The City of SAN Diego Council President Myrtle Cole Fourth District November 8, 2018 Judge Peter C. Deddeh Presiding

This small group of frequent 9-1-1 callers creates a serious logistical and financial strain on emergency medical services. Response: The Mayor and City Council partially disagree with the Grand Jury’s finding. Frequent 911 callers, who represent approximately one percent of the population (1,400+ individuals), typically generate 15% to 20% of the EMS call volume. Like other major EMS systems in the United States, the San Diego EMS system can manage this level of frequent use because system management is designed around call volume. However, an City of San Diego Response to San Diego County Grand Jury Report Entitled “The Resource Access Program: A Successful Program Disbanded” ever-increasing call volume in the general 911 system is a resource concern for EMS leadership.

RAP, a program designed to identify over users and reduce their 9-1-1 calls and ER visits, resulted in substantial financial savings and reduced strain on other emergency responders during the time it was in operation. Response: The Mayor and City Council agree with the Grand Jury’s finding.

Paramedics in a program such as RAP require an exemption from current law, allowing them flexibility in deciding appropriate treatment options for clients in the program. Response: The Mayor and City Council partially disagree with the Grand Jury’s finding. Most RAP functions, like coordination of services and navigation through the healthcare system, do not require an exemption from the California EMS Authority. However, certain specialized services provided by RAP paramedics do require a State exemption to operate in roles beyond the normal paramedic “scope of practice”. This exemption enhances the program because it allows RAP paramedics to, for example, transport patients to non-hospital locations or to provide medications or treatment that 911 paramedics cannot. Legislative efforts to implement this as a permanent scope of practice are in progress.