Agun August 17, 2022 The Honorable Erick L. Larsh Presiding Judge Orange County Superior Court*

Despite fire departments throughout Orange County having evolved into emergency medical departments, most have not updated their emergency response protocols accordingly, but have absorbed emergency medical responses into their existing fire response models. The City of Laguna Beach wholly disagrees with this finding. The City of Laguna Beach Fire Department has methodically evolved into an efficient all-risk organization providing fire suppression, fire prevention, hazardous materials response, rescue, public education, and emergency medical services, to name a few. This multi-function capability capitalizes on assets originally placed in geographical locations in order to arrive firefighting forces to fires and rescues quickly. In response to a growing population, the geographic layout of the City, and community expectations, the City Council authorized the funding and expansion from one fire station to three fire stations in 1968. In 1987, the unincorporated county area of South Laguna was annexed per LAFCO requirements, and the City absorbed a fourth fire station. The station previously housed the county paramedic unit that provided contract paramedic service to the City of Laguna Beach. The Orange County Fire Department relocated the paramedic unit to another area in South Orange County, and it was no longer available. In response to the 1987 annexation, the City Council authorized and funded a City-sponsored paramedic program utilizing firefighters already staffing fire units. Therefore, the additional recurring annual cost to operate an engine-based paramedic unit is nominal when using this model. In the 34 years since the inception of the City's paramedic program, six models for service delivery have been deployed. Past models include contract paramedics from the Orange County Fire FAX (949) 497-0771 TEL (949) 497-3311 505 FOREST AVE. LAGUNA BEACH, CA 92651 RECYCLED PAPER The Honorable Erick L. Larsh August 17, 2022 Department, a single paramedic engine at Fire Station 2, a single paramedic van at Fire Station 2, a paramedic engine at Fire Station 2 and a Paramedic Assessment unit at Fire Station 1, two paramedic units based out of Stations 1 and 4, and the current deployment of paramedic engines at Stations 1 and 4 and Paramedic Assessment Units at Stations 2 and 3. These changes in the City of Laguna Beach's EMS service delivery models were significant. When considering EMS services, the desire to provide the highest level of fiscally responsible service to the community has always been the City Council's goal.

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. The City of Laguna Beach partially agrees with this finding. The City of Laguna Beach comprises unique topography not represented in other areas of the county. Rising to an elevation of 1,200 feet within a mile of the Pacific Ocean, the City is primarily built upon hilly terrain with homes designed to take advantage of expansive views. Designed in the early 1920s, the City does not have a typical gridded neighborhood system. Instead, the streets are narrow, the homes built closely together, and residential sidewalks a rarity. The Laguna Beach Fire Department operates out of four strategically placed fire stations. Each station houses three firefighters per day. A typical medical aid response comprises a fire engine and an ambulance, or five total people. To deliver service to the entire community, the Department and the City go to great lengths to design apparatus capable of accessing the tight streets and challenging neighborhoods. The act of taking care of a single patient that does not require immediate lifesaving interventions can safely occur with two people. However, the response to a medical aid is rarely limited to simply providing care to a patient. The tight quarters, difficult terrain, and hillside homes add a measure of difficulty to the equation that additional staff can only solve. Frequently patients need to be carried up or down flights of stairs, across a large expanse of beach, or through older homes built without easy access. Additionally, forcible entry and changes in the patient's overall status add complexity to the response beyond the capacity of two providers.

There has been a breakdown of communication and trust between the OCEMS and the Orange County Fire Chiefs. The City of Laguna Beach partially agrees with this finding. The Laguna Beach Fire Department works closely with OCEMSA. The Agency provides overall medical direction and scope of practice to each firefighter within the Department. In addition, the Department participates in several monthly meetings attended by, or organized by, OCEMSA. As a continuing education provider, the Laguna Beach Fire Department receives on-site inspection and review of training records by OCEMS personnel. Additionally, OCEMS controls the central electronic repository for all medical records generated by 911 responses within the City. The Honorable Erick L. Larsh August 17, 2022 Historically, the department's staff experience and interaction with OCEMSA have been positive and productive.

Over-deployment of firefighters for medical aid calls contributes to the current climate of forced hiring and firefighter fatigue. The City of Laguna Beach wholly disagrees with this finding. The Laguna Beach Fire Department operates its four stations utilizing a constant staffing model. Under this model, there are 13 firefighters working 24-hours each day. If a firefighter takes a day off, another firefighter gets hired behind them. In addition, firefighters may sign up to voluntarily work overtime shifts before a firefighter is force-hired to fill the vacancy. The need to provide an adequate response to fires drives this policy. The number, type, and resource deployment to individual calls have no nexus to force hiring.