Resolution 2005-04

Resolution 2005-04

SAN FRANCISCO FIRE COMMISSION RESOLUTION
EMS RECONFIGURATION


WHEREAS, the mission of the San Francisco Fire Department is to protect the lives and property of the people of San Francisco from fires, natural disasters, and hazardous materials incidents; to save lives by providing emergency medical services; to prevent fires through prevention and education programs; and to provide a work environment that values cultural diversity and is free of harassment and discrimination; and

WHEREAS, the provision of pre-hospital emergency medical care is an integral part of the San Francisco Fire Department's mission; and

WHEREAS, in July, 1997 the City and County of San Francisco integrated the provision of Emergency Medical Services (EMS) into the Department through the merger of Basic Life Support (BLS) services previously provided by the Fire Department and Advanced Life Support (ALS) services previously provided by the Department of Public Health; and

WHEREAS, the merger of EMS services with other emergency services provided by the SFFD into one, unified, fire-based provision of EMS has resulted in improved service and improved patient outcomes; and

WHEREAS, the fire based provision of EMS is a national model that has been adopted by numerous municipalities throughout the country as the most effective and efficient method of providing emergency medical services; and

WHEREAS, the reduction of response times to medical emergencies has resulted in improved patient care and in many instances has saved lives that would otherwise be lost; and

WHEREAS, the Department has been reviewing the current configuration of staffing and means of responding to calls for emergency medical services in the City; and

WHEREAS, the Department and the Commission desire to continually improve the provision of emergency medical services to patients, including improving response times; and

WHEREAS, the Department has reviewed the working conditions of its members, particularly those members who regularly work on ambulances for a 24 hour shift; and

WHEREAS, the Department has a continued concern regarding fatigue of some of its members who regularly work on 24 hour ambulances; and

WHEREAS, the Department began researching means through which to improve the provision of emergency medical services and to improve the working conditions of its members; and

WHEREAS, the Department engaged in an inclusive process in which the Chief of Department and her administrative staff have, in connection with the proposed reconfiguration, conducted several open meetings within the Department to solicit ideas and proposals for the reconfiguration from the Department members and from other City agencies, including the Controllers Office and Department of Public Health, and have identified changes that can be made to the EMS delivery model to improve services; and

WHEREAS, the Department engaged in an extensive review of data regarding EMS calls, including the time of day and geographical location of calls for service, and response times in different response areas; and

WHEREAS, the Department concluded that one means of reducing ALS response times is to station and position ALS responders throughout the City by increasing the number of ALS Engines; and

WHEREAS, the Department concluded that a further means of reducing ALS response times is to dynamically deploy a number of its ALS ambulances and adjust and manage their posting locations to meet changing conditions; and

WHEREAS, a working shift of less than twenty-four hours will help to reduce fatigue for those members staffing ALS transport ambulances; and

WHEREAS, maintaining the provision of EMS within the Department will provide for better unification of command and control of emergency services at all times and will also improve surge capacity at times of disaster; and

WHEREAS, maintaining the provision of EMS first response and transport services within the Department will provide for more efficient control of Continuous Quality Improvement; and

WHEREAS, maintaining the provision of EMS within the Department will provide a means of recruiting a workforce that is reflective of the population of San Francisco; and

WHEREAS, the hiring of Fire Transport Paramedics and Fire Transport Emergency Medical Technicians (EMTs) will provide fiscally responsible EMS to the people of San Francisco; and

WHEREAS, maintaining ambulances within the Department will provide an efficient means of maintaining the paramedic skills of both Transport Paramedics and Firefighter/Paramedics; and

WHEREAS, maintaining the provision of EMS first response and transport services within the Department is consistent with San Francisco's cherished and honored history and purpose of directly providing emergency medical services to the people of San Francisco in order that all residents are afforded equal access to emergency healthcare; and

WHEREAS, the Chief of Department and her administrative staff have provided written reports and materials to the Commission concerning the reconfiguration and have reported to the Commission at several of its regular meetings and at its November 4, 2004 special meeting which was dedicated to the topic of the reconfiguration, all of such meetings having been open to the public and the public having been given the opportunity to comment thereon; and

WHEREAS, the Chief of Department having recommended to the Commission that it adopt the proposed reconfiguration; and

WHEREAS, the Director of Public Health and the Director of the Emergency Medical Services and Emergency Operations Section of the Department of Public Health (EMSEO) having recommended to the Commission that it adopt the proposed reconfiguration; and

WHEREAS, the San Francisco Health Commission having approved the proposed model as consistent with its regulations of emergency medical services;

NOW THEREFORE BE IT

RESOLVED, that the Fire Commission accepts the Chief of Department's recommendation and authorizes her to take the steps necessary to implement the reconfiguration of the San Francisco Fire Department's provision of Emergency Medical Services as follows:

Create two new job classifications for Fire Transport Paramedic and Fire Transport EMT whose duties and job descriptions conform to the job classifications identified as 2525 Fire Transport Paramedic and 2512 Fire Transport EMT;

Hire and train persons in those classifications to staff dynamically deployed ten hour shift ambulances;

Originate the deployment of ten hour shift ambulances from a location that will enable the most efficient shift changes and re-stocking of supplies;

Gradually increase the number of ALS engine companies staffed on a regular basis with at least one H-3 Firefighter Paramedic;

Proceed with the reconfiguration over a period of three years, hiring Fire Transport Paramedics and Fire Transport EMTs in stages, with the current expectation that, at the end of the three year period, the Department's EMS will be deployed utilizing as many as: 42 ALS Engine companies; four station - based twenty four hour ambulances staffed by H-3 Firefighter Paramedics; and five to eighteen dynamically deployed ambulances, each staffed by one Fire Transport Paramedic and one Fire Transport EMT;

In consultation with the Commission, formulate a policy concerning the hiring of Fire Transport Paramedics and Fire Transport EMTs into the ranks of the Department to serve as H-2 Firefighters and H-3 Firefighter Paramedics;

The configuration will progress in such a way that its implementation will not compromise other aspects of the Department's mission;

Monitor and report on the success of the reconfiguration on a continual basis. Success should be measured by the following factors: maintenance or improvement of current patient outcomes; maintenance or improvement of current response times; achievement of uniform response times among the City's Battalion districts; compliance with accepted and applicable standards for the provision of pre-hospital emergency care; compliance with EMSEO Section and Department agreed upon standards and Continuous Quality Improvement guidelines; reduction in the current level of fatigue experienced by EMS responders and transporters; fiscal accountability; and the effect on the ability of the Department to provide a balanced response to all types of emergencies;

The Chief of Department shall report to the Commission on a quarterly basis, or more often as circumstances warrant, on the progress and success of the reconfiguration, and shall make recommendations to the Commission concerning any proposed changes to the hiring and deployment schedule outlined above;

The Commission reserves to itself, in consultation with the Chief of Department, possible modification of the hiring and deployment schedule outlined above as the reconfiguration progresses and its level of success and other circumstances warrant.

Adopted at the Regular Meeting of the San Francisco Fire Commission on

March 24, 2005

Ayes: Conroy, Nakajo, Clarke
Nayes: Fernandez-Pifer, Goldman

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Tania Bauer, Commission Secretary