1. The Fire-Rescue Department’s Emergency Medical Dispatch:
A Change to the Dispatch Procedure Can
Reduce Response Time
Knighton Award Presentation to ALGA
May 5, 2013

2. Introduction This audit is important because:
It has the potential to save lives.
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
We conducted this audit because:
The Fire-Rescue Department is one of the largest departments in the city
The majority of emergency calls it receives are for medical aid
Even a small efficiency improvement could have a significant impact
We had previously conducted an audit of Emergency Medical Services (EMS) but were unable to delve into dispatch operations

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

4. Audit Team Eduardo Luna, City Auditor
Chris Constantin, Assistant City Auditor
Toufic Tabshouri, Performance Auditor
John Teevan, Performance Auditor
Martin Wilson, Performance Auditor
This was a straightforward audit
However, it was data-intensive, presenting the usual problems:
Extracting the data
Understanding the data
Assessing the reliability of the data
Dispatch systems are not designed for reporting

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

6. EMS Delivery in San Diego
San Diego uses two channels to deliver EMS:
The Fire-Rescue Department operates other rescue units

7. EMS Delivery in San Diego
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

8. Level of Activity
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

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

10. Response Time Measurement
Response time is divided into three segments: Dispatch Time, Turnout Time, and Travel Time
To account for variance, 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

11. Performance Standards
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

12. Response Time Standards
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.
30 seconds
20 seconds
Travel Time: Begins when the unit departs to the scene and ends when it arrives at the scene.
5 minutes
4 minutes
Overall Time: Total of the above. Time from phone pickup to arrival on scene.
7 minutes
6 minutes

13. 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 minute
12%
3 minutes
1 second
Turnout Time: The interval between notification and departure to the scene of an incident.
30 seconds
90%
28 seconds
Travel Time: Begins when the unit departs to the scene and ends when it arrives at the scene.
5 minutes
76%
6 minutes
13 seconds
Overall Time: Time from phone pickup to arrival on scene.
7 minutes
69%
9 minutes
27 seconds

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

15. Improving Performance (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

16. Response Process

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

18. Recommendation 1
We presented two options to the Fire-Rescue Department
Assigning and deploying Fire-Rescue units to all emergency medical calls when an ambulance is assigned
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

19. Projected Results Measure City 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 Performance
59%
1 minute 44 seconds 
Overall Time: Time from Phone Pickup to Arrival On Scene
7 minutes
30 seconds
69%
9 minutes 27 seconds
82%
8 minutes 22 seconds 

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

21. Finding 2 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

22. Recommendation 2
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

23. Department Response
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

24. Gauging the Audit’s 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.

25. Questions / Contact Questions? For more information, contact:
Eduardo Luna, San Diego City Auditor
Toufic Tabshouri, Senior Performance Auditor