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
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2004 Reconfiguration Project
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Workgroup convened By Chief Hayes-White in
March 2004
Open Process
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Organizations and individuals invited and
encouraged to participate
Develop multiple models for EMS in San
Francisco
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Why the need for a workgroup?
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Refocus on the goals of the merger
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Patient Care Issues
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Increase in Unusual Occurrences (UOs)
Increased exposure to litigation
Recent focus on Department
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Rapid paramedic response
Adequate transport resources
Budget Analyst, Controller, Grand Jury, Media
Crisis of morale
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H3 FF/PM attrition 8 times higher than H2
Firefighter
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And it could get worse
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Many Departments aggressively
recruiting paramedics
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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
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Salaries / benefits (sp / dp)
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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
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What we have now
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Nineteen statically deployed
ambulances – 24/7
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Staffed with 1 FF/PM and 1 FF/EMT
Two Dual H1 ambulances (1 per watch)
42 Engine Companies
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25 Paramedic Engine Companies
17 Basic Level Engine Companies
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Has lead to…
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Overworked ambulance tier
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Conscripted H2 FF / EMTs assigned to
ambulances
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Frustrated H2s
40% of runs require “triple dispatch”
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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
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Parameters used to develop
models
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Provide highest quality patient care in
economically efficient manner
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“no increased funding”
Increase employee satisfaction and
reduce paramedic attrition
Development of a sustainable system
Promote diversity and opportunity
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Result of Workgroup: 4 Models
Model 1:
FD transport tier with
accelerated hiring of Single
Function (H1) Paramedic
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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
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Little Attention Paid to:
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Model 2: All Private Transport
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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
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Little Attention Paid to:
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Model 3: Privates on Code 2 runs (30%
of volume)
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Significant loss of revenue (50%)
Time required for RFP
Subsidy for Private Providers
Same uphill battle for even less payoff
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Focus of Group
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Model 1
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Retains municipal ambulance / transport
service
Model 4
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True public / private partnership
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Model 4: Public / Private Partnership
(Org charts are provided)
Fundamentals – Best practices in San Diego
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City submits RFP for a private partner to provide
additional ambulance resources
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The City and partner form a Limited Liability
Corporation (LLC)
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The corporation is governed by Board Of Directors
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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
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San Diego requires $650,000 GF draw annually
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Model 4: Public / Private
Partnership
Model Strengths
 Provides 42 paramedic engines (100%)
 Increases number of ambulances
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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
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Model 4: Public / Private
Partnership
Model Weaknesses
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Shared revenue
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Time required for RFP
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Reliant upon financial stability of
Private Providers
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Same uphill battle in privatizing
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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
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Defer hiring of H2 Firefighters
Move FF/PM & FF/EMTs to suppression
Increase number of ambulances to affect workload
Eventual transition to:
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Twelve/Fourteen 10 hr ambulances
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Sixteen ambulances 24 hrs 7 days a week
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Dynamically deployed
Ambulances staffed w/ Dual H1 paramedics
Statically deployed from firehouses
Initial deployment of 25 or 26 paramedic engines
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Two to three year ramp up to 42 paramedic engine
companies
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Model 1: Keeping ambulances in the FD
Model Strengths
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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
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to 393 from 257
Overall increase of 67 FTE’s
Initially continues need for H-2
assignment to ambulances (conscripts)
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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
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Model A: Another option
Best Elements of the Models Developed:
 Recruitment of Single Function PMs
 Transition off 24 hour ambulance shifts
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42 PM ALS Engine Companies
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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
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Model A: Another option
Fundamentals
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Accelerated Hiring of Single Function Paramedics and Single
Function (SF) EMT
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24 peak-period / 16 off peak ambulances
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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
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Model A: Another option
Model Strengths
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Increase in ambulances impacts work load
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Transition off 24hr ambulance shifts
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Continues revenue stream
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Retains ambulances as training platforms
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Savings with SF PM’s and SF EMTs
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Increased diversity in recruitment pools
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Huge community outreach potential for EMTs
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Model A: Another option
Model Strengths
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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
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42 Engines/24 ambulances/4 Rescue Captains
40% increase in paramedic units deployed
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Model A: Another option
Model Strengths
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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
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Model A: Another option
Model Weaknesses
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Loss of 24 hour ambulance shifts
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Overall increase of 29 FTEs
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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
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2.
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5.
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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
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Returns / Adds to suppression:
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86 FF/EMTS
77 FF/PMs
Eliminates immediate need for H2
classes
Should significantly reduce:
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Attrition / Sick / Disability / OT in H3 rank
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