City Manager's Office November 19, 2012 The Honorable Thomas J. Borris Presiding Judge Orange County Superior Court*

Fire departments that once primarily responded to calls for fire emergencies now have become emergency medical response departments primarily responding to medical emergencies. This evolution has occurred since the onset of "9-1-1" call where all emergency calls are received at one place. The City of Huntington Beach partially disagrees with this finding. The Huntington Beach Fire Department was founded in 1909 and for more than 100 years has continually grown to meet the changing needs of our diverse coastal community. One of the multiple services provided by the fire department is emergency medical services (EMS), which has been part of the Huntington Beach Fire Department mission and service delivery for more than 50 years, dating back to the 1960's. This is prior to the establishment M Response to 2012 Grand Jury Report – Emergency Medical Response in Orange County November 19, 2012 of the 9-1-1 system. The history of emergency medical services is rooted in a 1966 report from the National Academy of Sciences entitled, "Accidental Death and Disability: the Neglected Disease of Modern Society" that called attention to the lack of local government preparation to deal with medical emergencies that threatened the safety of millions of Americans on a daily basis. In 1967, the California State Legislature enacted the Emergency Medical Care Services Act, followed by Health & Safety Code 219, which mandated fire personnel and other public safety personnel to meet American Red Cross first aid training by July 1969. This was followed shortly thereafter by the Wedworth-Townsend Paramedic Act in 1970 to expand paramedic services throughout the State, which grew out of a trial paramedic program in Los Angeles County. The Fire Chiefs in Orange County have always taken a leadership role in the fire service and in 1973, along with other key stakeholders, began a process to develop a comprehensive county-wide EMS delivery system. This effort followed an area wide study by UCLA that identified fire department personnel as best suited to perform this highly skilled function. Concern for a high quality program that provided for public safety and welfare in a cooperative effort among the cities was a key motivation for the fire service to provide emergency medical services to the citizens of Orange County. The "dual role" concept of firefighters performing additional duties has tapped a highly skilled, strategically located workforce to provide excellent service for a small marginal cost difference. Add to this a highly coordinated automatic and mutual aid systems, and virtually every emergency scenario is capable of being managed. Orange County's first paramedic class graduated in 1973, which included firefighters from the Huntington Beach Fire Department. The leadership efforts of the Fire Chiefs culminated in 1974 with the Orange County Fire Chiefs Association development and implementation of an Emergency Medical Services Element (Paramedic) Master Plan. It was not until 1980 that the legislature enacted the Emergency Medical Services System and Pre-hospital Emergency Medical Care Personnel Act (EMS Act of 1980) which established the California EMS Authority (EMSA) and local EMS agencies (LEMSA). The EMSA was vested with responsibility to coordinate the state-wide EMS system and the law provided for each County to establish a LEMSA to administer the local EMS system. The Orange County Board of Supervisors designated the Orange County Health Care Agency as the County's LEMSA in 1982. In 1983, with the development of regional trauma center systems and the designation of trauma centers by OCEMSA, EMS providers were able to begin triaging and transporting trauma patients to the appropriate trauma facility for specialty care. This concept was further developed by OCEMSA that currently allows paramedics to triage patients to specialty centers for stroke, cardiac, burn, obstetrics, and reimplantation. The EMS Act recognized the tremendous efforts and the highly effective delivery system already established by the California Fire Service. The City of Huntington Beach provided Response to 2012 Grand Jury Report – Emergency Medical Response in Orange County November 19, 2012 these services prior to 1980, and as such has maintained its local control of service delivery to the community. As a long time fire service leader, the Huntington Beach Fire Department has provided EMS as a component of its all-risk fire and emergency service delivery system for more than four decades, and has provided fire department paramedic services as part of the county-wide EMS program since the early 1970's. The Warren – 911 – Emergency Assistance Act, which was originally passed in 1972, did not require every local public agency to have a basic 911 system until December 31, 1985, and the City of Huntington Beach established its first 911 system during this period.

As the fire departments evolved into emergency medical departments, the model for operating the fire departments has not radically changed. The fire departments have simply absorbed the emergency medical response into their departments under their old "fire response" model. The City of Huntington Beach disagrees with this finding. The City of Huntington Beach has continually been recognized as a leader in the fire service and the fire department has adapted to meet the changing needs of our community as it has grown over the years and demands for services have increased. In fact, the fire department service delivery model has changed numerous times over the past 30 years to meet these changing needs. In the 1970's, the City expanded its EMS delivery system and began providing paramedic services by placing two paramedic vans into service, each staffed by two firefighter-paramedics. These paramedic units responded with the closest fire engine, which were staffed by a crew trained to the first aid level, and eventually to the level of Emergency Medical Technicians. In 1987, one of the City's fire engines was upgraded to a paramedic engine company in order to enhance paramedic service in the Huntington Harbor area. This paramedic-engine also became the primary paramedic unit into the unincorporated area of Sunset Beach through an agreement with the County. A new EMS subscription program was implemented in Huntington Beach in 1990 with subscription revenue targeted to help expand the paramedic program. In 1991, a third and fourth paramedic van were placed into service. As the delivery of paramedic services changed over the years, the Huntington Beach Fire Department made further changes to its delivery model to improve patient care. This included establishment of a fire department ambulance program in 1993, and upgrading three fire engines to be paramedic-assessment engines. This new program provided for improved paramedic level assessment of patients at stations where a paramedic van was not co-located. In 1994, due to call load increases, the fire engine located at the City's Gothard fire station, was upgraded to a paramedic-engine. Advanced life support services were now provided in Huntington Beach through cross trained firefighter-paramedics who were assigned to three paramedic vans, two paramedic-engines, and two paramedic- assessment engines, with supporting ambulance transport provided by the HBFD ambulance program. In 1995, the Huntington Beach Fire Department made another major shift in service Response to 2012 Grand Jury Report – Emergency Medical Response in Orange County November 19, 2012 delivery. This was done in order to improve paramedic response times, improve ambulance response times, and expand advanced life support service at minimal cost. This was accomplished by taking the three paramedic vans out of service, and assigning the personnel to fire engines throughout the City. The net result was an increase from a paramedic team at five stations to a paramedic engine at all seven fire stations, while also reducing daily staffing from 42 to 41 personnel. By having firefighters on the fire engine serve in a dual role as paramedics, the Fire Department has dramatically enhanced advanced life support services at an additional cost of only $4.75 per hour. The City of Huntington Beach is also a regional partner in a seven city regional dispatch center. As part of the evolution of EMS delivery, fire department dispatchers are now trained to provide life saving instructions over the telephone while fire department units respond to the emergency. In 2000, due to development in the Seacliff area of the City, an eighth fire station was added. To provide staffing at this new station and maximize resources, the second fire engine that was operated from the Gothard fire station was relocated to the new station and placed into service as an eighth paramedic-engine at minimal additional cost. Over the decades as service needs have changed in Huntington Beach, the fire department has adapted to meet the challenge in a cost effective manner. Currently, the City of Huntington Beach has fewer firefighters on duty, per 1000 residents, than surrounding cities. In addition to cross trained firefighter-paramedics, the multifunctional, all risk delivery model also provides cross trained firefighters to staff a hazardous materials response team, and an urban search and rescue team with no additional personnel. By evaluating service delivery over the years, and adapting to meet changing service demands and community needs, the Huntington Beach Fire Department has actually reduced staffing and currently has a lower level of staffing than 20 years ago. This, despite the fact that the City has steadily grown in population to nearly 200,000 and fire department emergency incidents have increased 43% over the past 15 years to 14,643, plus an additional 1,297 responses to neighboring communities, for a total of nearly 16,000 in 2011. The Huntington Beach Fire Department has not simply "absorbed" the emergency medical response into the department under an old "fire response" model, but has methodically and strategically evolved, as part of an county-wide EMS Master Plan, into an efficient all-risk fire and emergency service agency that has met the changing needs of our large and diverse coastal City. In doing so, the Huntington Beach Fire Department also has achieved a 99% customer satisfaction rating.

Economic recessions have forced local fire department boards of directors and city councils to re-evaluate their models for providing fire and emergency medical responses. While this brings to the fore issues of staffing, response times, public safety, training, consolidations, union rules and privatization of their various services, it also spotlights the model used for all emergency responses. The City of Huntington Beach agrees with this finding. Response to 2012 Grand Jury Report – Emergency Medical Response in Orange County November 19, 2012 Over the years, as economic challenges have been encountered in our community, the City of Huntington Beach has made a variety of changes to the way it provides services and implemented major cuts in its budget. Throughout the City, including the fire department, this has included operating reductions, elimination of positions through layoffs, early retirement programs, freezing of funding for vacant positions, outsourcing services, negotiating with all employee bargaining groups for increased employee retirement contributions and other concessions, and increasing revenue when new opportunities have been identified. The fire department has also changed service delivery by evaluating its business practices and replacing sworn, safety personnel in administrative positions with non-sworn civilian staff. Each community must continue to look at its own unique environment and service needs, evaluating priorities, and adjusting services to ensure economic sustainability through a variety of alternatives. Many communities have undertaken studies of service delivery. This includes the City of Huntington Beach which has completed studies on outsourcing of various services, as well as consolidation of services. In a recent study completed for the City of Glendale Fire Department in 2011 by Management Partners Inc., an outside third party consultant, one of the fire departments used for comparison was the City of Huntington Beach. This was due to the HBFD being of similar size and the HBFD service delivery model of cross-trained firefighter paramedics on fire engines and lower cost emergency medical technicians on the City ambulances. The report completed by Management Partners, Inc. identified the HBFD as a model for service delivery that incorporates numerous best business practices and recommended the City of Glendale Fire Department reorganize into a similar delivery model which is currently being implemented.