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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. 2004 Reconfiguration Project. Workgroup convened By Chief Hayes-White in March 2004 Open Process

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San Francisco Fire Department

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  1. San Francisco Fire Department San Francisco Fire Commission EMS Configuration Project Report September 9, 2004 Chief of Department Joanne Hayes-White

  2. 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

  3. Why the need for a workgroup? • Refocus on the goals of the merger • Rapid paramedic response • Adequate transport resources • Patient Care Issues • Increase in Unusual Occurrences (UOs) • Increased exposure to litigation • Recent focus on Department • Budget Analyst, Controller, Grand Jury, Media • Crisis of morale • H3 FF/PM attrition 8 times higher than H2 Firefighter

  4. 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)

  5. Participants

  6. 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

  7. Has lead to… • Overworked ambulance tier • Average Unit Hour Utilization (UHU) .39 • Recommended UHU nationwide .25 • Medical community opposed to 24 hr ambulance shifts • Conscripted H2 FF / EMTs assigned to ambulances • Frustrated H2s • 40% of runs require “triple dispatch” • 2 engines (1 paramedic / 1 EMT) / 1 ambulance • Inability to bridge the “culture” divide

  8. 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

  9. 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

  10. 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

  11. 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

  12. Focus of Group • Model 1 • Retains municipal ambulance / transport service • Model 4 • True public / private partnership

  13. 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

  14. 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

  15. 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

  16. Model 4: Public / Private Partnership Possible Time Line for Implementation (based on San Diego experience) • Submit RFP 10/31/04 • Select partner 02/15/05 • Begin Testing and hiring 05/31/05 • First Training class 7/1/05 • Completed 06/30/06

  17. 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 • Dynamically deployed • Ambulances staffed w/ Dual H1 paramedics • Sixteen ambulances 24 hrs 7 days a week • Statically deployed from firehouses • Initial deployment of 25 or 26 paramedic engines • Two to three year ramp up to 42 paramedic engine companies

  18. 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

  19. 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)

  20. Model 1: Keeping ambulances in the FD Possible Time Line for Implementation • 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

  21. Model A: Another option Best Elements of the Models Developed: • Recruitment of Single Function PMs • Transition off 24 hour ambulance shifts • Peak period / short shift staffing • 42 PM ALS Engine Companies • 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

  22. Model A: Another option Fundamentals • Accelerated Hiring of Single Function Paramedics and Single Function (SF) EMT • Defer hiring of H2 Firefighters • Move FF/PM & FF/EMTs to suppression assignments • 24 peak-period / 16 off peak ambulances • 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

  23. 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

  24. 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

  25. 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

  26. Model A: Another option Model Weaknesses • Loss of 24 hour ambulance shifts • Overall increase of 29 FTEs

  27. 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 • 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

  28. 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

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