Fire and Life Saving Depts*

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 medical responses into their existing fire response models. Response to 2021-2022 Grand Jury Report August 23, 2022 The City of Newport Beach disagrees wholly with Finding F1 as it pertains to Newport Response: Beach. The Newport Beach Fire Department (NBFD) has integrated emergency medical services since its inception in 1911. For over 110 years, the primary mission of the department has been to preserve life and property. Because of Newport Beach's topography and coastal waters with high surf, the City of Newport Beach (City) has always needed to provide rescue and lifesaving services for its residents and visitors. The NBFD is comprised of firefighters and ocean lifeguards who have emergency medical technician (EMT) certifications and paramedics who are licensed emergency medical services (EMS) providers by the State of California and the County of Orange. As reported in the City's 2011-2012 Grand Jury response, the NBFD was presented with its first mechanical resuscitation device that was used on one of the first fire apparatus in 1913. In September 1927, the department's first rescue squad was placed into service for the sole purpose of providing life-saving resuscitation in the case of drowning, smoke inhalation, or other medical emergencies. In 1937, the sign in front of the NBFD headquarters read "Fire and Life Saving Depts."1 It was not until the late 1960s and the early 1970s that pre-hospital emergency medical services became more formalized. This was recognized in a document published by the National Academy of Sciences (NAS) in 1966 entitled, "Accidental Death and Disability: The Neglected Diseases of Modern Society." The NAS Report (1966) concluded that accidental injury was the "neglected epidemic of modern society" and "the nation's most important environmental health problem." Importantly, The NAS Report (1966),

response to medical calls and do not compromise the quality of medical care. The City of Newport Beach disagrees partially with the Finding F3 as it pertains to Newport Response: Beach. Within the fire service, ambulances respond to medical calls, fire rescues, and traffic collisions, and, if needed, transportation of patients to a hospital. The City partially agrees with the portion of Finding F3 stating, "ambulances ... are often the most appropriate response to medical calls." First, embedded in this finding is the implicit recognition that ambulances and fire agency emergency response vehicles are appropriate resources to be deployed when a 911 request for medical assistance is received. This response capability is achieved by careful consideration, assessment, and planning that ensures that fire engines are strategically placed throughout the jurisdictional area, thereby safeguarding that the engine typically arrives on scene first. The geographical area which a fire station primarily serves is known as its "first-in." Moreover, because fire department officers and personnel are very familiar with their first-in areas (e.g., the local traffic patterns, street configurations, and other factors that impede a timely response), a fire engine captain knows the fastest way to reach an emergency incident location regardless of whether it is a house fire or call for medical assistance. This first-in response of the engine's three crew members allows them to initiate prompt medical aid to the patient when indicated. If there is a critical patient or patient requiring additional stabilizing measures, fire engine crew members will accompany the patient in the ambulance to the hospital. This level of response ensures that the quality of immediate medical care is not compromised. When experiencing a medical emergency, the patient's immediate care is a top priority for all involved from those at the scene, to the dispatcher, to the responding agency and its personnel. Even with the existing tiered dispatching through Metro Net, there are incidents that need to be upgraded for additional support of personnel and/or equipment. The unpredictability of a dynamic emergency scene and the unknown level of care a patient may require, warrants more than the response of two personnel in an ambulance or squad vehicle. The Grand Jury Report states, "OCEMS has established a minimum requirement that one paramedic and one EMT respond to EMS calls."10 However, per OCEMS Agency Policy/Procedure, "a prospective EMT-P service provider agency shall" commit "to provide ALS service meeting OCEMS staffing requirements for each unit. (2 EMT-Ps per ALS unit; 1 EMT-P per paramedic assessment unit.)"11 Further, the OCEMS Policy/Procedures defines an ALS unit as, "an emergency vehicle, such as a van, engine, company, truck company, squad, helicopter or other emergency vehicle specially equipped and staffed."12 The assumption of responding to calls with a "minimum" requirement put forth by OCEMS should not be 10 2021-2022 Orange County Grand Jury, "Where's the Fire?", . Orange County EMS Agency Policy/Procedure, Policy #700 EMT-P Service Provider Criteria, Section III, B, 5. Orange County EMS Agency Policy/Procedure, #090, Definitions. Response to 2021-2022 Grand Jury Report August 23, 2022 misconstrued to represent the actual dynamic needs of providing the most appropriate and quality medical care to the public The National Fire Protection Association (NFPA), the agency that provides standards for emergency response and fire protection, recommends a minimum response of four personnel to provide for patient care and safety and the safety of first responders. An incident runs efficiently and effectively when an appropriate number of personnel are on scene, functioning as a high-performance team, to help assess, treat, and move the patient toward definitive care. While on scene, even with four to five personnel to assist, there can be untold obstacles for a patient that is injured, immobile, trapped, or in distress. Having adequate personnel and equipment as part of the initial response prevents unnecessary delays in patient treatment and transport. Additionally, safety is a factor for patients and responders particularly when "entering an unknown situation that could be unpredictable and EMTs are taught priorities in a specific order: 1) personal safety, 2) safety of their partners or colleagues, and 3) care of the patient. Any threat to one prevents moving forward to the next."14 Thus, responses to busy highways, drinking establishments, and even private residences can suddenly turn dangerous. As noted above in the Response to Finding F1, fire departments have a long history of responding to medical emergencies because they have strategically placed fire stations with highly trained personnel, they are equipped to manage a multitude of assignments, and can provide the most comprehensive service. Many agencies currently implement fire-based ambulances to assess, treat, and transport patients from emergency scenes to hospitals while maintaining the ability to respond to numerous other types of incidents. Removing fire engines and trucks from EMS-related responses could potentially create an environment that has the potential to double current staffing and equipment needs while reducing service levels to the community and delay in responding and compromise quality patient care. The Grand Jury Report further states that sending a fire engine to medical calls is creating "unnecessary wear and tear on the streets" and that replacing an engine with "paramedic squad vehicles would save the expense of wear and tear, maintenance, equipment, and operating costs." As to wear and tear on streets, the Grand Jury Report focused on the 5,000 average annual EMS and fire calls in the city of Laguna Woods. The assumption that this volume of trips by fire apparatus is tearing up roadway infrastructure is unfounded. According to the Laguna Woods General Plan, 15 the highest average daily traffic (ADT) is 45,000 on Moulton Parkway with the lowest ADT of nearly 6,000 on Santa Maria Avenue. Of the streets listed in the General Plan the average ADTs is 37,140, which equates to an average annual traffic volume of 13,556,100 in Laguna Woods. Thus, the 5,000 annual trips by fire apparatus are only 0.037 of the annual traffic volume on the streets of Laguna Woods. While it is true that the cost to purchase a new fire engine is more than an ambulance, they serve different purposes, and one could not replace the other. For the NBFD, the wear and tear and maintenance needs of ambulances far exceed that of a fire engine. Because of weight, high usage/mileage and more, ambulances have a shorter life expectancy and are replaced more frequently than an engine. Per the Newport Beach City Council Policy Manual, 16 ambulances are scheduled for replacement every eight years 13 National Fire Protection Association, Codes & Standards, NFPA 1710, 2020. National Library of Medicine, EMS Scene Safety, Klein and Tadi, May 8, 2022. City of Laguna Woods, Laguna Woods General Plan, Circulation Element, 2002. City of Newport Beach, City Council Policy Manual, F-9 City Vehicle Replacement Guidelines, 2016. Response to 2021-2022 Grand Jury Report August 23, 2022 and fire engines are replaced every 13 years. Thus, 1.6 ambulances are purchased for every engine. The Grand Jury's hypothesis of cost savings is unsubstantiated. The Newport Beach Fire Department continually reviews the changing needs of the community, and new technology and equipment that becomes available. Fire agencies within Orange County, and across the country, continually work to innovate response models focused on serving the evolving needs of communities while not compromising fire protection or life-saving abilities. Adjustments for responding to these changes are ongoing; however, fire engines will continue to be a part of the response. Therefore, while we agree that ambulances are often the most appropriate response to medical calls, eliminating the additional response of an engine (staffed with a paramedic and 2 EMT's) or truck (staffed with EMT's) will compromise the quality of medical care, efficiency, and safely

There has been a breakdown of communication and trust between OCEMS and Orange County Fire Chiefs. Response: The City of Newport Beach partially agrees with Finding F4 as it pertains to Newport Beach. The Orange County Fire Chiefs Association (OCFCA) and NBFD seek collaboration with our Regulatory EMS partners in providing optimal EMS services to our community. At the request of OCFCA, an EMS advisory committee was formed over 2 years ago to facilitate communications and collaboration with Orange County EMS (OCEMS). One of the goals of the advisory committee is collaborating on the implementation of policies to ensure OCEMS intent is clearly understood, and policies are written clearly, with no ambiguity, prior to being carried out by personnel. Frustrations understandably arose when the advisory group was not utilized by OCEMS for the purposes with which it was created for. OCFCA has had a decades long effective and strong partnership with OCEMS in putting policies, related to the delivery of optimal medical services, into practice in the field, however those relationships have been strained the last 4 years or so. This relationship, when based on mutual trust, respect, open communication, collaboration and with reasonable expectations, results in straightforward implementation of OCEMS medical protocols, as it had been done consistently over the past decades. Despite our sometimes-conflicting viewpoints, the NBFD and OCFCA remains willing and engaged to continually improve the partnership with OCEMS through collaboration and open communication to ensure optimal provision of EMS services in Orange County.

Over-deployment of firefighters for medical calls contributes to the current climate of forced hiring and firefighter fatigue. The City of Newport Beach disagrees wholly with Finding F5 as it pertains to Newport Response: Beach. The NBFD's staffing model ensures the right-sized, highly trained, and prepared personnel respond to each unique call for medical aid. This staffing model ensures that enough fire personnel, consisting of a minimum of two paramedics and three EMT's, and the necessary equipment are deployed and available. Fire personnel are trained to respond effectively, efficiently, and promptly, to a myriad of high risk, all hazard conditions. Having multi-function personnel on scene allows for the safe management of scene Response to 2021-2022 Grand Jury Report August 23, 2022 hazards, bystanders, victims, and personnel. Often, patients are non-ambulatory, and care may involve rescue, extrication, or complicated maneuvering that requires assistance from all responding personnel. Providing the optimum level of service to the community, regardless of the nature or the circumstances surrounding the emergency call for service has always been the goal of fire agencies. Firefighter EMT's and firefighter paramedics are not "over deployed" on medical calls, and it is not a factor of forced hiring or firefighter fatigue. Force hiring is a mechanism to ensure minimum daily staffing levels are met. Daily staffing levels are critical in providing a 24/7/365 timely response capability within the Newport Beach community as well as providing mutual aid throughout the county and state. Force hiring occurs when a vacant position is not filled voluntarily. Vacancies can occur when personnel are on approved leave, get sick or injured, are deployed on an incident strike team or overhead assignment, or when there are open positions waiting for the recruitment and hiring process to be completed. Force hiring does not occur because of deployments to medical aids. The current climate of forced hiring and fatigue is largely due to multiple contributing factors. The Pandemic Emergency is still in effect and is continuing to affect first responders and healthcare personnel. The surge periods significantly impacted firefighter personnel over the last two years, while also responding to and fighting some of the largest wildfires on record for California. Additionally, the demand for emergency services is increasing. Some contributing factors include increased population, over-utilization of the 911 system, emergency departments being used in place of a primary care doctor visits, decrease in preventative care strategies, delay in seeking care until a health issue becomes an emergency, and increases in trauma-related incidents, mental health and substance use disorders, as well as COVID-19 related health emergencies. During these times of system stress, force hires were required to maintain daily operational capabilities, with staffing levels at pre-pandemic levels, and services within our community, as well as the needs of the public throughout the County and the State. Conversely, during this period, many private ambulance companies faced challenges in maintaining daily service levels, experiencing significant decreases in staffing due to challenges related to the pandemic. These staffing challenges resulted in extended response times by private ambulance companies. The NBFD manages its EMS response system to ensure, within the scope of our available resources, that when a member of the public calls 911, they will receive rapid, optimal care from professionals. Therefore, we disagree wholly on the Grand Jury's hypothesis that forced hiring and firefighter fatigue are due to a perceived over-deployment of firefighters due to our EMS delivery model. 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 oversight. The City of Newport Beach partially agrees with Finding F9 as it pertains to Newport Response: Beach. Response to 2021-2022 Grand Jury Report August 23, 2022 The Grand Jury correctly observes that public ambulances are not automatically subject to certain regulatory inspections by OCEMS. However, this circumstance results not from the NBFD's actions, but from a legislative determination that public safety agencies are exempt from certain regulatory requirements applicable to private, commercial transportation companies. Thus, OCEMS has comprehensive private ambulance provider oversight, including policies on licensing, ambulance design, retention of state and county licensing records, and so forth. Nevertheless, the NBFD agrees that OCEMS should conduct inspections of ambulances to confirm that such units have the proper medications, supplies, and equipment as prescribed by OCEMSA Policies #325.00 Advanced Life Support (ALS) provider Minimum Inventory and #720.30, Section V-Ambulance Equipment. However, for public agencies, these medically related inspections are not for licensure or permitting purposes as they are for private companies, but for medical quality assurance purposes. Lastly, any associated Inspection related fees, if any, should be cost based. According to the OCEMS Agency Policy/Procedure, "OCEMS may inspect any ambulance vehicle operating in Orange County." Further, the "policy sets minimum acceptable standards, any exemptions for public providers allowed by law."17 The NBFD is a public provider of emergency services, prehospital medical care, and emergency transport. The NBFD follows the requirements placed on public agencies by OCEMS and the State of California, which has more stringent requirements. The NBFD agrees that OCEMS does not currently automatically inspect all publicly owned ambulances. GRAND JURY REPORT RECOMMENDATIONS