San Francisco Fire Department

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San Francisco Fire Department

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

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Goals of the merger

• Rapid paramedic response to reduce response times
• Assure adequate transport resources
• Capitalize on economies of scale
• Infrastructure
• Training
• Administration

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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

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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

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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

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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

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What does that look like?
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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

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

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SFFD The Goal 42 Paramedic Engine Co.s
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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

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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

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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

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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

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Proposed Timeline

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

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Critical Link-Project Management
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Operations
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Logistics / Administration
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Human resources
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Training
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Liaison to ECD
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Liaison from EMS Section
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Oversight Committee

• Committee of eight members
• Reports to Fire Commission
• Members from
• Emergency Physicians Association

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The numbers game -1

• Current staffing
• 243 H3 Firefighter/paramedics
• Nine (9) currently assigned to SFO
• 20 H1 Fire Rescue paramedics
• 14 currently working

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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

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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

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Why a cushion of H3s?

• Training
• Continue ongoing truck training
• Absorb attrition from promotional exams

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FAQs

• Will this be an entry level rank into the Fire
  Department?
• Im 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?

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FAQs

• Isnt 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?

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Thanks for your attention and ongoing support