Dual H1 ambulances (1 per watch) 42 Engine Companies 25 Paramedic Engine Companies 17 Basic Level Engine Companies

7. 7 Has lead to… Overworked ambulance tier Average Unit Hour Utilization (UHU).39 Recommended UHU nationwide.25 Medical community opposed to 24 hr ambulance shifts Conscripted H2 FF / EMTs assigned to ambulances Frustrated H2s 40% of runs require “triple dispatch” 2 engines (1 paramedic / 1 EMT) / 1 ambulance Inability to bridge the “culture” divide

8. 8 Parameters used to develop models  Provide highest quality patient care in economically efficient manner  “no increased funding”  Increase employee satisfaction and reduce paramedic attrition  Development of a sustainable system  Promote diversity and opportunity

9. 9 Result of Workgroup: 4 Models Model 1: FD transport tier with accelerated hiring of Single Function (H1) Paramedic Two variations (790’s 1A and 798’s 1B) Model 2: All Private Ambulance Transport Model 3:Private Ambulances for Code 2 runs Model 4:Public / Private Partnership

10. 10 Little Attention Paid to: Model 2: All Private Transport Complete loss of revenue Time required for RFP (18 months) Loss of ambulances for training resource Degradation of command control Complete privatization is an uphill battle

11. 11 Little Attention Paid to: Model 3: Privates on Code 2 runs (30% of volume) Significant loss of revenue (50%) Time required for RFP Subsidy for Private Providers Same uphill battle for even less payoff

12. 12 Focus of Group Model 1 Retains municipal ambulance / transport service Model 4 True public / private partnership

13. 13 Model 4: Public / Private Partnership (Org charts are provided) Fundamentals – Best practices in San Diego  City submits RFP for a private partner to provide additional ambulance resources  The City and partner form a Limited Liability Corporation (LLC)  The corporation is governed by Board Of Directors  membership split equally between the city and private partner  Transport division is then shifted to the control of board of directors  City’s has fixed financial investment  San Diego requires $650,000 GF draw annually

14. 14 Model 4: Public / Private Partnership Model Strengths  Provides 42 paramedic engines (100%)  Increases number of ambulances  Peak period staffing  24 peak period (19 private / 5 Fire Department)  Decreases response time  Can generate profit  Maintains some FD ambulances  Training, special rescue, haz mat, etc  Farm System for future firefighters and firefighter/paramedics

15. 15 Model 4: Public / Private Partnership Model Weaknesses Shared revenue Time required for RFP Reliant upon financial stability of Private Providers Same uphill battle in privatizing

16. 16 Model 4: Public / Private Partnership Possible Time Line for Implementation (based on San Diego experience) 1. Submit RFP 10/31/04 2. Select partner 02/15/05 3. Begin Testing and hiring 05/31/05 4. First Training class 7/1/05 5. Completed 06/30/06

17. 17 Model 1: Keeping ambulances in the FD Fundamentals Accelerated Hiring of H1 Single Function Paramedics Defer hiring of H2 Firefighters Move FF/PM & FF/EMTs to suppression Increase number of ambulances to affect workload Eventual transition to: Twelve/Fourteen 10 hr ambulances Dynamically deployed Ambulances staffed w/ Dual H1 paramedics Sixteen ambulances 24 hrs 7 days a week Statically deployed from firehouses Initial deployment of 25 or 26 paramedic engines Two to three year ramp up to 42 paramedic engine companies

18. 18 Model 1: Keeping ambulances in the FD Model Strengths Increase in ambulances impacts ambulance work load issue Continues revenue stream Career opportunities for single function paramedics Some increased diversity in recruitment pools Decreased reliance on private providers Some enhancement in system flexibility and efficiency by using of peak period short shift ambulances

19. 19 Model 1: Keeping ambulances in the FD Model weaknesses Continues reliance on 24 hour shifts for ambulances Increase of 136 Paramedics to 393 from 257 Overall increase of 67 FTE’s Initially continues need for H-2 assignment to ambulances (conscripts)

20. 20 Model 1: Keeping ambulances in the FD Possible Time Line for Implementation 1. Testing for H1 Paramedics – 1/05 2. First class of H1s enter academy – 6/05 3. Deployment of 1 st H1 ambulances – 7/05 4. Total deployment of system – 6/07

21. 21 Model A: Another option Best Elements of the Models Developed: Recruitment of Single Function PMs Transition off 24 hour ambulance shifts Peak period / short shift staffing 42 PM ALS Engine Companies Providing high level of service to all neighborhoods Eliminating the “triple dispatch” Focusing on diversity in recruitment / retention Retaining ambulances for training / PM skills Redeployment of H2 from ambulance to suppression

22. 22 Model A: Another option Fundamentals Accelerated Hiring of Single Function Paramedics and Single Function (SF) EMT Defer hiring of H2 Firefighters Move FF/PM & FF/EMTs to suppression assignments 24 peak-period / 16 off peak ambulances Staffed w/ 1 SF PM & 1 SF EMT All 10 hr / dynamically deployed ambulances Swift deployment of 42 ALS Engine Companies Small “cushion” (25+) H3s Continue cross-training Ambulance rotations Anticipate impact of promotional exams

23. 23 Model A: Another option Model Strengths Increase in ambulances impacts work load Transition off 24hr ambulance shifts Continues revenue stream Retains ambulances as training platforms Savings with SF PM’s and SF EMTs Increased diversity in recruitment pools Huge community outreach potential for EMTs

24. 24 Model A: Another option Model Strengths Creates natural “farm system” for recruitment of H-3s and H-2s Can match hiring to retirements Provides enhanced H-3 job satisfaction/retention Creates 70 paramedic response platforms 42 Engines/24 ambulances/4 Rescue Captains 40% increase in paramedic units deployed

25. 25 Model A: Another option Model Strengths Enhances system flexibility and efficiency in use of peak period short shift dynamically deployed ambulances Provides career opportunities for single function paramedics / EMTs Maintains current reliance on private providers Optimizes disaster response

26. 26 Model A: Another option Model Weaknesses  Loss of 24 hour ambulance shifts  Overall increase of 29 FTEs

27. 27 Model A: Another option Possible Time Line for Implementation 1. Testing for SF Paramedics / SF EMTs – 2/05 2. First charter class enters academy (2 x 33) – 6/05  Three / four week academy 3. Deployment of 1 st SF ambulances – 6/05 4. Second charter class enters academy – 1/06 5. Final charter class enters academy – 5/06 6. Total deployment of system – 6/06

28. 28 Additional savings in Model A Returns / Adds to suppression: 86 FF/EMTS 77 FF/PMs Eliminates immediate need for H2 classes Should significantly reduce: Attrition / Sick / Disability / OT in H3 rank