San Francisco Fire Department What Does the Future Hold?

Additional ambulance shifts, 2. Additional staffing, 3. Replace aging ambulance fleet, and 4. Cross-­‐training of new uniformed employees (entry level firefighters).5 Cross trained firefighters are able to handle both fire suppression and emergency medical responses but few stations have firefighters who are cross-­‐trained as paramedics. In our research, we were struck by the following: • In spite of the dynamic model, ambulances cluster around the hospitals, which are located in the Mission, Western Addition, Parnassus Heights and downtown areas; no such clustering exists in the outlying western neighborhoods (Battalions 7, 8, 9 and10). • For ambulances dynamically stationed in the western neighborhoods and requiring replenishment of supplies during their normal shift, an inordinate amount of time is consumed in traveling to and from Station 49 (located in the southeastern part of San Francisco at 1415 Evans Street). • Response times for ambulances to the outlying western neighborhoods suffer as fewer ambulances are available. (See the red sections of the map below) 5 Performance Audit, June 2014. San Francisco Fire Department 10 Percent of Code 3 Medical Calls where a Transport Unit Arrived on Scene that are Greater than 10 Minutes 48 0.452 0.27628 0.197 16 0.414 51 0.211 0.191 41 02 13 0.167 0.218 0.150 38 35 0.120 0.157 10 03 0.13001 0.26314 0.166 31 0.12905 0.319 34 0.160 21 0.10236 0.18608 0.12729 0.18 22 0.14712 0.12506 0.362 23 0.115 07 37 0.31120 0.1524 0.145 0.33018 0.143 11 0.289 40 0.16709 25 0.265 39 0.30726 0.244 0.261 32 42 0.266 15 0.224 0.405 19 0.291 17 0.32743 0.35844 0.311 33 Source: SFFD Time Period: April 28 2014 through April 27 2015 Challenges The primary reasons for failing to meet EMS response time standards are: EMS staffing and ambulance deployment, aging equipment, working conditions, population trends, and the absence of strategic planning.

Aging Equipment Another reason for slow response times is a chronic lack of serviceable ambulances. The ambulance fleet is aging; more than a few need to be permanently retired. As time is of the essence in responding to medical calls, dependable ambulances are a must. The useful life span for a SFFD ambulance is 10 years. In 2014 almost 50% of the fleet exceeded the 10-­‐year life span. As of February 2014 the average mileage for 6 Performance Audit, pg. 14, June 2014. San Francisco Admin Code Section 2A.97. San Francisco Fire Department 12 these older ambulances was 158,299 and the average repair cost per vehicle over its lifetime could be as much as $162,554. (See Appendix 3: Rig Inventory). The Department does not track the number of ambulances out of service on a daily basis 8 but Department officials note that as many as one-­‐third of the ambulance fleet may require servicing at any given time. 19 new ambulances were placed into service in spring 2015. However, the Department ambulance fleet of 54 vehicles requires regular replacement of aged equipment as well as upgrading technology on all SFFD vehicles. (See Appendix 6 Technology Needs).

Working Conditions The Civil Grand Jury observed less than optimum working conditions for paramedics at Station 49. Some key issues for this facility include: • More than 100 paramedics and other Department personnel use Station 49 on a daily basis. This facility was not originally designed for ambulance storage and does not adequately accommodate this number of people and equipment. For example, there are only three bathrooms, two for men and one for women. • Station 49 lacks essentials for the staff who work out of there. There is no water fountain, no kitchen or break room, unsafe street parking for employee vehicles, a deteriorating interior and exterior, and an inadequate security system. The Ambulance Working Group noted in its final report that Station 49 is to be replaced with a new, state of the art facility. Plans for this $40 million facility will be incorporated into the City’s upcoming 10 Year Capital Plan and into the anticipated 2016 Health Bond.

Population Trends Growth in the City’s population is one of the reasons for increased demand in emergency medical services. Between 2000 and 2013, the population of San Francisco grew by 7.8%. The Association of Bay Area Government projects the population of San Francisco will increase by another 35% in three decades.9 San Francisco also has a high daytime commuter population. According to the 2006-­‐ 2010 American Community Survey, the resident population during that period averaged 798,172 but the daytime population during the same period was 951,627, which is 21% higher than the resident population.10 At the same time that the Bay Area population is growing, it is also growing older. In 2014, residents over 65 constituted 22% of the total City population, thus increasing the number of emergency medical calls from elderly residents. Ibid. 9 2014 Performance Audit of Emergency Medical Services Resources at the San Francisco Fire Department. June 2014, p.24. See www.onesanfrancisco.org. San Francisco Fire Department 13 The effects of rapid population growth are apparent to anyone who lives in, works in or visits San Francisco. Traffic is a growing problem along with available street parking. It takes longer to travel in many parts of the City, not just downtown. The City is growing vertically with the development of many high-­‐rise offices and housing. Each of these issues affects the SFFD and their ability to respond in a timely manner to fire and medical emergencies. For example, ladders on SFFD fire trucks can only extend to the 6th story of a high rise. These problems will continue to intensify as more people occupy San Francisco.

Lack of Strategic Planning Strategic development is vital to SFFD in order for it to provide the City with a safety net. Without it, plans cannot be made to meet future needs created by changing demographics, catastrophic events, aging obsolete equipment, and staffing needs resulting from attrition. Population growth will impact SFFD’s ability to keep San Francisco safe. SFFD is remiss in not planning adequately to provide service in the event of a great natural disaster. It cannot ignore the reality that San Francisco is a City that sits near the San Andreas earthquake fault and has already suffered major natural disasters. Living in a time when a terrorist strike on San Francisco could be a reality rather than a movie, we asked SFFD personnel about the training they receive to respond to a disaster. Their responses indicated that such training is not provided, particularly for rank and file. Strategic planning would provide SFFD with necessary tools such as performance analysis, research, continuous quality improvement, risk management, and grant writing functions. Since at least 2002, the Budget and Legislative Analyst has recommended that the Department formally conduct strategic and organizational planning. The SF Fire Commission meets regularly with SFFD leadership to consider budget, personnel and other Department business. The Fire Commission should oversee the development and monitor the implementation of a strategic plan, including receiving regular performance reports from the Chief of Department with detailed action plans, including dates. San Francisco Fire Department 14 Findings F_1.1 SFFD continues to fail to meet EOA response time standards, resulting in lost revenue for the City. F_1.2 The current dynamic dispatch model fails to meet EMSA response times in the western neighborhoods of the City (Battalions 7, 8, 9 and 10) for several reasons, chief among them the long distance from Station 49 for re-­‐stocking an ambulance during a working shift and the long distance from hospitals, where ambulances tend to congregate in the natural course of their duty. F_1.3 A number of firehouses are without paramedic-­‐level service due to a shortage of firefighter/paramedics. The shortage is caused by insufficient cross training of personnel and insufficient training for paramedics. F_1.4 SFFD has reduced the mandatory minimum of four Rescue Captains to three, resulting in an increase in span of control from a recommended 10 ambulances per Rescue Captain to 20. F_1.5 SFFD has no formal strategic plan and is not creating such a plan in the near future; the Fire Commission seems a natural group to assist the Chief in this very important venture.