closest unit*

Despite fire departments throughout Orange County having evolved into emergency medical departments, most have not updated their emergency response protocols accordingly, but have simply absorbed emergency medicals into their existing fire response models. Response: The City of Fullerton disagrees wholly with this finding. Response time is the absolute priority for emergencies and is key to the survivability of a cardiac event where 4 minutes can determine life or death and for a structure fire which can mean the difference between keeping the fire isolated to the room of origin or contending with flashover which dramatically reduces survivability of the occupants and increases the amount of property damage. These all-hazard emergency services are deployed using the "closest unit" concept which is based off the GIS location of a fire unit and the amount of traffic at that time of the day. An everyday example of this same technology is the use of ridesharing applications such as Uber or Lyft. Technology enables each of our fire apparatus to be THE EDUCATION COMMUNITY 303 West Commonwealth Avenue, Fullerton, California 92832-1775 (714) 738-6311 • [email protected] • www.cityoffullerton.com tracked by our dispatch center. When a call comes through the 9-1-1 system, the closest fire unit is immediately dispatched to handle that emergency. In the case of a medical emergency, the dispatcher utilizes Criteria-Based Dispatch guidelines to determine the level of care required for the patient, the urgency for the care to be given, and specific medical criteria for determining the response. Based upon these guidelines, the Clausen System is then utilized to categorize the medical response into four primary types from the basic to the most severe-Alpha, Bravo, Charlie, and Delta. As the dispatcher continues to ascertain the situation with the calling party, they may increase or decrease the response level. At the end of the day, the determination of the response level is only as good as the information received and often, the situation is worse or more complex upon the fire department's arrival. This can be seen across all types of emergency responses-traffic collisions, structure fires, trench collapse, allergic reactions, cardiac or stroke events, or diabetic incidents. As described above, technology has been leveraged to enable the fire departments to continue to improve their performance and overall response. The Orange County fire service leadership continually looks for methods to improve fire and medical services to the citizens and businesses in the most cost-effective manner. This collaborative and innovative group demonstrated this best as the men and women of their agencies responded to the thousands of patients who were symptomatic with COVID19 while simultaneously working with the Orange County Health Care Agency to create and deploy a model to have our Firefighter/Paramedics deliver the vaccine efficiently and effectively to thousands of people per day in our densely populated county. These Point of Dispensing sites or PODS, initially started at the fire department training centers located in Anaheim, Huntington Beach, and Irvine and within a short time led to the first public-facing POD at Disneyland. It's important to note, that while the Firefighter/Paramedics were working at the PODs, the fire stations continued to be staffed and respond to emergencies within their jurisdictions. This is one important and relevant example of how the Orange County fire service can pivot to handle a large- scale issue and demonstrates the flexibility of the system and the willingness of those who lead this system.

ALS staffed ambulances or smaller squad vehicles are often the most appropriate response to medical calls and do not compromise the quality of medical care. Response: The City of Fullerton disagrees wholly with this finding. ALS-staffed ambulances maybe smaller but must abide by the same driving laws governing emergency response as larger fire apparatus. Industry standards are to dispatch and respond two licensed Paramedics to the side of a patient as quickly as possible for the best outcome. The FFD staffs and deploys its resources to accommodate any type of emergency in any geographic location of the city. As an all- hazard fire department, it benefits the community to have an emergency response service that is multi-functioning rather than single functioning. Trained, licensed ALS personnel responding on an apparatus with a variety of equipment to handle any emergency is in the best interest of our citizens because what maybe most appropriate is not always appropriate. The City of Fullerton has six fire stations. Each station is manned by four fire personnel. As previously stated, two licensed Paramedics are required to staff an ALS ambulance or squad. If, as suggested, an ALS ambulance or squad responded to a medical incident, the fire engine assigned to the station would remain out of operation due to the reduced staffing until that ALS ambulance or squad returned. While the fire engine is out of service, response times would increase throughout the City as incidents would have to be diverted to neighboring fire stations to respond to any additional emergency incidents, including medical emergencies. Sadly, it is probable that increased response times would result. To avoid the increased response times, the City would have to place two additional Firefighter/Paramedics at each station to ensure that the City would retain the ability to respond to medical incidents and any other call for service without adversely impacting the response times. While this would achieve the desired result for the Grand Jury, it would also result in an almost fifty percent (50%) increase in the City's required staffing. This would double the City's operating expenses for the department. This increase would not be tied to any additional funding or revenue. As such, it would be an increased cost that the City cannot afford. Following the Grand Jury report would effectively create an unworkable dilemma. It could either significantly increase the response times for calls for service or it would force the City to pay money that it cannot afford.

There has been a breakdown of communication and trust between OCEMS and Orange County Fire Chiefs. Response: The City of Fullerton disagrees partially with this finding. For decades, OCEMS was trusted because of strong communication, reasonable expectations, and continual collaboration with the Orange County Fire Chiefs. This partnership enabled the emergency medical system to evolve in a respectful manner. The willingness to effectively communicate, collaborate, and allow the Orange County Fire Chiefs to participate in important discussions, prior to establishing policy, has been challenging over the past 3-4 years. This breakdown in communication is not from a lack of effort of the Orange County Fire Chiefs and is the contributing factor that has eroded the trust with OCEMS. Realizing the situation wasn't improving, the Orange County Fire Chiefs requested the creation of an advisory committee to meet with the OCEMS Medical Director to discuss OCEMS policy additions and edits prior to implementation. The ability to have a discussion on the operational components of a policy or new mandated equipment is important for both sides to create the most robust, vet concise policy. This advisory committee is made up of fire department representatives who respect the expertise of the Medical Director and the oversight of the county regulatory agency yet are responsible for providing their own subject matter expertise from the field perspective. While there have been a few regulatory policies discussed and agreed to by this committee, there remains a larger issue of notice and inclusion that would aid in the forward progress of this relationship and the re-building of trust. In this case, both parties must be humble and open to the discussion to focus on what is best for the EMTs and Paramedics who are the faces of the EMS system. The Orange County Fire Chiefs remain willing and capable of embracing this essential partnership with the leaders of the OCEMS to improve this situation.

Over-deployment of firefighters for medical calls contributes to the current climate of forced hiring and firefighter fatigue. Response: The City of Fullerton disagrees wholly with this finding. The FFD is budgeted for a specific number of suppression personnel to deploy on a specific number of fire apparatus to respond to the quantity of incidents within the City on a 24-hour basis. This methodology does not contribute to the force hiring of In order to maintain 24-hour all-hazard emergency service to every Firefighters. geographic location of the City, we may force our Firefighters to work due to vacancies, approved City leave, or mutual aid responses. The higher the number of the aforementioned leaves and the longer the duration, the more often a Firefighter may work which may lead to fatigue. As a not for profit public agency providing emergency services, if we do not maintain the staffing to provide this service, we run the risk of being unable to fulfill our duty to protect the citizens of the City of Fullerton.

OCEMS has the authority and responsibility to inspect all for-profit ambulances operating in Orange County; however, publicly owned ambulances are not automatically subject to OCEMS oversite. Response: The City of Fullerton disagrees partially with this finding The FFD is currently engaged in a public/private partnership with a private ambulance provider as it pertains to emergency ambulance transport under the City's obligatory right referenced in Section 1797.201 of the California Health & Safety Code (Division 2.5, Chapter 4, Article 1) and understand that OCEMS will inspect those ambulances which are under contract with the City. In the future, if the FFD deploys city-owned ambulances, the FFD supports similar inspections by OCEMS as a quality control mechanism to validate the overall emergency transport system in Orange County.