paramedics, in the department as a whole? >> no, we probably have 250. oh, 250, but about 140 are paramedic trained and that is a higher level of training and we were able to do skilled and perform skills in the field that are beyond the scope of the bulk of the employees in the fire department who are emts and so they have a lot of skills that they can perform and the basic life support, including being able to operate and use automatic external defibrillator and skills like starting a vein drug, and we have roughly 140, >> i think from my experience because i have not down a ambulance ride along, but i have with the departments, where there are paramedic firefighters on board and in all of those cases for some

reason it was mostly medical calls, and that was the person in every instance that had to deal with the situation. constantly, and i just see that it clearly from my perspective, it seems like it is something that we should begin to look at. and whether, and analyze, and determine whether or not that is a good route for the department to take. because, it definitely as you know, from your experience, i mean the need is definitely out there, and it may cost money on the front end, but could it be a real cost savings on the back end, and could it be, you know, a savings of efficiency, on the back end? to be able to address this with the department? >> right. >> and supervisor, breed, and i am going to ask him to step in for the next two items and he can certainly weigh in more appropriate than me, but as a certified emergency medical tech nifm i know that the fields that we are trained in are helpful in the field and we

have nine receiving hospitals unlike more rural areas, we are able to get to the scene within three to five minutes, and we pride ourselves on that on any typical ip day and we stabilize the patient in the field and do the best that we can to get them transported as quickly as possible to the hospital that we are going to be transporting them to and so having said that, currently and we are willing to explore, and the doctor can weigh in more since he is one of the emergency physicians, but we feel that, the bulk of the calls, that having an emt with the basic life support skills is adequate and having one or two trained members in the higher level or advanced life support works well and it is a team oriented approach and so you have one person that is the medical authority and the highest level of medical authority at the scene and all of a sudden they are calling the shots and they have the skill and they are orchestrating what all of the other people are doing in terms of getting the patient ready and prepared for transport and

so in many cases having the skill is sufficient, but we are happy to look at that and provide the statistics from other departments. >> and so the other issue, 2.5, restore the 911 provider committee that was mentioned by the budget and the legislative analyst and i thought that this was the most interesting because it included the private ambulance companies as well. and one of the things that i think, which is a really good recommendation, that they have tracker systems, within those particular ambulances, and i think that having the regular meetings with these kinds of committee kaos help to figure out a solution as to why we should move in this direction and hold them accountable in some capacity from the city's perspective and so i just wanted to get an understanding of your partial disagreement in that regard. >> and that is 2.5. >> and so i would probably defer, a believe, that was and that is not our matrix and so we have rob here that is... >> i am sorry. >> he is the deputy director.

>> okay. >> and just from my perspective, the san francisco fire department is a provider of the service, and like the other private entities and the local, emergency medical service, agencies, that... >> i will come back to that because i know that you got to get out of here, so i will come back to that and focus and get through to the section 3.1, which is continue to work with the department of emergency management and the department of public health to explore all thives to providing non-emergency services and setting other than emergency department or other hospital setting and report the budget, and legislative committee on these options at june 25th budget and finance committee meeting. >> okay, and supervisor breed, i would like to introduce our medical director, to address these issues and i would like to before bringing him up that let you know that i am in lock

step with barbara garcia regarding advocacy for making sure that when we do respond that we try to do the best that we can in terms of the proper resources and all. so some of the people that we are responding to do not require use of the 911 system or the hospitals but rather the other sources and the doctor can talk about that. >> i will say that is where my concern is, because in listening to the calls, and hearing where they are located, and hearing the challenges and seeing them physically, i just, the ability to be able to transport someone for emergency basis, we know is extremely important. and so, the plan that you implemented in the past in the department when it was funded the ability to actually have people out there, on the streets, to effectively address those issues, seems like i don't have any numbers or data to demonstrate its effectiveness, but it seems like it is a better alternative than utilizing our limited

resources, with the ems service. so, that is really what i am trying to figure out. what we can do, because it does not seem like it is really expensive to implement, but it could be really effective. >> okay, thank you. >> thank you. >> good morning. chair breed and supervisors chiu and tang. so, with regard to the community paramedicine question, i wanted to say a couple of things with permission sort of off the bat. and the terminology of the para medicine is not one that is familiar with a lot of people and i actually think that it is preferable to refer to it as what it is and which is a practice of medicine and you know, we see ems as the gateway to the healthcare system and for a lot of our patients it is really the only way that she enter face with the medical care, to me it is the idea of shifting emergency traditionally considered emergency out of hospital care,

to the majority of what we do is not emergency care, looking for alternative treatments that do not involve bringing the patients into the care system if they do not require it. and this is something that i think that we as a city should be very proud, we have been, ground-breakers and we have been pioneers in this area, and supervisor breed and you mentioned that some of the early efforts of the home team within the san francisco fire department, and these are really seen as national models and it is something that is being explored again at the national and the state level, and however, one of the subnative components of our partial disagreement to this particular recommendation has to do with the level of state regulation. so, currently, within the california state ems agency, and california health and safety codes, paramedics are really permitted to render care and emergency circumstances and

only permitted to transport patients to acute care hospitals. this is something that the state is looking at altering in addition to expanding the skillful practice to allow for programs like this but it is really only considered on a pilot program basis. and the other thing that i think that it makes sort of common sense to people that none of these programs were designed to prevent care and we are not trying to prevent access and calls but we are really looking for better alternatives for people within our healthcare system other than entering into the 911 system and the emergency departments but in order to do that, these other alternatives have to exist and there needs to be other compelling ways that people can get help other than being transported to an emergency department. >> and so in order to do that. >> that is helpful. >> that is really what we are looking for and what i would say is that this as a fire department we are actively collaborating with the dem and the department of public health in looking and creating these programs to undertake this and it is? ing that we can only do in the limitations of the national and the state scope of practice.

>> okay, thank you. >> okay. >> the chief also asked me to mention something about the cross training issue. you know, we have a lot of different levels of providers at different areas and one of the things that we are trying to do is look at rendering the right level of care at the right time, and you know, particularly for things like cardiac arrest, one of the most time sensitive issues, the biggest interventions about, initiating cpr and using the defibrillators are basically the life support and the by stand aerer level intervention and so one of the pushes that i recommend is for the city to expand its efforts in the community training on both cpr, and recognition of cardiac arrest. >> okay, thank you. >> do you have any questions? >> okay. okay, and i want to, and is someone here from the department of emergency

management? >> hello. >> hello. >> i am rob and i am the deputy director of the department of emergency management and i over see the department. >> can you speak into the microphone? >> better? >> yes. are you, i was not aware that the department of emergency management was available to present, but did you want to make a few comments. certainly, i can make just an overview of the fact that we generally agree with the majority of the report there are very few things that we have any kind of a comment on at all. we do believe that the city should move forward with getting the fire department the resources to it with the 80 percent obligation and in the capacity, the ems agency for the city and county of san francisco. and our purview is looking at the system as a whole and putting up the regulations and the policies and the medical prod kol and making sure that

they all work together including the public and the private and the hospitals the fire department is one big operational component and with their meeting the obligation of 80 percent that helps you insure, that we will maintain the exclusivety which keeps the system stable, if they do not, as the chief mentioned we are at risk of the state coming in, and not just reevaluating, but frankly saying that we no longer are eligible for exclusivety under the law that we established it and which will leave us with some options of being an open market where anybody with come and provide service, and we will have to distribute the calls equally. or having to do a competitive process to reestablish exclusivety and neither of which are very advantageous for the city at this time. so we do support the idea of the fire department getting the resources necessary to meet the obligations under the exclusivety agreement with the state. >> i guess, that the question that i have for your department is there does not seem to be

the san francisco ambulances, and the san francisco fire department ambulances have been or have the vehicle locater devices. >> yes. >> and from my understanding, there is a lack of efficiency in terms of the 911 dispatch center because it is not required of private ambulance companies? >> correct. >> and so, legislatively, is there a proposal from the department to actually make that change? so that the system is more efficient because it is a recommendation on the table. >> it is, this is where it gets, it gets a little complicated because if we start to make too many requirements we run in the scope and manner and the way that we establish it back in 1980, and it goes all the way back to how we operated in 19980, we can't change the manner of scope and delivery and maintain exclusivety under what is called grandfathering in state law, and because we did not do

it then, if we start to impose the requirements on the privates now and start to require that they have a certain presence in the 911 system, and we run the risk of creating this prab for us where we run afoul and scope and manner and lose exclusivety and so what the plan has been, and is, is that once we have a commitment from the city, that they are going to support the resources necessary to meet the 80 percent obligation, to reconvene the 911 provider group, and to start to hammer through the details and we have had many discussions with the privates about putting avls into the ambulances, and it is quite complicated actually because they have to be able to turn them on and turn them off and come into the system and come out of our system because they are also available for their own work. so, it is a matter of how do we do this? and work with the complications and how do we pay for it? and now it is something that i have no problem considering this a cost of doing business, you know, if the private ambulances want to be part of the 911 system and i don't have a problem of saying that it is

a cost of doing business and a policy issue and making it a requirement going forward with some lead time so that they can prokur the equipment, the risk that we run, though that if we pick a financial burden too great on the private providers and they change and we change the scope and manner and we run the risk of losing it because we don't have the same number of providers and we don't have the same providers and so reestablishing exclusivety and getting it reworded in 2012 was actually a very lengthy process that took a lot of negotiating and making the state understand the uniqueness of san francisco. and so, we are in an interesting position with that. and so while we support it, we want to be able to do it in a way that does not burden the private provider much and so it makes it well, so that it will be a return on their investment and i am confident that we can find a way to do that and maybe we can find the grant money to assist them, but until we do that, i don't want to come out and commit that it is going to

happen. and the other thing that we can look at and we are looking at is working with the other division of the department, and the emergency communications, and looking at the over all process of dispatch and working with them and the fire department to say how do we dispatch and what are the practice and how can we improve the efficiencies on the front end and that was not a recommendation but it is something that is ongoing. >> okay. >> and can you give me a potential time line of when this could potentially get to that point, because it sounds like we are looking at waiting until the numbers increase to at least 80 percent, to meet the obligation in the eoa and for the committee would even be considered to reconvene? >> no, no, no okay. >> the city is committing to the resources and then it makes sense to bring or it makes sense for the committing so it make sense to reconvene the group and we were in limbo for the past year because we were waiting on honestly and waiting on a plan for how the fire

department is going to build to meet this capability and that plan never came forward. and so, until we had that, and we had a time line, and it did not make sense to continue meeting and so we went on hyatus and now that we have a commitment and the board seems to support it and you mentioned it and the mayor's office and we will reconvene that group and work immediately and it is not just about getting to the 80 percent, it is those changes and the things that we can do now to help to improve the over all efficiency and the over all system as a whole and so we will actually start meeting the summer is my guess. >> okay, and can you stay focused on coming to the board with proposals for. >> absolutely. >> for the als system and the private company ambulances. >> anywhere there is a legislative fix needed i will be happy to bring it. i appreciate it. >> okay. >> we have tom o'connor is here and i am not certain from the local 798, i thought that i saw

him walk in, did you have any comments? i know that you just walked in the door? >> not yet. >> i saw danny here earlier and he might have left. >> good to go? >> okay. colleagues, are there any other questions on the table for anyone involved? is there anything else that you would like to add based on the comments heard? >> okay. >> well this has been very enlightning. clearly, this is what government is all about. looking at the issue, providing the data, asking the hard questions, putting the hard facts on the table. and making the right decisions with how we spend our money in the city to address it. i want to thank everyone again for bringing this information forward, it was definitely a difficult conversation to have. but, as far as i am concerned, of course, we know that lives are at stake here and we want to make sure that we are providing adequate resources to the department in order to

basically save lives, which is what they are good at. and with this system and with the way things have been, i am going to be paying very close attention to this issue. and hopefully, we will be able to allocate the appropriate resources for the coming fiscal year, no, it is not the amount requested by the department but it is a step in the right direction, and looking forward to feedback when those new ambulances are out on the streets, what is happening with the department, it will be helpful that not only the board, is notified but we are able to communicate with the public, so that they are confident that things are moving forward in an efficient way, thank you for being at the hearing, colleagues are there any other questions or comments? >> seeing none, we are going to open this up for public comment. and are there any members of the public who would like to make public comment? >> seeing none, public comment is closed. >> okay. do we have a motion to file

this item to the call of the chair? >> so moved. >> thank you. >> without objection, this item. >> do you want this filed or continued. >> continued to the call of the chair. >> is there a motion to continue this item to the call of the chair? >> without objection, this item is continued to the call of the chair, thank you all for coming today. >> madam clerk, could you you call items number 1 through 31 as one item. >> they are memos of understanding between the city and the various unions. >> okay. >> hello, good morning, supervisors and i think that it is still morning. and through the chair, mr. president, supervisor tang, and supervisor breed, i am martin grand and the relation's director for the city and county of san francisco.

and i am here today to proudly present 31 individual pieces of legislation, 31 contracts, amendments and or ordinates, we have 34 mous in the city and we renegotiated and amended every single one except for two related to the police and two related to our city's doctor and dentist and so we think that we have a new record. >> what you see this, and embodied in these agreements, are a three-year contract. which, in which all of those 31 contracts are proud in, in time. and we believe that these are fair and sustain able contracts fair to the employees and the city. the three-year deal preserves general equity between bargaining units, and the wage package and the economic items in the contracts line up very well with each other.

there are a couple of anomalies due mostly to the items that went into the arbitration, but by and large the labor feels that the process was fair and that the results are fair. the single biggest issue in these negotiations was of course, wages. as you know, prior to the raises given in this current fiscal year, employees went five years without a raise, coming out of the financial crisis of 2008. in addition to not receiving wages, employees also gave back in concessions either in the form of furloughs or delayed raises that were negotiated previously. every single one of the city's unions gave back and i am talking about the ones on the city side of the leger, meaning the non-mta side, the dhr does not directly negotiate the

transit operators contract, although we are assisting in trying to bring that contract in before june 30th, pursuant to the charter. however, i would like to point out that the transit operators or the one, and only group whose leadership chose not to reopen and give back in the form of wage concessions when the city was going through the worst of its budget times. and the mta transit operators are also interestingly the only labor group not to have or pay the 7 and a half percent contribution toward their own pensions and in this round of bargaining the last couple of groups that had some small portion left to be the city pick up went to full contribution status and we think that is very important, in addition to the furloughs and the wage referrals the period after 2008, the city also worked closely with our labor partners to overhaul the city's pension system, and the

city's retiree, health investing and benefit system. >> both measures resulted in employees, in the vast majority of employees contributing something towards additionally towards the pension obligations and also start to paying into the retiree trust fund and so as we entered into these negotiations, we certainly had some pent up demand and we tried to reconcile what the expectations were with the realities of having a healthy city budget but not a limitless one and so we believe that we reached a very fair agreement, the details of the wage package are as follows, effective october of this coming of 2014, the 3 percent general increase, and effective on october 2015, three, and one quarter percent, and then in the third year, of our three year deal, a wage increase which is based largely

on how or what the rate of inflation is and so if we continued to be in good times it will be at the 3.25 percent, or if we are or if the economy were to turn downward, 2.14 percent. and so we believe that this is, again, it is a fair and sustain able package for both the city and the employees. and of course, the labor negotiations are never just about one issue. the agreement that you see before you, are the product of literally thousands of hours of negotiations and at least that much time spent behind the scenes frankly by both parties without analyzing best practices and where the city stands in the labor market these are the other public jurisdictions to evaluate the wage and premium proposals and so it represents a lot of work and i would like to thank publicly my incredible staff, who performed just admirablely and i hate to single out anyone and i would like to thank our

compensation steven and our employee relations manager emily for really stepping up and helping to manage this process as well as lucy who kept us going in the right direction. and so i also need of course, to point out mickey cal han the director of hr and her dedication and her expertise in this process and she is amazing and we work closely with the team. in terms of the mou, one is paperless pay, and currently, the and for decade wes have used a very wasteful system to make sure that folks get a paycheck or a pay advice, or a pay stub, if you will and now on every other week on payday, every department sends a person to the ppsd building and they file up and they grab a briefcase with it and with the checks and they take it back and they drive back to the

departments and somebody walks around and gets every person their paycheck and it is incredibly time consuming and wasteful both environmentally and in productivity and now under the program that we negotiated we will be able to rely on direct deposit for our by and large for the transmission of the moneys but also for or to a bank card if someone chooses not to have a bank account and that, and the pay advices and the pay stubs will be made available, in an on-line system and so we are very happy that we are going to join this 21st century in this regard. likewise, the control, and now, that was largely an initiative of the controller's office and this second one is also an initiative of the controller's office and that is, to make sure that we are paying the rank and file workers who approved and come pension torrey time off or cto when that banks grows and that person promotes or transferred to another department that will

be a trigger to paying that out. and so that we pay the employees current rate rather than waiting decades until the wages grow, and due to the promotion and the regular cost of living increases and so we think that is also a very good government piece and you will also find two firefighters contracts and these contracts are excuse me, they are reflect very much the economics of a agreement reached with the police officers union in which, they are lower start rates for recruits and very modest cost of living increases in the next three years and so we are very happy to present these fire contracts because, with these lower start rates, we are able to afford to start some strong series of recruit classes which will, as you know, keep the san francisco safer and allow the police and the fire departments to bring in the new talent, that is always needed.

and so, again, in conclusion, these are agreements that are representing thousands of hours, of hard work and they contain far too many provisions to go through in any great detail and i believe that you have the materials that will help you to do that and if you have any questions i will be happy to answer them. >> thank you. supervisor tang? >> i don't have a question, i did have a chance to look over all of our summary sheets and i want to thank you you and your team for all of your work and even when we think about all of the contracts that you had to negotiate this year it was a huge headache and so really thank you so much for all of your work and i know that all parties had to come to an agreement, for the best of our city, and so, again, just wanted to express my gratitude. >> thank you very much. >> and i want to express my surprise that you reached an agreement in such a timely manner, before we were... so thank you and your team for your hard work on this and we really appreciate it. colleagues? are there any questions?

>> no. >> any motions on the table? >> to make a motion to on ford. >> you need to take the public comment. >> i apologize, are there any members of the public who would like to make the public comment at this time? >> seeing none, public comment is closed. >> colleagues, are there a motion to move these items forward with positive recommendations? >> so moved. >> as the committee reports? >> committee reports? >> yes. >> okay. so motion to move item 1 through 31 that is the committee report to the full board of supervisors. >> yes, with recommendations. >> yes, thank you. >> without objection, without objection, the item moves forward, thank you again. >> madam clerk, could you please call. we are just going all over the

place today 34. >> item 34,resolution authorizing the mayor's office of housing and community development to submit an application to the california department of housing and community development for funding under the calhome program; the execution of a standard agreement, if selected for such funding, and any amendments thereto; and any related documents necessary to participate in the calhome program. >> okay, is there someone from the mayor's office of housing that is presenting today? >> good morning supervisors i am the director of the home management and the below market rates at the mayor's office of development and this is simply interesting your permission to apply for cal home funding which we have done for the last, i believe, five years. the cal home funding that we used 1.5 million and we are requesting to provide down payment assistance to our below market rate, home buyer purchasers. and if there is no fiscal impact to a city, it would allow us to provide 25 loans to,