Current EMS Deployment - San Francisco Fire Department
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Transcript Current EMS Deployment - San Francisco Fire Department
San Francisco Fire Department
San Francisco Fire Commission
EMS Configuration Project Report
September 9, 2004
Chief of Department Joanne Hayes-White
1
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
2
Why the need for a workgroup?
Refocus on the goals of the merger
Patient Care Issues
Increase in Unusual Occurrences (UOs)
Increased exposure to litigation
Recent focus on Department
Rapid paramedic response
Adequate transport resources
Budget Analyst, Controller, Grand Jury, Media
Crisis of morale
H3 FF/PM attrition 8 times higher than H2
Firefighter
3
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)
4
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
SF Emergency Physicians
Association*
Emergency Communications
Department
SF Hospital Council
5
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
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Has lead to…
Overworked ambulance tier
Conscripted H2 FF / EMTs assigned to
ambulances
Frustrated H2s
40% of runs require “triple dispatch”
Average Unit Hour Utilization (UHU) .39
Recommended UHU nationwide .25
Medical community opposed to 24 hr ambulance
shifts
2 engines (1 paramedic / 1 EMT) / 1 ambulance
Inability to bridge the “culture” divide
7
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
8
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
9
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
10
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
11
Focus of Group
Model 1
Retains municipal ambulance / transport
service
Model 4
True public / private partnership
12
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
13
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
14
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
15
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
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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
Sixteen ambulances 24 hrs 7 days a week
Dynamically deployed
Ambulances staffed w/ Dual H1 paramedics
Statically deployed from firehouses
Initial deployment of 25 or 26 paramedic engines
Two to three year ramp up to 42 paramedic engine
companies
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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
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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)
19
Model 1: Keeping ambulances in the
FD
Possible Time Line for Implementation
1.
2.
3.
4.
Testing for H1 Paramedics – 1/05
First class of H1s enter academy – 6/05
Deployment of 1st H1 ambulances – 7/05
Total deployment of system – 6/07
20
Model A: Another option
Best Elements of the Models Developed:
Recruitment of Single Function PMs
Transition off 24 hour ambulance shifts
42 PM ALS Engine Companies
Peak period / short shift staffing
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
21
Model A: Another option
Fundamentals
Accelerated Hiring of Single Function Paramedics and Single
Function (SF) EMT
24 peak-period / 16 off peak ambulances
Defer hiring of H2 Firefighters
Move FF/PM & FF/EMTs to suppression assignments
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
22
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
23
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
24
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
25
Model A: Another option
Model Weaknesses
Loss of 24 hour ambulance shifts
Overall increase of 29 FTEs
26
Model A: Another option
Possible Time Line for Implementation
Testing for SF Paramedics / SF EMTs – 2/05
First charter class enters academy (2 x 33) – 6/05
1.
2.
3.
4.
5.
6.
Three / four week academy
Deployment of 1st SF ambulances – 6/05
Second charter class enters academy – 1/06
Final charter class enters academy – 5/06
Total deployment of system – 6/06
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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
28