>> the city of san francisco sfgtv meeting of the government audit and oversight committe occurring june 11, 2014, will begin shortly. >> >> the city of san francisco sfgtv meeting of the government audit and oversight committe occurring june 12, 2014, will begin shortly. >>

>> the committee clerk, is miller and i would like to thank sfgov tv and madam clerk are there any announcements? >> please be sure to silence all cell phones, items today will be on the june 24th board of supervisors agenda unless

otherwise stated. >> today we have a few scheduling conflict, so we will be calling things out of order. could you call number 32 >>hearing on the budget and legislative analyst's performance audit of the fire department. >> campbell will be presenting on this. >> good morning... amanda was the manager and she has a brief powerpoint and we are available with any questions that you may have. >> okay. >> good morning supervisors, in response to a finding, and the budget and legislative analyst procedure audit of the fire department, they conducted the

audit with the narrow focus on the allocation to the resources to the emergency medical services at the fire department our analysis resulted in three major finding areas, staffing operational inefficiency and alternative to ems since 1997 the san francisco fire department has provided emergency responses to two types of calls in 911 and emergency medical services and suppression, and as this table shows a number of calls for medical services exceeds the number of calls for suppression, in 2013, 77 percent of all calls. from 1991 to 2008, the city maintained an area for area of responses in san francisco this is a designation that is granted by the state ems

authority, which restricts the number of providers to enable a predictable response through a central dispatch system, they enabled it in 2012, and enabled the fire amount to respond to a minimum of 80 percent of ambulance responses. in san francisco, the fire department is not the only ambulance provider, for 911 medical calls. although, currently two other providers, those are king american and amr that provide ambulance response for advanced calls as shown on this table here, the percentage of the fire department ambulance responses has declined since 2007. in 2013, the fire department's response was 73 percent of the total market, which is below the eoa requirement established by the state of 80 percent.

and in order to determine the staffing level needed to increase the fire department market share, audit team compiled since months of data from 2013 to calculate the demand at every interval of the day, between 6:30 a.m. and 6:30 p.m. on average, the fire department needs three more ambulance shifts in order to increase the number of responses to meet the 80 percent minimum requirement. these three ambulance shifts would require 16 additional ems positions and those have been included in the mayor's fiscal year, 14/15 budget. while our analysis indicates that the three ambulance shifts would be sufficient, to increase the fire department's market share to the 80 percent requirement, we did identify

other staffing inefficiencies that we recommend the department review, in order to further improve its ems response. those include increasing over time for sick leave in ems, currently when ambulances are staffed by two ems employees, it is one of those employees calls in sick, currently, that partner is assigned to administrative duties at station 49 and that ambulance which was schedule to be in service is not sent out in service and we recommend that the department look at increasing over time allocations in order to insure that all of the ambulances schedule are able to get out in service for the day. in addition logistically at station 49, currently ambulances are stocked and cleaned by the ems employees. we believe this is not the most efficient use of this highly skilled labor force.

we know that other jurisdictions employ civilian staff to do that logical support work, and we encourage the department to consider expanding the use of their store keepers at station 49, to provide that service. and sfienally, in terms of supervision, given the increase in medical call volume, there is a need for greater oversight, particularly in the fact that the ems supervision has declined and a reduction in the number of h43 section chiefs and rescue captains and we believe that the department should consider increasing those numbers to improve supervision of emergency medical services. and in addition to staffing, there were other operational inefficiencies that we identified, and the first round

of the, aging ambulance fleet, they indicate that the use of a life span in san francisco for an ambulance is approximately 10 years, and it is given the city's topography and the medical call volume. failure to replace, these ambulances in a timely manner, results in a high number of ambulances that are called out of service for repairs, and this reduces further reduces the city's ability to meet at the 80 percent threshold, we have been told that typically there are eight ambulances that are taken out of the service on any given day for repairs. the city has approved since the fiscal year 2012, the replacement of 16 ambulances in the department. to date, none of those have been purchased. we recognize that the department move forward with those purchases urgently and i am mri the vehicle replacement plan of approximately 5

ambulances per year. we also identified some other areas for increasing system wide coordination of ems service delivery. specifically, given that the exclusive operating area was reinstated in 2012, we recommend that the city implement a system wide deployment plan, and we convene it is 911 provider committee. and these are, we believe, useful opportunities for the city and the private ambulance providers to work together to manage changing service needs and to insure that they are able to provide the most effective patient care. we also recommend, >> can you explain and i know that it was detailed in the report, but please explain what the 911 provider committee is and what it consists of and

what they have done in the past. >> the provider committee was sort of established in the short term, i believe that it was established in 2011, and it was established to, again, bring together all of the various 911 emergency providers, that care for san francisco residents. and it was in place, i think, for about a year, and the purpose was like i said to just insure that there is an opportunity for those various entities to talk about their ability to participate in the market, and the changing market needs. to make sure that we have sufficient coverage for medical needs in the city. it is our understanding that the committee stopped the meeting about a year ago because there was ongoing uncertainty about whether or not the fire department was

going to need that 80 percent and what the city's commitment to that is. >> thank you. >> and the final thing that we identified in terms of system wide coordination is the automated vehicle locater system which is the effort that the city began but it is not in full implementation yet. and this is a project that is to install, basically gps devices and all ambulances. so, in order to expedite, and auto mate, ambulance dispatch. currently the private ambulance providers do not use the avl devices in their vehicles and this requires manual dispatch and assignment of those cars which simply creates inefficiencies and furthermore, the city having invested in avl itself is not really getting the most from its investment and so we encourage, the department to evaluate ways to fully implement avl in

coordination with the department of emergency management. while the scope of this audit was really focused on the analysis of ems resources, in our review, we identified a few other areas outside of the scope, the latest to staffing and deployment that we believe warrant attention from the department as well. first, we found that the department is currently in violation of the city's administrative code in two ways. the administrative code requires that the department maintains four static ambulances at all times and what that means is that four of the ambulances at least, four of the ambulances will be stationed at the fire houses. and currently, the department has all of its ambulances dynamickly deployed out of station 49 and secondly, as the administrative code requires that the city maintains four field rescue captains, again,

because of the role that station 49 has come to play and dynamic deployment, one of those four field rescue captains is permanently stationed at station 49 and so as it is not functioning as a field rescue captain. so the department is in violation of that as well and we believe that they should review those issues. and the other area of staffing that we recommend the department evaluate is cross training of new uniform employees. we did find as we looked at ems service delivery in other jurisdictions that there are jurisdictions who have merged the services of the ems and suppression more effectively and one of the ways that they have been able to do that is by requiring that all uniform employees be cross trained and we are simply recommending that the fire department reevaluate

this model >> the final thing that we looked at in our analysis was alternatives models to delivering ems care. it is clear from research that there is a disproportionate amount of calls coming into the 911 system for medical care from what our call high users and from specific communities in the city. data shows that 25 percent of calls that come in are coming in from the tender loin and south of market areas, new patients are suffering from substance abuse and mental health issues that are not best treated by ems or hospital emergency rooms, the fire department in 2004 launched the nation's first community para medicine program and this is an effort that partnered one paramedic and one public health

clinic an and it was highly regarded as a success and we recommend that the department reconsider establishing a similar program like that. and in addition the department of public health, is operating for a similar type of programs and through its sobering sensor and the hot team and we recommend that the fire department work closely with the department of public health, in those efforts, and work to coordinate better to provide better patient care. and that is the summary of our findings and we are happy to answer any questions and we would like to thank those the staff at the fire department and the department of emergency management for all of their assistance. >> thank you. >> colleagues, are there any questions? >> and thank you so much to the budget and legislative analyst office for getting this report done in a timely manner, i know that we wanted it before the budget season was at its pique and so the whole point was to

insure that we had the information that we needed in order to provide additional resources to the department to address some of these issues and so thank you for getting it done in a timely manner. and i do apologize that the report was only released to the public yesterday. and ultimately, we had to move forward with this hearing because it is a funding conversation. before i bring the chief up, i definitely want to make some comments, in january of 20, on january 23rd, we had held a hearing at this committee with supervisor cohen to evaluate the budget and the legislative analyst report, previously regarding the recruitment, hiring and over time usage and a medical emergency medical services with the san francisco fire department. and that was not the report primary focus, there was very alarming revelations about the emergency system, first the department is clearly out of compliance with its own eoa

agreement with the state to respond to 80 percent of the emergency medical calls in san francisco, in fact, it is well below that mark and there are serious concerns about the ambulance availability in the city over all and specifically the medic to follow calls, which is a term used to describe the calls to the 911 department, which has no, and it means that they have no ambulance to send at that time and it happens about 2,475 times in the first ten months of 2013, that is about eight times per day. these medic to follow calls have increased over 500 percent since 2008 and is clearly outlined in the budget and legislative analyst report that we have before us. and if these calls are happening eight times day on average, what happens in the event of an emergency and earthquake or a terrorist attack or anything. i was dismayed to think that in a city with $8 billion budget that we have a problem of this magnitude. the fire department is out of

compliance with its state agreement and routinely has no ambulances to send when someone calls, so, i ask the budget and legislative analyst to produce follow up reports specifically about the fire department's emergency medical services. and over the past few months, they have tried to shed a lot of attention on this issue and i worked with the department to understand specifically what they need in terms of new ambulances and new medics. and i have conveyed my concerns directly to the mayor and worked with him and his budget team to secure new funding for this fiscal year's budget. and i have tried to help this issue gain a lot of support from the public. unfortunately just yesterday, the chronicle published the kind of story we have feared, that of a serious injured young child whose parents had to wait, 13 minutes for an ambulance to arrive. medical services make-up about 77 percent of the department's emergency calls. and yet only 23 percent of the

department's staffing. paramedics not only don't work out of the fire houses they often tell me they feel very uncomfortable and unwelcomed. funding has been allocated for new ambulances but they have not been purchased. this is a real problem that i am hoping we can address today. millions are spent on new fire engine and fire boats while the ambulances have taken out of service for repair because they are so passed their usable life, if there is a sense that ems is not part of the fire department or it is not important, it needs to change. the mayor has provided funding for six new medics and three new ambulances in this year's budget. i want to thank him and his office for working with the fire department to make this possible. but, we clearly have a lot of work to do as this report lays out. and at this time, i want to invite chief joanne white up to the podium to provide feedback on the report from the san francisco fire department.

thank you good morning, chair breed, and supervisors tang chiu, san francisco fire department, and first of all supervisor breed we would like to acknowledge you for your advocacy on shining a light on some of the challenges that we have in the san francisco fire department. much appreciated. and i know that you have some particular insights having served on our fire commission for a few years before you became supervisor. and so we appreciate your work and again your advocacy, and we also appreciate the work of the budget analyst, who after doing their audit on staffing, and recruitment, in august, took a closer look at our ems staffing and if i could make the quick comments to what you just commented on supervisor breed, both the mission of our san francisco fire department is a duel mission and its fire-based ems which is you see in many urban departments across the country, i can assure you as

the chief. both the mission for ems and fire is equally valued in our department as it should be. and the mission is to protect lives and property, and be it through the fire prevention and fire suppression and education and the provision for prehospital care through our emergency medical services. and there is a high, percentage of medical calls that we respond to but one of the misnomer it does not mean that an ambulance arrives at the scene, there are many resources that are applied, typically there are six to ten responding to a medical call. and so it is not just an ambulance that will show up but it will also be members working on the fire engine and fire trucks and that is how we provide that mission. regarding specifically to the audit, we are pleased and it is timely as you said it is the budget season that we have been advocating for years for

additional funding for our ems division. and this was a little problematic though, because as amanda explained accurately the city has an exclusive operating area and that area was called into question in 2008, and never once did the san francisco fire department believe that we should have lost the speed of the operating area because there was a decision at the state level that the provision for ems changed in terms of its manner and scope and we did not believe that it did. if anything it expanded, when we began to provide service into the procidio and the treasure island but the manner and scope never changed. so with a lot of collaboration and partnership, we worked with the city department and the department of public health and 98 and we were able to continue to lobby and ask for a reevaluation, and we were able to have the exclusive operating

area restored, for a 4-year period of time there was such uncertainty that the budget came into question as to how we were going to budget during this up certain or an open period of time and so we are in the rebuilding phase, and the eoa called for an 80 percent threshold for transport business our department and we dropped to a low of 67 and now we are up to 73 percent but we believe firmly that without additional investments we will not be able to meet that threshold and we are out of compliance and we have been out of compliance since that has been restored in 2012, the good news is that we are marching forward in a positive way finally, and we had asked in this budget cycle for a ten million dollar investment specifically in to our ems division, and it was for equipment, staffing, and it looked like you have a question? >> supervisor tang? >> i didn't mean to interrupt. >> i just wanted to know, and i think that it is great that you are taking steps to try to

address the requirements under the state for the eoa i am just wondering what does happen if we are out of compliance with the 80 percent requirement? >> so the state restored the exclusive operating area, which means that we need to get back up to that 80 percent. and technically we are out of compliance and so that has been our concern, all along since it was restored, we worked closely with the mayor's budget office as well as the department of emergency management and the deputy director is here today, rob and he has done a lot of work with us and so we are out of compliance with the state and technically could say that you are out of compliance and we want to reevaluate this and i am an optimistic person and i feel better now that i have learned that this budget season, our analysis showed that we needed to invest about ten million dollars, and it does not look like we will be receiving the ten million dollars and we are getting three million dollars and i know that i spoke to supervisor breed about it the other day and so i am saying that it is a step in the right direction, we will be getting 16 new