Orange County Grand

Despite fire departments throughout Orange County having evolved into emergency medical departments, most have not updated their emergency response protocols Tensions have been further exacerbated by COVID and the demand placed on ambulances that, accordingly, but have simply absorbed emergency medical responses into their existing reportedly, have failed to respond to calls in a timely manner. The extent of the problem is debatable. fire response models. However, the OCFA Fire Chief took the problem into his own hands. In December 2021, the OCFA Chief directed that all EMS responses be classified as Code 3 to speed up ambulance response times. A 14 Citygate Associates, Inc., Standards of Coverage Service Level Assessment OCFA, p. 8 (June 2020). OCFA Comprehensive Annual Financial Report, FY ending June 30, 2021, p. 148. Correspondence from OCFA to OC Public Health, cc: County Executive Officer, January 25, 2022. Letter from OC Fire Chiefs Association to OCEMS, November 8, 2021. Joint Statement on Lights & Siren Vehicle Operations on Emergency Medical Services (EMS) Responses 17 OCEMS Temporary Suspension of Diversion and Actions to Reduce APOTs, December 29, 2021. February 14, 2022. ai165662501356_01 Final-2022-05-20_Where's_thg_Fire_Trucks_to_Medical_Calls 16.pdf 1 6/30/22 2:36 PM ai165662499553_01 Final-2022-05-20_Where's_thg_Fire_Trucks_to_Medical_Calls 17.pdf 1 6/30/22 2:36 PM Report WHERE’S THE FIRE? WHWERheEre’S’s TthHe EF iFreI?R E ? 1 Stop Sending Fire Trucks to Medical Calls? Stop Sending Fire Trucks to Medical Calls Stop Sending Fire Trucks to Medical Calls least two minutes longer than for the smaller vehicles to roll out.14 Although that approach adds a Code 3 response requires lights and sirens.18 Code 3 responses have been shown to pose a significantly fourth paramedic unit to the service area, causing a shift in assignments, additional staffing greater danger to the public and emergency personnel.19 The Orange County Grand Jury is concerned would not be necessary. Additionally, the cost of two fully equipped paramedic squad vehicles is that this OCFA directive and the power struggles existing between the Fire Chiefs Association and less than the cost of a single Type 1 Engine. The typical cost for a fully equipped Type 1 engine OCEMS may be viewed as self-serving rather than serving the best interests of the public. is between $750,000 and $1,000,000 as opposed to the typical cost for a fully equipped Similar acrimony was evident when OCEMS received pointed criticism for taking a position on 2021 Paramedic Squad vehicle (based on a Ford F-350 Super Duty Diesel chassis) which is under proposed legislation that was pending in Sacramento that directly affected OCEMS without conferring $200,000.15 with the OCFA or independent Fire Chiefs. While Orange County fire leadership is free to disagree with the position taken by OCEMS, OCEMS had no obligation to consult with them prior to advocating for Friction Between OCEMS and OCFA itself in Sacramento. Fractures between OCEMS, the OCFA, and independent city Fire Chiefs are apparent. This is There is consensus from both sides that the problems between these entities have escalated over the past exemplified in a letter written to OCEMS from the Fire Chiefs that pointed to OCEMS’s “offensive” year; however, there have been some recent signs of better collaboration and communication. action in implementing policy changes without prior notice or collaboration. This complaint was made despite the Fire Chiefs’ specific acknowledgment in the same letter that a joint advisory committee had been formed and had been discussing the issues.16 COMMENDATIONS Despite the OC Fire Chiefs’ complaint about OCEMS overstepping its authority, the only example (cid:31) Fire department personnel for their professional service and steadfast concern for public provided to the Orange County Grand Jury was the emergency action taken by OCEMS in 2021 when safety. hospitals were backed up. This caused long wait-times for first responders who transported patients to (cid:31) All Emergency Medical Services personnel for their tireless efforts on behalf of Orange the emergency room and kept them unavailable to respond to other emergencies. In response, OCEMS County residents. introduced an emergency measure which allowed EMT and paramedic transporters to leave patients in (cid:31) Interviewees for their cooperation and time spent with the Orange County Grand Jury to the hands of the hospital on a portable cot provided by the ambulance squad.17 Although the change explore these issues. addressed the fire departments’ problem of extended “wall time” for fire paramedics, it resulted in a (cid:31) Special commendation to the City of Placentia for innovation in the face of concerted strong rebuke from Fire Chiefs for failing to provide adequate notice to them or provide an opportunity opposition. to collaborate. Although OCEMS could possibly have provided better notice to OCFA and the independent Fire Chiefs, the OCEMS appeared to be working in the best interest of all parties involved. FINDINGS This was a fact that was, at best, only begrudgingly acknowledged by a few OCFA union representatives and other fire agency personnel.

Despite use of a tiered dispatch system, OCFA’s deployment of resources for medical R5 Departments with publicly owned ambulances should allow OCEMS to inspect their responses are the same for nearly all calls, resulting in unnecessary wear and tear on ambulances for compliance with State EMS guidelines and adopt OCEMS expensive fire-fighting equipment and public infrastructure. recommendations. F9

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. RESPONSES

There has been a breakdown of communication and trust between OCEMS and Orange County Fire Chiefs. California Penal Code Section 933 requires the governing body of any public agency which the

Over-deployment of firefighters for medical calls contributes to the current climate of Grand Jury has reviewed, and about which it has issued a final report, to comment to the forced hiring and firefighter fatigue. Presiding Judge of the Superior Court on the findings and recommendations pertaining to matters

Code 3 response is over utilized by OCFA, unnecessarily putting the responders and under the control of the governing body. Such comment shall be made no later than 90 days after public at risk. the Grand Jury publishes its report (filed with the Clerk of the Court). Additionally, in the case of

Since the outbreak of the COVID pandemic, there has been an emergency medical a report containing findings and recommendations pertaining to a department or agency headed personnel shortage. The pandemic also has contributed to longer wait times at hospitals by an elected County official (e.g. District Attorney, Sheriff, etc.), such elected County official resulting in firefighter personnel being out of service for longer periods. shall comment on the findings and recommendations pertaining to the matters under that elected

There are specific areas within Orange County, such as Laguna Woods and Seal Beach, official’s control within 60 days to the Presiding Judge with an information copy sent to the that have an extremely high percentage of medical calls which, under the current model, Board of Supervisors. results in the stations servicing those communities to require two engines.

OCEMS has the authority and responsibility to inspect all for-profit ambulances Furthermore, California Penal Code Section 933.05 specifies the manner in which such operating in Orange County; however, publicly owned ambulances are not automatically comment(s) are to be made as follows: subject to OCEMS oversight. (a) As to each Grand Jury finding, the responding person or entity shall indicate one of the

Placentia’s changes to the emergency medical response protocols after leaving OCFA following: have resulted in improved medical call response times. (1) The respondent agrees with the finding.