A Report of the 2003-2004 Civil Grand Jury For the City and County of San Francisco The Merger of Emergency Medical*

Recommendations 11

• R1
  The SFFD and the DPH should establish specific criteria for measuring the success of the merger and for determining when it is complete.
• R2
  There should be stronger medical oversight of the SFFD Emergency Medical Services (EMS).
• R3
  SFFD leadership should define and communicate the values of the Department to ensure that EMS is at least on a par with fire suppression.
• R4
  Resource allocation should reflect the shift in workload from fire suppression to EMS. The Mayor, Board of Supervisors and Fire Commission should direct and support the Chief to make the necessary resource allocation changes.
• R5
  SFFD needs to take immediate action to address the shortage of firefighter/paramedics through recruitment, retention and cross training.
• R6
  The Department should provide comprehensive leadership and command training for all officers prior to their assumption of command. Periodic training should emphasize professionalism, responsibility and accountability and be given on a regular, ongoing basis. Training should include conflict resolution and team building. REQUIRED RESPONSE: Fire Chief – 60 Days VII. PROMOTIONS AND TEMPORARY OFFICER APPOINTMENTS
• R7
  SFFD should provide better management training for all officers. It should hold officers accountable for carrying out their supervisory duties.
• R8
  The Mayor should investigate why promotional examinations have not been given in SFFD.
• R9
  The Mayor should investigate why the Civil Service Commission implemented a certification rule favored by neither management nor labor; in effect, the new rule makes everyone who takes the examination eligible for promotion.
• R10
  SFFD needs to determine the extent of all on-duty alcohol consumption and drug abuse problems and should institute policies and procedures to deal with the problem effectively. There must be no tolerance for on-duty substance abuse.
• R11
  The Mayor should initiate a comprehensive, in-depth review of SFFD by outside professionals, similar to those conducted in Chicago and Boston. GLOSSARY Acting Officer - An officer or other member designated by Department order to perform duties at the next higher level of authority. An acting officer is paid at the higher level. ALS - Advanced Life Support. Persons trained in ALS can provide high-level emergency medical service. This includes the ability to start intravenous lines, administer medications, place endotracheal tubes (artificial airways that pass through the larynx), provide advanced cardiac monitoring, and apply manual defibrillation. ALS engine – An engine staffed with an officer, a driver (firefighter), one firefighter-EMT and a firefighter/paramedic. An ALS engine is equipped with a locked drug box containing medications needed in providing ALS care. Twenty-one of the City's 42 fire stations are equipped with ALS engines. Ambulance - A vehicle equipped to assess, treat and transport medical patients. Also known as Medic Units, they carry some firefighting equipment to provide medical and rescue support. The SFFD has 19 such units that are staffed by one firefighter/paramedic and one firefighter/EMT. The SFFD also staffs one or two ambulances per day with two paramedics. These ambulances provide ALS treatment and medical transport and carry less fire suppression equipment than Medic Units. BLS - Basic Life Support. Persons trained in BLS can provide Cardio-Pulmonary Resuscitation (CPR), basic first aid and patient transport, and can use an external defibrillator. DPH – Department of Public Health. EMS – Emergency Medical Services. EMT - Emergency Medical Technician. A person trained and certified in BLS. SFFD requires that all new firefighters must have EMT-1 licensure. Currently, 74% of SFFD firefighters are EMT-1 certified. Emergency Medical Response Times – The San Francisco Emergency Medical Services Agency of the DPH has performance standards governing the maximum allowable elapsed time, from call to arrival of the first responder to medical emergencies. The SFFD responds to two types of calls, Code 2 and Code 3. Code 2 calls are non-life threatening; Code 3 calls are those that are life threatening. The SFFD measures 3 responses to Code 3 calls: • Responders capable of performing BLS and defibrillation. Response time is 5 minutes. • Responders capable of performing ALS. Response time is 10 minutes. • Responders capable of patient transport. Response time is 12 minutes. Engine – A fire suppression apparatus staffed by an officer and three firefighters and equipped with a pump, hose and a water supply. Each of the 42 fire stations in San Francisco has an engine. Firefighter – A member trained in fire suppression. Firefighter-EMT – A member trained in fire suppression and BLS. Firefighter-Paramedic – A member trained in fire suppression who is also a licensed paramedic capable of delivering ALS emergency medical care as well as BLS. Heavy Rescue Squad - Staffed by an officer, a driver (firefighter) and two firefighter EMTs, the Department's two rescue squads are first responders on medical calls. The Rescue Trucks are specially equipped with infrared camera, Jaws of Life and scuba gear, as well as medical equipment and defibrillators. Rescue squad members are trained in scuba, surf, hazardous materials, cliff, tunnel and confined space rescue. Like Work Like Pay - A short-term acting officer assignment, usually for a day at a time. The pay is at the higher rate for time worked only. Medic Unit - A staff of either two firefighter/paramedics or one firefighter/paramedic and one firefighter-EMT: medic units provide ALS treatment and transport of ALS and BLS patients suffering in medical emergencies. Medic units also carry firefighting equipment and can provide medical and rescue support at fires and other emergencies. The SFFD has 19 such units. The term "ambulance" is used in this report to mean Medic Unit. Member – Officers and other personnel of the SFFD. MOU - Memorandum of Understanding between the City and County of San Francisco and San Francisco Firefighters Union, Local 798, IAFF, AFL-CIO. Provisional Officer - A temporary officer who is a step closer to permanent status than an Acting Officer. The member is appointed by the Chief for up to 3 years or more with approval of the Human Resources Director. A physical examination is required for a provisional officer appointment. Provisional officers are paid at the higher level when on duty and on vacation or sick leave. A provisional officer who retires will receive retirement benefits based on the higher salary. Truck - Called "hook and ladder" by laymen, trucks are staffed with an officer (lieutenant or captain), one driver firefighter, one tiller firefighter, one firefighter-EMT and one firefighter. Trucks carry ladders and other equipment and are used to provide ladder access, rescue and ventilation. Technical definitions derived from SFFD data and the City and County of San Francisco Office of the Controller's report, "A Review of the San Francisco Fire-EMS System, April 28, 2004. OVERVIEW The San Francisco Fire Department (SFFD) consists of a diverse group of brave men and women, the majority of whom are dedicated to protecting the lives and property of the citizens of San Francisco. They provide protection from fire and natural disasters, provide life saving emergency medical services and prevent fires. The leaders as well as the rank and file of the Department treated the Civil Grand Jury courteously and helpfully. Our hope is that this report will result in the elimination of the problems that are currently keeping the Department from achieving its potential. The main focus of this Civil Grand Jury investigation is the status of Emergency Medical Services (EMS) that merged with SFFD in 1997. This primary objective led us to focus on eight key areas: