of a life threat with the transfer to the hospital many, many times it involves careful assessment of the detailed interviews a very extended building of trust and then a lot of coordination and communication with other entities that come up with a plan of care and conviction so this is an extended encounter and something that ems 6 is specifically adopted to do and allows our other 9-1-1 assets our engines and ambulance cruise to go back into certify and be very available for other services rather than performing this type of assessment we have a total of as i mentioned we average around 7 encounters per watch but ties about 13 in the busiest of days and a total of 6 r 4 hundred and 67 units you may

notice the unique client list is smaller that might seem puzzling but you'll see themselves 68 high users we've been - maybe the best way to put 2 involved in the care of people that depend on 9-1-1 a lot this is the people we gave me in we encounter each individual is a high number of encounters and the number is those extended evaluations are involved when we engage the high users when we can prevent or find a different solution than arbitrating to the hospital that is different and

in terms of the financial implication if you recall that a single transport every in our system is $1,700 charge that means there are around 60 avoided ambulance introverts to the new if any, that amounts to one hundred thousand dollars for the first charges and so certainly we have a lot to improve in the lives but this system is an indication of the type care as well workplace in mind, i will i'm going to turn it over to captain tang to give that a little bit more perspective on the cases. >> welcome captain. >> good morning, commissioners and my name is captain simon tang and case study one is a woman in her 40s a mother of

grown children she's been living in the city homeless for several years in 2015-2016 she's a top one percent patient high user of multiple city services it many means she used more than 99 percent of other folks she had a history of the alcohol abuse disorder and millennials and trauma we began graphing searching for her on the street to try to prevent the next 9-1-1 call one day one evening my colleague of the homelessness outreach team relocated her on a beverage with an empty bottle of red wipe she was passed out couldn't stand or talk that was getting discard it

was very cold she was wearing a shit if we didn't locate her we would have had a medical emergency what it took to get her to stay in detox not easy then we got her into treatment there were many relawyers up and at this point, i want to point out the graph to you on that graph in the vertical access is a number of contact by 9-1-1 contacts or ems 6 outreach contact so the red line is a number of new any contacts that she had by two week integrals over 2016 so as you can see on this particular slide here that big red spike she called 9-1-18

times if you look at carefully that ems 6 had 3 engagement with her on that sdwral and over time i think this graph shows we effectively drove down her 9-1-1 usage as our number of engagements increased one day in june after she was sober so for many weeks in a unit she her family back east or in the mid west had a family tragedy she told us she wanted to be with her family so on her own she called the doctor and bought a bus ticket and left we stay in contact with her she's got difficult moments relapsed but the last time we spoke she was sober and happy.

>> good morning commissioner i'm kathy and go over a case study two and three so case study 2 is a location of the collaboration with the sober to get a gentleman into supportive of housing this is a gentleman who had beat previous addictions but on the streets called the services and began to outreach him aggressively and into the sober center he went there and agreed to case management we coordinated a entry into medical detox he was disconnected from services we were able to find him a program he was discharged from detox and went into the streets and relapsed and sobering to secure the

appointments we cooperated a resubway into the treatment program in the meantime the sobering case manager submitted the case he got the housing the supportive of housing daily contact with the case manager and keeps in touch with him and - case study number 3, is a gentleman that we helped to re50i7b9 with his family the number was 69 in 2016 this gentleman had two lengthy stays where he was not generating calls and must not calls one day during an 8 hour period 4 contacts i realized there was a significant impairment problem we called the hospital and talked with the social workers and the nurse they reached

cynthia pollock in transfer to the medical hospital with insurance and after a long lengthy process with insurance dph and patient we decided to transfer him to another insurance plan so the readmission he has mel deintoxicated and allowed to go home after the family at dph the decision to an assistant home a social working and ems accompanied him across the country where he is now. >> let me say you're the one that k0i79d him to reunite with his family; correct? >> correct. >> i'd like to thank. >> (clapping.) >> i want to add that last thing that april described for the

last 3 years were the top one hundred percent of the patients this slide shows not able examples where people lives have been changed and this colombia second from the left and red those are the number of new any calls forces 2016 prior to my attention and the column in blue - it's shared with so many others blue in these cases ems 6 has been influential in the outcome so i want to point out that if you add all the red numbers adds up to 6 hundred and 429-1-1 calls

in 2016 if you add up the blue numbers and x palate the blue numbers are 2016 and up to now if you extrapolate them for 4 quarters of 2017 it comes out to a fraction of what of those happening i'll point out some examples case 3, 19, 9-1-1 calls this was a male in his 60s with schizophrenia and called 9-1-1 but never stayed they hospital long we asked we budget committee searched his assets for a higher degree of oversight they did and since then in july zero 9-1-1 calls case no. 1038, 9-1-1 calls a

homeless meddle person he is mel frail we began to stir him to the center repeatedly until it become habit every night he'll could go to the sobering center since december 3rd a 3 month period on there 3 times and extrapolate that is 12 far lower than 38 and finally example will be case 1248, 9-1-1 calls this is a person with seer alcohol had that is mentally illness and resistant to treatment we shepherded him through detox and treatment as of two weeks he's housed in the first 8 months of

2016 he called 9-1-148 times and the previous 8 months 5 times now the finally case study we'll be remiss if we only shows certain case but we noticed it the case that gives you the most difficulty often involve people with severe mentally illness a male in his 50s schizophrenia and with a disorder formally housed but evicted from direct assess housing pr his case manager booked a hotel at the start of every month after a week goes by he's on the streets this individual calls 9-1-1 says he's hunger when i arrive on

scene he says simon i want to sandwich if at the didn't get one he walks into traffic and uses the hospital for a shelter and leaving paramedics and outreach workers and nurses to clean up after him he's well known in pe s but police holds are listed one minutes and his suicidal so what do we do if you look at the graph as you can see we're unable to manage his 9-1-1 usage we can't get on top of that curving next steps i'll leave that to doctor yeah. >> so thank you both very much and i wanted to i hope this is illustrates some of the great work that paramedic captains tang and bassett and others our

partners have been undertaking i think when i see that last case in particular that makes me release there are a lot of struggles and challenges i want to say that in terms of engaging our highest users within the system i feel like the design of ems 6 has shown that is an acceptable design in fact 90 percent of ems 6 have encountered people that saved that high user super user excuse me - having more than 10 encounters with 9-1-1 in a 12 month period we look at the overall statistics we see there among other things we gave me less than half of them; right? there is a request why are people depending on 9-1-1 so much not having the services met whether this is a matter of

deployment or circumstances that is difficult to say i have suspicions i think that that can drive the programs of the future but suffice is it to say in this system 101 to grow and that designs is very, very busy engaging the clients i think we need to engage from that stand point the design is successful i wanted to note that we had a lot of concerns initially and trying to decide and see the assets of vulnerable for that the clients 71 percent of the people that engaged were super users recorded homelessness in 2016 i think the housing and security is significant part of the challenge for the people that we're trying to help so this slide may be difficult to see some of the numbers but the upper box illustrates what i

think we're all aware of the system is growing we are seeing annual growth rates in the overall 9-1-1 calls and relative increase in the super users that says that growth level is stable excuse me - continuing the lower box, however, shows the number transports that each super user in 2016 we the actual number of transport was stable and decreased despite the number of users in the system grew and the other system grew it is difficult to conclude very much from an overall broad number i'll point out that is one of the specific metrics this was

designed to address the number of ambulance - the amount of ambulance utilitytion what is been stable so with that are the contributing things to allow the stabilization as mentioned multiple times a multi departmental and complex source problem that are a lot of questions answered but in the gross of metrics we have the system impacts and finally one of the most existing things that developed over the last 12 months was i'll say was the development of the california states pilot projects in the entry of the pilot progress announce with the san

francisco sobering center the fire department has become california ems authority pilot project number 13 we join a number of projects throughout the state that are addressing novel ways to provide care i think we'll be able to better address the needs of the population so the specific projects involved are community paramedics and owl paramedics in the system improving patient care by instead of bringing patient to a hospital selects a number of patients who are stable and have evidence of alcohol intoxicate to bring them to the sober center instead thank you for the partners who were able to make that happen both the department of emergency management and department of health and the california ems authority and of note in january we as a department completed a

paramedic core course and graduated 10 paramedics that joined in the first paramedics of state that's an enormous accomplishment in the system for the department so next steps forward given what i've shown you already about the impact of operations and what you've heard about the challenges and the successes of the operation we have our work cut out for us the need continues to the system and the team is intentionally out there we have been over the last year improving the data methane internal records system i'm happy with but can improve with other providers in the system as well as the hospital the more we share information and learn the 0 more we involve the partners that improves the patient care i mentioned the conditioned efforts with the project and the

last foe things i want to say has to do with with the additional resources that are important certainly is a continued need for complex case management in clients that have behavioral go health issues this is people that have behavioral issues and homelessness and medi-cal frailty are some of the most vulnerable people in the system although i'm pleased and hopeful i think the champ in the next 12 months will be being able to get our clients there and have the connections because behavioral health is the next big challenge as a team with that said i think we have continued need for coordination with law enforcement and our legal system there are some mechanisms and challenges a

client sees in connecticut servingship and a lot to gain with the agencies and overall direction i think the next layer on the program is an added amount of administration oversight analysis i think that is part that will help us find out what the smartest next moves are with that, i'd like to move to turn to a couple of our partners ask them with the commissions prediction permission to give their preservation. >> please do. >> can i ask doctor john brown to come up. >> welcome.

>> good morning, commissioners chief and staff members of fire department and guests and community paramedics i want to make 3 brief points to owl my support of the program i wanted to say first of all, that i'm excited about this practicing emergency medication for 34 years a medical director for 21 years i don't give in easily i'm excited about the program (laughter) icon test to that. >> this is one the fire department snatch i think moments and efforts for the city i ask you to think for a moment of the iconic festivity photograph that was taken care of a little boy that was a receiving from his home that was destroyed and receiving care i want you to think of the picture and the setting of that picture

that picture was taken in ems vehicle the ems system and the fire department specifically is in the lead in taking care of the marginalized people anywhere in the world but specifically in san francisco this is the fire departments outreach to the marginalized to the refuges to the immigrant to those in that needs who have dropped introduce the safety net of care and ems group is pumping that up and ems 6 in a unique and valuable way the second point i want to make in terms of participation 2, 3, 4 california ems community paramedic program the pilot program throughout the state we're one of 13 sites the most recent newcomers but bring in expertise and the specific assets to the serving center in operation over 10 years but those are 13 of the ems

systems leading the state we join that leadership group the program will continue for another year at which point the ems authority in conjunction with the usf have come up with a standard of practice for paramedics throughout the state with the endorsement of the community medicine we're participated in the development, if you will, the imprint that will serve us well had medication is a standard practice for paramedics in the state the third point community medication and the fire department with specific has been a training program that the fire department how did collaborated with amazing partners with the department of health and the sobering and the city college of san francisco, and with other folks from the department of health and zuckerberg san francisco general and the kaiser facilities to put

on the one and 50 hour plus training bright men and women to take on the job i was fortunate to be part of commissioner moore group i can verify i've seen all of those young people do they're testing their practical testing in scenarios across the board with things they'll encounter and did an outstanding job i have confidence it not inclusively we hope the team will join us in the care sites to them and eventually all the paramedics will benefit from this training that the fire department hosted and future it ration to expand the service that is a fantastic service and different routes to go in the last is the future of the

paramedics we're now returning to taking practical from the 9-1-1 system to the sobering center as in the past with a robust evaluation and now studying that to document the results i think the next step will be in conjunction with the behavioral health colleagues the ability to screen and assess the placates directly from the 9-1-1 because patience that have problems are not at the emergency depended part is they tried to do that note the best environment for the services they need that will be a next phase if 9 program i think another phase shortly therefore, taylor will be the stabilization of patients that are frail and discharged from the hospital and so forth have community paramedics help them placed in the xhufrnt and not

bound back and forth through the emergency system for care and eventually the fourth phased the involvement of the hospital with general and improving the technology the physicians and being with community paramedics opponent and on scene will do a lot more to help the patient maintain they're what they're doing at their home their domicile or help them in corrective behavior or resources to help in the sense of the paramedic bind the best of the paramedic level of emergency care a social worker and heartache programs in the community and mentally illness care to help the patients in acute crisis and evaluation of their substantive use and evaluation an amazing program i appreciate the partners in our community of san francisco and i

will design, engineering, and construction assistance services to aid in the program thank you. >> thank you, john - recognition people mike and d m is a fantastic partner and helping to improve our be care system thank you, mike and the d e m and mr. shapiro who also serves with ems 6 on a basis and one the graduates of our 10 community paramedic community excuse me - academy and also 0 brandon brandon are you back there thank you for attending i'm going to turn it over to jim. >> good morning my name is jim the director for

the san francisco homelessness outreach team that is a program of the department of homelessness and supportive housing i want to start off by personally thanking you chief joanne hayes-white sorry get to background and the san francisco fire department for this wonderful partnership it is very successful i'm a huge fan of what with ems 6 does the ems 6 hot partnering in my opinion is extremely valuable to san francisco the clients they serve in my opinion are the most vulnerable and disfranchised citizens of the city i think that was demonstrated by your presentation thank you with the assistance the controller's office the department of homelessness and

supportive of housing doing an assessment and analysis of whole sf hot program including staffing, programming and all the special projects with the ems 6 program and i want you to know with you have my personal commitment as the director of hot team to give you our ongoing support of this program i think that as a cost effective program for the city of san francisco it is extremely important and wanted to see that continued thank you. >> thank you very much. >> thank you very much so with that, i believe we have to take my time.

>> - these services may not be available after service hours so body camera in the 9-1-1 system we have to get connective services and if they're not available it takes more coordination that is one piece to do additional improvements on that side so simon. >> i'll say we hit the ground running there is voicemails and e-mails all we return to the case managers and follow-up on the previous night and trying to figure out what we're going to do with the preying people needs and found out the availability and weekly i'll try to do the

outreach calls during the normal business hours and towards the evening run into people that are hunger and do love of the street outreach. >> i think that like april said our work what we do during parts of day differs if we need to meet with the clinicians there is one time i can't say is busier than another. >> how do you interact with the project homeless connect. >> it's a great resource we have been present and you know attempted to be part of the plaintiff many times i'll say which afternoon available ems 6 is part of a that program so we're going to - with that so

we have this wonderful ability that our hot team partners and us can split up on projects homelessness connect we have a lot of the individuals that we are working with and not only during project homeless connect but all days of the work jason and jones chin will come in earlier and take the g a and decreases appointments everything so projection homeless connect they're busy. >> so i'd like to point you think that is housing in the city without g a but something there so it is invaluable for getting this appointment and figure that out and getting it done at that end of it. >> very good can someone please talk about the sobering center

what it is? how cases are handled how long it takes for someone to go through the process of everything that the sobering center has to offer and things of that nature. >> san francisco sobering center is an enormous fantastic program i demographic want to sell them short by a cast of a summary but the sobering center is a unique resource here in the city that cares for people who are specifically intoxicated with alcohol and this is something that was started i know doctor brown says 13 or 14 years ago to address that population so the intact staffed by a nurse and the unit assistant twenty-four hours a day and housed next to hospital respite

and a now is an ems designations so people who are screened have not 9-1-1 system deemed to be intoxicated and moot a long and careful checklist can be taken to the sobering center to see sobering services ooishl under the care of a nurse and assistant and then the best part they've connected with the sobering services and provided social work in my opinion is a better way than usually happens in the hospital designed to care for strokes and acute trauma i want to connect the department for the sobering center that is a bit of a cap summary. >> thank you, dr. brown did you have something to add from the interest. >> when it went into effect in 2004, it was supported by the

hospital council and the city and the san francisco emergency association helped to get it started showing the benefits and safety we use it a little bit for non-trorpts and the numbers from the 9-1-1 system the patient have slowly decreased we thought that would be about ben between 20 and 40 patients within the twenty-four hour and now 2 hundred patient run but now up to two hundred and 60 or 80 it's increased the one limitation we're trying to work on that and fully engaged to develop a search capacity so on nights of week and year there are more intoxicated patient in the system and having the sobering center to see have more

space staffing is i believe and we should have them testify the issue of spaces but have done a marvelous job and now all of the trainees in the system some of the emt and all the paramedics come to city college and the university of san francisco come to the sobering center and spent a lot of time with the nurses to get a better experience of assessing those patient and what their needs are and doctor pointed out a vital part is screening them they're not there all the time but pretty much come through everyday for the patient intoxication program and so forth not a sobering from one instance of intoxication patient needed need to be helped to stabilize them in the community and this is something we're trying to improve it.

>> i would assume around the holidays the christmas holiday you'll see a spike people are feeling the absence of their families. >> that's correct that's correct you think i know another time that is big is new years eve so we have appreciate spikes from the previous hearing supervisors we're analyzing data and trend to try to pro 86 prepare better to have more capacity for various things that is one of those things the event with well known in the city you know about the holiday and certainly i think everyone can understand that but do you mention the particular days of week what days of the week are showing spiked. >> like traditionally it is weekend times when individuals don't have plans the following

day they can over inindulge but other patterns hidden has to do with with the individual that are chronic people that have alcohol addiction disorder might be geared towards receiving money i hesitate to talk about the specific days but we can teeth out from the data we have for 10 years when the days are you know the service center motives their staffing so they're able to fully use all the space when they have the peaks. >> thank you so doctor yeah. is that the goal of ems 6 to try to reunite people with their families else were are in the country or to get them housed here. >> that's a great question we

undertake a strategy of you know whatever it takes to help people to get period of time better for many people that changing an environment to get into a more supportive area typically with family around makes the biggest difference but that is not a specific goal we don't in any way focus this is one the polk interventions that is available in the city there are different locals when people are relocated or reannounced with their families we are specific about the way that happens the criteria that he needs to be met with people agreeing and having a supportive environment to go to i hope that addresses a little bit of that question specifically we undertake any means necessary but it is did not on the individual circumstances. >> the city has money available

to give to people or to i should say purchase tickets to return to the a placement perhaps they grew up in; is that correct. >> i don't believe so this is not a program we administer though the ems 6. >> i know there are more money is available i wanted to find out from you if it is still available and particularly if this is an increase increase in the money available. >> the department of homelessness. >> introduce yourselves. >> jim the department of homelessness and supportive of housing has a program called homeward bound staffed by workers that assess a clients ability to relocate norms do they have to someone to go to fame and friends, etc. to set up the services in their hometown

where ever we can and provide them with a bus ticket back home as a small subsidy so for food, etc. so the city supports that this is one of the resources that the hot team uses. >> do you have any figures as to how many people avail themselves to that service. >> i don't have them but can get them to you i'll have sam dodge in the communications department write down our name and is your e-mail we'll get it e-mail for you. >> thank you. >> great. >> okay. so let's see i had a couple of other questions i can hold them until the commissioners speak okay. thank you. >> thank you commissioner covington and chief joanne hayes-white i want to say

something. >> thank you commissioner president cleaveland and others are in line to speak thank you to all of you involved and ems of you know the concept of the program that now a year in running a initiate and creative i believe a model program for the country if not doing business as usual we've identified a sector of the population that are the most vulnerable poise of the population and we found a better way to serve throw in partnership and collaboration and our city services the program will not be a success not because of me but the people that believe in the program and there are actually doing the work in the program every single day i want to acknowledge doctor yeah. for being an advocate and the two heroes that started from day one it takes a certain is

type of person the members are dedicated to serve those are a long 120 hours their emotional and complex cases we're dealing with every single day and this is 7 days a week that is the two captains and some relief paramedics that have served when they need a break once in a while this is not easy work and really not with the fire department when you sign up this is not enlightened years ago that was basically as doctor yeah appointed that was great work being done but a rapid hospital assessment and trovrpt and properly tropt people from doctor brown a physician in addition to his day job that is initiate and can't say enough about your dedication and

examination and also 10 of our members went through the paramedic training and we're proud of them for step forward to do that it is all about the team we have a great team in the fire department but joined by the department of health and doctor brown has been advising us and he and guiding us sometimes critiquing us not always agreeing that is what makes a great program and the department of emergency management we have the directors here and also wanted - we are wear a uniform we get more acknowledgment but for jim and the colleague in the back the day to day work jason the day to day work your nature not to be acknowledged you're sitting in the back of the room i'd like rather have you in the fronted of room you've dedicated your

lives wouldn't have been possible without the great leadership and partnership with the sf hospital so thank you very much that's all i pretty much wanted to say i'm proud of the program and as you can see from the figures it is really taking off i'll add to what draw yeah said in relation to our question commissioner covington that each case is unique so the goal of who housing is appropriate or reunification depends on the nature of the person their desires what their goals are so our goal will be to make sure that we can try to make their days and lives better whether this means unifying with the families that are support or housing in the city it is the result a complex because everyone is handle on a katz

basis so thank you very much for your support of the program. >> thank you chief for your kind words absolutely earned like to call on commissioner hardeman now. >> wow. thank you, mr. president and not to echo the words of commissioner covington or chief joanne hayes-white by the way, thank you very much for all you do and all the patient you have and i think this is the best thing about this thing a variety of folks a dozen have been trod and the captain simon and captain april and doctor yeah, and doctor brown is probably get to see where the resources will are going and hopefully, people will watch and learn about what is happening with the resources they've extended to the city and how difficult the job it, it is an example i was taking a

streetcar home off on 14 and with respect a storefront changing an ambulance pulled up i'm watching it they pull up and a guy standing in the doorway and public health this is a transit corridor the m and others iron there the l and there is buses so this person observing i'm not seeing this guy who when the went to the paramedics tried to shake him and talk with him, i recognized the guy i've been watching him for a number of years he said leave me alone. >> he said leave me alone i've been sleeping in the doorway for 20 years. >> he's alive and his drug of

use is alcohol there for 18 years so how do you deal with that i was up in alaska 2 1/2 years on a cruise and they were talking about touring how they have a severe panhandling problem and homeless problem some rich philanthropist put together a program flew anyone anywhere in the continental united states and eliminated the problem that is as you were saying commissioner yee-riley about it you send them away then - but. >> excuse me - ask commissioner hardeman i was not strongly for anyone to be sent away and a lot of people in

alaska have one way tickets out (laughter) so this wasn't that cold of a spot that was reasonable i won't say you were advocating but pushing it i was listening to pbs what is happening in ohio in the last 5 years home share win as tripled i wonder about states in san francisco everybody knows that doctors are prescribing oxycontin i saw it as trustee from the trustee in a medical plan and see it is absolutely bizarre the amount of oxycontin the doctors are prescribing they got off that and the other drug is marijuana 70 percent home

share win users started wiusers in his county one hundred times had to use drugs to bring heroin a.d. directed back to life we know the cost of that just the ambulance alone in san francisco $1,700.00 not talking about what happened to the person while in the hospital the resources that are going towards that is a national catastrophe this program as captain simon and captain april had the patience to help those the department line they're now having a program they're trying to treat a misdemeanors once you get the

drugs whatever kind of drugs you get a ticket and you're basically not supposed to be using it, it's resource unless your attended this counseling course now they don't know how much effect that will be but the person being interviewed is like doctor brown was claiming that all about consequences from the consequences are nothing that they'll take care of you again later in the day or tomorrow or next week there is no incentive so that's what they're working on in the bio one county to incentivize is people a reason why you should maybe the consequences are worse maybe

incarceration maybe not incarceration but dealing with that taking a few pieces of pie from society it is sad i commend you don't have the patience and the patients and he paramedics of ems showed with that fellow were amazing then they left them there he you know he was sleeping that's where he takes he's afternoon nap and had to leave him lesson l.n. it is legal to show he was functioning all right. so thank you very much and hope the public appreciate all you do and the direction of department heading to help folks maybe in the number one, concern people when they visit for sure i know when you go to hawaii i was there had two trips to hawaii in the laced

two years 15 days total supposedly the same homelessness problem same as the percentage wise in san francisco it is the hoist and never get pan handled or bother they walk but you don't ask for money try to stay out of your way and walk down with respect and i get panhandled by 3 people a day a point i hope they're not mean to people in honolulu tourism is an important part of our economy and people that overdosed or whatever on drugs or alcohol from bothering the public is

something i'd like to put more effort not by your department thank you. >> thank you commissioner hardeman. >> nakajo. >> thank you very much commissioner president cleaveland thank you very much doctor yeah for your presentation and captains all of the participant at some point doctor yeah. if the commissioners can get a hardcopy of your presentation, of course, i want to be able to digest absolute materials which is a lot i very much appreciated that you asked doctor brown to participate also jim wagner, and also acknowledging jason back there because that was real important for myself as part of commission to hear the update in terms of one year anniversary of the ems 6 clearing the question

the collaboration and point of view of you doctor brown and of the homeless corresponding center as well i give you respect in terms of work with the homeless outreach team probably one the toughest jobs in san francisco compared to the dedication we all have again not that one cares more than another there are students in the city that are supposed to be living with this you used the word complex misrepresent system of doctors and that's exactly what that is it goes without saying the support of this commission for the ems 6 and for the creation of this ems of being part of our department now being part of this commission for a number of years it takes great learning curve where the san francisco fire department does simple

folks with depression and there is prevention and the airport but there is also the medical services and that ems doctor brown in the 21 years of working together has greatly expanded so when we hear the dialogue i hear the dialogue of the amount of numbers out there that are part of this the terminology has changed a lot in the last 21 years a frequent yourselves is now a frequent users there is more existence in terms of clients we're talking about and part of that two was there was an overall goal and multiple goals one of the multiple goals was to get our ambulance services and our paramedics to address the frequent fliers and try to have a system we can get back into the system because the strain the frequent sflierz or flyers to the hospital and the 2, 3, 4

take was acquit obvious to a point when i've been on this commission it seems like this is one find things we report to the scene and castle with the client on the street and basically transport them to a hospital i'm going trying to less on the conveyer but the person is discharged we get the call and everybody knows each other and repeat the process the cost of the ambulance and the cost of time spent at the hospital and prominently in terms of our personnel is that the duty of the fire department within the ems absolutely but in terms of ems 6 the start to start the frequent fliers to provide services so we can lessen the

time and con sfrant on the ambulance so clearing it has done some of the major goals it that we're looking at part of peripheral goals coddling and case management and mentally illness services and behavioral are new terminologies in this fire department when the question was succeed in terms of what extent do we do the services your answer was i appreciate that answer as a medical physician trying to deal with the complies with problems whether that is a case study of an individual leaving the city so we don't have to deal with that but that person on the road to recovery and the assistance there are reasonable cases that ems has performed in fact, i

would vulnerable to say you've saved lives and resources having said that, what i was listening for we stabilize the ambulance usage i didn't hear the word decrease i didn't know whether or not we could do that but the stabilization is an important factor it said that is working and it says we're doing our job my question in my mind how much work in the captains doing the ems 6 on a 12-hour shift i'm grateful for the graduates in the last period of 10 more individuals that are part of system to do that but clearing we're opening the door or taking the responsibility that is maybe not traditional chief joanne hayes-white for the interpretation of services i'm a social worker i call is case

management and case management improves to a level the stability within the patients or the case management means the coddling is larger and larger and large to a point the coddling is so large i'm not sure if two individuals or staff can be able to accomplish that therefore the collaboration issue between the definitions of the hot center and the sober center and the navigation center is clearly in our minds and the commission we can't do it on our own to pick up the patient and take them to the hospital and leave them and go on our business might be part of revenue bond oversight committee i'm not going to use of word shortsighted but didn't improve the problem and mitigate the problem so in terms of san francisco we are now we're the fire department we deal with the responsibility but clearly we're integer an arena that helps

mentally illness and the collaboration of health department and some part in this narrative i have to remind myself we're the fire commission wellness the fire department and this terminology is of this discussion sounds like a hospital health department type of relationship we have to be involved and be involved all the way through what i'm hearing in the nafrgs is the numbers are enabling aincreasing and to a - lrnsz for recommendations or next steps that's what i'm interested in the sense of scenario of the city of san francisco i 17 what our department needs in order to accomplish that a question doctor yeah in ems 6

doctor brown are we in the initiative program like this model ems 6 with paramedic captains tied do the city resources that is that different from the models on the list we are the newest members of the state. >> this is growing as a national trend but definitely think that it around issues of sobering and particularly around the explosion and connection to other agencies and services we're doing a better job we certainly could move forward but a lot of places are looking to us as hiv as a leader in if area hope that answers your question. >> you know doctor yeah, i'm proud we are all proud of this department ethics commission and the leadership is another terminology that i liken an

association and innovation and leadership with the model so ems 6 is the model and the cities are looking at us in terms of that have this model needs to improve and have the evaluations that in terms of resources to look at the model but clearly we're the department fire department that needs to have this agenda item high on the priority list of the other collaborated departments i called for this update on the suggestion that the chief of a one year anniversary is totally appropriate you're still here captain which to your credit yeah, you look good i know a level of burn out again with the case of a society working was in that it is amazing that now we're dealing with perimeters of

mental health and this is a learning curve i fall back to the captains with the emt and personnel are aware with the various examples to call some kind of decisions in terms of the money on the transport to the hospital to again results at the hospital capriciously to ourselves the eliminations of some of the cases into identified on a high percentage of levels congratulations thank you. >> thank you very much for this comprehensive report and thank you very much for you collaboration departmentally wise i don't know what else will occur with that but doctor yeah, you have a comment. >> thank you for your questions for the trauma center i know that i wanted to say thank you to the commission and the chief you've seen this from

the idea to the design and i'm happy to be able to bring back some results on this but thank you very much it's been a really positive contribution i think the other thing i want to bring up captain bassett has a bunch of appointment i was hoping with the chiefs permission we can skews her. >> thank you, thank you very much captain. >> thank you, mr. president and mr. vice president thank you for your your questions or comments. >> commissioner covington has a few more comments. >> thank you, mr. president i was going going to wait till you closed the door rearrange my desk just a few more so you said there, there are 2000 plus encounters and a complex interview to develop a plan for the equals that you go

interact with can you talk about that the nature of the procedures in terms of questioning as well as about how long this takes certainly so it again, it is very client specific i think that you know that is wonderful with the partnership with the hot team their outreach specialists are used to engaging used to communication skills so being able to do that with them is really extremely helpful but you know. >> i guess doctor yeah. my question does that all took place in mostly in one day during that first encounter or over longer periods of time. >> absolutely not those are the data we ine encounter someone in a shelter in the

midst of a 9-1-1 call but weekly coordination meeting a case management meeting and then our team has organized case conferences around clients as needed so this is a attach of things for each of one conversation for some cases you've heard about maybe a half-dozen outside conversations and have been involved discussing the management for over a year for some of the people who have been known to the system prior to even ems 6 coming online so, yeah to answer your question the on scene the discussions can be long and commissioner can talk about the ground work does that answer your question? about - >> yes. it does but i can ask you other questions on a grand last year level a little bit

later thank you for that response. >> do you have any information as to the breakdown between men and women that are going through this process. >> that is a that's a good question we did a data poll i'll say for the highest users there are it tends to be a male predepends on but that is is there a breakdown in terms of age groups so just by looking at a person you'll not be able to discern hold they are within a 10 year range. >> it is interesting based on older data my colleagues eye i

and i published data the highest users are male in the 40ish i don't remember the range but tend to have in common alcohol use people that are older unfortunately, the voukt makes it difficult to exist as you, you i exist on the streets as younger people tend to have other support or just be somewhat more robust and can't engage our services. >> sow people in mid-life and if i had to characterize i'll say yes. >> okay. thank you. >> what is your definition of bailiff health. >> uh-huh that's a good question i think that i think that functionally from a stand point of ems program i think

when we encounter people if with behavioral and psychiatrist conditions interfering with their lives that's what i'll say i would kind of duo not that as a behavioral situation we have many people that have psychological and behavioral challenges in life and managed them well and outpatient and didn't require 9-1-1 services or did not present a challenge within air everyday lives of society threat the goal of what we see when people can't manage that that is what i'll clarify as as behavioral challenge. >> and how is ems book with law enforcement. >> you know i might actually i'm going to turn it over to captain payne that can explain. >> we don't interact very much sometimes, we ask for a location

of someone we're searching for speed cops, know the homelessness people they established a caring relationship and so they'll seek us to out for assessment but generally, we work individually. >> okay. i wanted to thank everyone very, very much for this very important work to the payne fund (laughter) always be with ripped e relied on and then to have an emergency room physician always available for consultation and this is wonderful and those people who are you know the foot soldiers of effort just magnificent -

one question what do you need to enhance the program which is probably one of the most initiative and helpful program informs over and over for the people on the streets what do you need. >> first of all, the commission and the department chief you've been extremely helpful making this happen i want to say that and there have been struggles i appreciate that continued support so specifically i'd like to see initial level of analysis and object to decide what the next steps are you can't give you an accurate request i feel i want to make sure the growth and

expansion is a smart one point to look at the resources the department can provide we can be smart about allocating additional resources that way there are a couple of things the commission specifically i'll endorse no way you can help to foster the relationships for the department and strengthen them is that would be helpful and at the students level i mentioned our pilot projects mr. starr the notion around the sobering center for those of you who don't know there is movement to the legislatively level to create this type of practice and standards throughout the state this is why our serving center and ems activities related are currently in a pilot program that's an expiration of a legislation change so i've had conversations with other you

know go physicians before brown and i are engaging with physicians involved in metropolitan cities in the state i think that we really need to take this to the home plate and say we'll actually make some permanent changes to allow this not to be a pilot status. >> do we receive state funding. >> no state funding involved i believe that the funding i should role that back the pilot program has from the healthcare function in terms of analysis but specific programs are not funded centrally in the state. >> thank you very much i'd like to thank jim wagner for the partnership that we have the fire department has with the team. >> thank you, commissioners we will continue to share

information. >> thank you very much. >> madam secretary. >> call the next item. >> item 5 chief of the departments report report from chief of dependent on current activities and events within the department since the fire commission meeting of february 22, 2015, including the budget academies and special event and outreach to other government agencies and the public and report from operations on overall fold operations including the greater alarm fires and zero fire that prevention and update on h clafrgdz. >> this is my report since the last meeting of february 22nd before getting into the items listed on the agenda i did want to notify you that officially although i know i spoke with

commissioner president cleaveland yesterday and commissioner vice-president nakajo and we sent out the e-mail but have made a collection for ems division chief i wanted to let you know that 18 very qualified applicant placed an interest in 3 position of which 7 were interviewed by myself the two deputies and the deputy director march corso and i'm proud to announce and provide an introduction starting in his new role as deputy chief on monday and that is andy. >> (clapping.) >> thank you chief good morning commissioners i'm andy the ems chief want to give you a little bit of background i've been an emt since 1995 in sacking a

paramedic since 1998 and worked in system world like sacramento an urban environment i came to dph in 1995 and came over to the fire department in 1997 and had several positions in the department not just working with the administration i've worked that qualify improvement and worked as a captain at the center and i was one of the paramedics that was assigned to design the rapid response system one of the stand out of the positions i held was the secretary for two years and did that as well and want to thank chief and thank you to the commissioners for the trust your placing in me and giving me the ems position i accept the responsibility and not lighting i look forward to work with you

the commissioner and in my new role and look forward to the future we'll build together thank you for your confidence and the chief for your support. >> welcome. >> thank you very much thank you very much and congratulations commissioner covington. >> oh. >> excuse me - any public comment on this item? i don't think so. >> the chiefs report. >> commissioner covington. >> the bulk of my report unless anyone has any specific questions. >> this is the appropriate time to give them a hardy welcome so i'm proud of you. >> we'll have plenty of questions later (laughter) pursue thank you, commissioners thank you. >> chief please continue. >> they let you off easy return to my report regarding the budget we're on track as we

continue for revenue and expenditures as you may know we've submitted the budget on the february 21st deadline with a letter commissioner president cleaveland and myself related to the budget i have a brief discussions with melissa on the fact we have ongoing budget submissions data and in april we'll be presenting in front of the the budget committee prior to the mayors submitting the mayor submits june 1st and two dates i believe the third week in june will be presenting in front of the budget & finance committee and responding to my comments related to our submittal initiation to the academies the one thing and 21 academy their 49 members we have in category and we are anticipating

graduation for all 45 on april 14th and that will be other 10:00 a.m. at reardon high school we're on track for april 24th and anticipate 54 members in that class will be 42 members off the list and 12 from station 49 at that point a blend of not just 12 h-2 level but a blend of giving opportunities to speak of the h-2 emt come pricing the 12 at this point we have made as of this week 34 conditional officers to the members mobbing up the 42 number and last week in addition to filling this class for future classes we sent out offer 200 and 20 backward niegsdz fulsome u, if you will,

for ios members to submit back information related to the driving records, employment records and sfoertd for our review to complete the one and 22 make up but for future academies so i'd like to acknowledge my staff and others who are here but will be leaving here it is a lot of work and captain sheila hunter will be running to the field and now in form role the captain related to the background and getting everything organized so - in relation to the events since february 22nd did wanted to let you know that i attended parks alliance event support the rec and park department on the evening of february 23rd

on february 24th we were proud to graduate 25 now members h-3 emts i appreciated the participation and wonderful comments as always by commissioner vice-president nakajo welcoming the new members to the department if you for representing the commission and i wanted to acknowledge because unless shows out of town she showed up our assessor-recorder carmen chu a big supporter and great supporter comments welcoming the members and representing the department and irish society with the grand marshall bill of the evening of february 24th february 25th assisted with open go die ceremony for the baseball league which flame has a part thought it is our departmental program we work in conjunction with the rec and park

department, the helm was transpired from a member who took over from a long time partner and now ricky the coordinator for it flame and hundreds and hundreds of children starting opening day the wloefrn cooperated on the 25th the first of march i attended a chamber of commerce breakfast called the city breakfast over 11 hope people sort of i know that commissioner president cleaveland was there at least talking about sort of trend in the city and the direction the city is going in i thought a lot of information was useful on march 2 was read aloud day i was at sunset elementary doing the read aloud day and the government and oversight hearing

that same day related to the ems response time and wanted to acknowledge by deputy director corso as well as olivia for presenting supervisor yee was in and out of the meeting he was the chair and supervisor peskin as supervisor president london breed we can provide if we i don't know if we have provided the presentation i think that helpful and i think that a couple of people seen it on tv it was reach progress nothing it perfect but remarkable progress since 2014 and not related to the fire department seen it through other city business indicated she said remarkable that 090 percent of time in this city with this traffic you're able to get an ambulance to the

code 3 emergency we'll provide you that an information very foe questions for the fire department we are there with the partners in the controller's office and they do their piece of presentation they're the entity that is tracking the data and we also had a presentation from here a little bit the director of d b m michael and the doctor was present to give a comprehensive presentation regarding the item that supervisor peskin had placed on the agenda so we also invited them to continue to join the working group we're meeting we recoordinated recently but all in all i know we met in february and more than the 90 percent we were on time in the timeframe the investment not ems was much

need but we can definitely see some of the benefits to the newer fleet two additional staffing to innovative like ems 6 wouldn't have been possible without the support of fire commission and last night that afternoon that was a busy day we acknowledged a number of retirees in retirement civil rights ceremony you know that everyone that attended appreciated that and that wouldn't have been possible without the commission secretary so thank you to moreen for that and finally that evening i thought at the multiple sclerosis hotel an academy award summer so for their hotel i'm always a big fan of the hotel workers in uniform the doorman or the housekeeping staff so they asked me to present it is a fun event

to acknowledge the urban subsections heroes in the hotels on the third ever march i attended larkin street i'm on the committee over 4 hundred people at the hotel for a worthy cause on march 4 i attended the san francisco firefighters prevention fundraiser and on the 6 of march i know that commissioner covington will want to probably add to what i'm going to say a personal friend but a life ceremony so for ms. eileen hernandez a 90-year-old woman that has done in her lifetime extraordinary things i know that commissioner hardeman

you were at the celebration on monday fought for workers rights and wage equality and for your consideration commissioner president cleaveland i recommend adjournment in her memory for all she's done and iconicly today is women's international day i know that commissioner covington will honor her because she was a personal friend. >> on the 7 of march attended the department head meetings yesterday regarding health and wellness and additional training for city employees on the obesi training and the st. patrick's day they'll be gathering on second and market and before i answer the questions the other thing i wanted to share i'm not

personally spoken not family just received news sad news that a member of our department who had an recently diagnosed with cancer passed away this morning and so i like you to acknowledge and the memory of amy that passed away in 0 morning i just received word after the meeting i'll personally reach out to his family but our office was go contacted and did want to acknowledge that as well. >> so two very good people lost in since the last meeting that concludes my remarks thank you chief any public comment on the chiefs report seeing none, public comment is closed. commissioners commissioner covington thank you very much mr.

president. >> i will hold off on my comments regarding ilene hernandez she was a lovely person so i'll go to the chiefs report and i just have a question regarding this information that was in our packets from the civil service commission detailing the policy on family and romantic relationships at work i would like information how it is rolled out within the department thank you. >> thank you. i've asked did experts good timing i said she could be dismissed. >> game-changer commissioner president cleaveland and commissioner and chief so since the department i've

changed the updated romantic policy we created a database and the departments human resources division and we've gotten actually great response and terms of compliance people reporting family and romantic remiss i relationship we'll get an e-mail and log every single report of such relationships so far we've not encountered any relationship that will require a management plan but if we do meaning if so it a direct inspiration whether family or romantic i'll definitely report it to chief joanne hayes-white and chief williams and we'll develop a management plan to roach the conflicts. >> so those are people who are saying oh, by the way, my

brother has been hired with the department that sort of thing. >> correct. >> so is they're going to be my additional information september out to people or any training in the academy regarding this matter. >> so i don't believe there will be any additional materials the new policy has been expanded sections how to report it is detailed and i'm happy to report that members are coming applying it has only been a few days that's you encouraging that's a grandkid i haven't revised the power point but definitely a good addition to the e o policy complainant as a separate flag presentation to entry-level academy. >> thank you

you're welcome. >> thank you commissioner covington and commissioner hardeman. >> thank you, mr. president. >> that was a good report chief you're very busy i'm compliment you on our read aloud a couple of people said you were great the kids love you, you have a great presence about you and just wreck of carr charisma interesting the retiree civil rights the other day for any of the president to be firefighters one gentleman his not able day his first day he had 2, 3 fire alarm foyers and 4 he said he never will experience that again but quite a thing asked that end

of the extend shift how he felt he said it was fun so he has a nature to be able to do that ilene hernandez a remark person a person of prestige i've known here forever since late san jose and came from a distinguished family back east her family was from jamaica but sharp looking being a person of privilege or prestige like fdr she devoted her life to taking care of the under privileged i was happy to have known her the chief brought up the st. patrick's day parade saturday i'll head to my grandsons i'll

miss the parades but no way gary the grand marshall deputy chief should have been police chief but should i see not to do that i met him in 1979 along with retired chief tom most people in the room have no idea but the greatest chief and the same time met the chiefs father and that was a group called the american irish alliance you had to a quarter of an irish they let me in that was - we preceded in over a decade does er did some remarkable things it was fun to

be part of you gave the achieve a copy of something that kevin star wrote in the paper i was chairman for other person that people didn't know jack we did a testimony monthly. >> he was one hundred jewish but he was a great person that never said nothing negative and give him $5,000 in the 80s that was a wonderful thing but anyway, i hate to waste anyone's time that's my story on the st. patrick's day happy st. patrick's day to everyone. >> thank you commissioner

hardeman i have a few questions of chief do you you wish to be excused. >> all right. on the promotion of captain do have you someone in mind that will take over the chief investigator within the department. >> yes. we do. >> but you can't announce it as yet. >> we do have - our plan to transfer the captain currently christopher over to replace andy in his residential we've gotten an agreement to do so we didn't want that position to be without someone. >> it is an important position we thank christopher doing that. >> at the hearing the gao what were the supervisors key concerns did they express and

polk solutions to those problems they were - >> bringing to the public attention. >> the genesis of request to have the agenda items before the gao was and evening on friday the 13th where supervisor peskin was made aware of the fact that we were short ambulances all the ambulances were deployed and one call that was overflow room code 2 to non-life-threatening call but it was upgraded to code 3 an elderly woman that hesitate fallen she's recovered from that fail i understand and there was a detailed responded between 7:00 and 8:00 p.m. open 2 on that friday night a delayed

response greater than 5 minutes they wanted an overall presentation we assured him that by and large on a monthly base we are reaching that goal december we had had challenges and in january but 89.5 and now 92.3 so i think we're able to showcase all the progress that was basically around that one night and his question was is there a normal friday night in the event of a large-scale emergency how will the system work we explained if this is a huge surge last year, we handled it well and the per diem in the huge event of a disaster we'll

be able to. >> budget committee lay their concerns for the most part revisit it and have your leads come to the meeting we attend. >> continues to go up more resources will be noted. >> we appropriated and the controller's office said they have been tasked would go looking at does that staffing level of 200 ftes for the ems division that was factored on the 2014 dictated so does that make sense? to revisit that have a higher booster to the staffing look at other creative solutions like having the ambulance if we can not wait as long during the zero period we're short on equipment and shorten that length of time

and particularly if so a code 2 we're looking at staffing and relayed that out to him. >> thank you chief on the flame program can you, you gives give us as brief description. >> i used to know the acronym but i think that it would be a great trivia question. >> it is musical too i'll get that for you talking to puzzle me i used to be in charge of the project but through the good nature of the firefighters many of them when they start and i say pretty much not that we know the acronym we're partner by having a small amount taken from our paychecks to support the athletic events throughout the city there are flame tournament

w host to offer boys and girls and involving ball and basketball and partnered i know over 10 years used to be separate and it works better with rec and park to help to support the little league the baseball league so the money is received through donations from active and retired members we have a full-time employee that is detailed part of time to manage the program and there the direction of the deputy chief. >> any firefighter can volunteer and be part of it. >> absolutely. >> thank you, chief commissioner vice-president nakajo you have a few questions and a comment mr. president, thank you kijdz thank you report i wanted to give a comment and a compliment and appreciation in the sense of your attendance in

many of the parades i know that you'll be leaving shortly we have a rally outside for the international woman's day and express my appreciation mr. starr at the retirement ceremony and mr. president like to recognize commission secretary for taking care of that event because again being a recent retiree i certainly believe there should be a ceremonial conclude for the employees that support of those i want to comment and appreciate that thank you, madam secretary for your involvement. >> thank you, mr. president. >> commissioner hardeman. >> thank you i'll get back to chiefs wonderful appointment of

captain andy to the head of ems what a desire he was so modest really never didn't sound like you were quite as qualified as you are but probably know the department as well as anyone you served as secretary for the commission, which give us an sight to a lot of things behind the scenes, you also have been when the chief investigators poignant by chief joanne hayes-white to look at complex and confusing cases of problems in the department including discipline and you've had it put in tremendous amount of effort and resources into that that so, so you've earned our stripes and talked about your background

with ems and the paramedics that is actually, the number one, thing to do your job but really very qualify and i received that message last time that moma e e-mail from the chief saying the appointment i said wow, i never gave it a thought the chief was interviewing i know had a number you were on the list i doubt if none in the department including the person that wanted the job to say you're in the the perfect choice congratulations. >> thank you choice commissioner hardeman our chief of operations chief gonzales will not give us a quick update. >> good morning commissioner president cleaveland and commissioners and good morning chief chief gonzales this is my operations report for february we have one greater alarm that

was on february that it was change of shift firefighters and ongoing off going and oncoming cruise so the trucks will be more fully staffed therapists great no recorded injuries actually there was one that i remember they said the guy ran away the fire was electrical fault the changed was commander burk smoke from the second floor and the fire trucks were on scene the building had 7 commercial spaces and 21 single-room occupancies on the second floor pr retained were exiting the building when we arrived a report the fire was in residential unit number 9 the cruise recorded smoke from vents it was second floor residential area

our cruise on the streets sided the building looking at the commercial units assess for any basement area they were forced industries and confronted with heavy fire the tried to make entry but the - the stalker on the street side and entered the basement the basement fills with three or four foot of water the utility was called for the heavy duty pumps to pump out the water they brought a jack hammer to breach the concrete floor where the for was smoeld overall this was a difficult fire responding from the battalion chief they performed extremely well this fire required a fire watch on to community outreach we continue to put out safety

messageings as well as the fire presumption of negligence doing things for the public and gathering information other finest of note for the fire alarm on 2255 they instructed a male and startled cpr a fire alarm fire one rescue no injuries also on february of one male rescued in injuries city high-rise comments and thank ac second row smiling he did a great job put this together it was one of the best probes i've seen 3 stations owl members remembered more about understanding what your role is rather than having the members run up the stairs but they did that as well with hose lines and

ventilation as well that was really a good drill. >> on february 12th a suffer rescue they rescued a 45-year-old male and accomplished the return and he's doing well and transferred to kaiser on february 15th you might have seen in the media structure compromises with 0 multiple evacuations a large portion of 35 floor the top floor posed a collapse hazard our unit working with other agencies with the unified command built over 5 hundred evasions no injuries or collapse they do a nice job and andrews handing of the media on february 16th a fire alarm one

female rescued from a one story balcony and one firefighter injured on february 19th and 21st multiple trees and wires down due to the storms on february 21st fire alarm fire with a rescue on martin luther king market an february 28th a multiple vehicle collision on south bay multiple injuries one adult was trapped under the car we have x causations and two critical did a good job. >> the following media report on to february 15th mother and daughter learned how to use cpr thank you on to ems our ambulances as the chief mentioned respond through 10 minutes 92 percent of the

time that's outstanding did a good job and traffic is a concern and there was a spike that are a concern spoikz when we have limited resources that's why i like to piggyback on the roll i think that should be expanded and taking calls out of the system and looking at the emergency vehicles that might address we're mandated to be four and a half minutes to get on scene we've never met that when our stoogsz are where they're at if you introduces the conflict response vehicles we may make that goal how our units are outstanding on average on keen in 3.22 minutes as mentioned the training for the trorpts is the service center that helps the service if our unit transport a patient to

a serving center rather than a hospital that is not nearly the time is not a line they drop off the patient in 15 to 20 minutes and the concerning the new fire commission our new assistant deputy chief will be handling that as of mentioned the new members added to station 49 on to community outreach or excuse me - the fire prevention at headquarter that had employments issued and 16 hundred intishgsdz comedy with the outreach they conducted two fire safety working groups for h-2 for building owners for them

on fire safety and detail attendance was thirty there rh-2 video is in development i'm trying to convince the chief to be in the video it is not going so well also in bureaucracy fire prevention since they they started in september of the 2015 did next hearing for march 21st of the 7 meetings we'll have violations at 57 properties at the next meeting there are 12 buildings on the agenda and in february the fire prevention hsa has 6 orders to vacate that listed on mission and they also participate 3 task force with the city attorney's office land section on mission street 8 hundred and 3 permit

that were approved the warriors arena is under review the site plans are close to approve and the task on third street sfmta presented march 9 the task proposal to add two at badges adjacent to the curbside parking isolated by the market street that was one the proposals we thought was okay. no hamper our operations is agree that is a good working together us and mta also with task we were given speed humps to look at we reviewed them and of the 18 that they give us on a case by case basis no objection to 10 of them the unit so you usa it was a well traveled street or somewhere remote we can this with 6 of the humps we obtained

to and b f i say open investigation one and 7 a decrease of one from the most before and two andrew's i want to call of chief to do a quick update plus he'll give is prepared presentation power point on all the airports operatio operations. >> welcome. good morning sxheldz and commissioners and chief joanne hayes-white i'll talk about what has been happening at the airport you as you may know new station there 3 we've been in there one month 95 percent complete a taking care of the minor details with a grand opening at the end of the month you'll be joining us in the celebration recently late

september we should something at the airport a fire inside the conveyor belt from the a o a to the baggage area got off track and rubbing and had friction in this area this area a almost like an attic type of environment due to the friction caught a fire and got going prospecting good our units got to a catwalk and maneuvered around the area to put out the fire and again this is not something we see all the time at the airport they did a fabulous job and this week active fire training at the airport we'll have the training unit from san

francisco and sfpd have been training this is ongoing training going on quite a few of the at the airport and our partners in the city some outstanding training taking place this for all members between march 24 that is who the entire airport facilities by the faa something that is done think a yearly basis we make sure that everything is in order throughout the airport to our members have been working diligently to get ready for the inspection during the 20 and the 24 on the inspection on the high-rise will be a grand hyatt hotel a 80 mile from station 3 this will create dialogue between fire department and sfo

administration how this may change our preparing for a fire at that facility again, a high-rise fire we have to approach it as much similar to what we do in the city so ongoing conversations firemen's in terms of personnel and equipment they happiest this building completed by 2019 late argue our marina program is planning a drill which will require several agencies up and down the peninsula and some of the unit from san francisco to participate in a something we hope to use as. >> disaster drill a marina drill but the airport wants to go in a different direction we have been planning and we'll do that type of drill so we'll do

an additional drill in august simulate and whatnot that will require quite a bit of preparation we're looking forward to that drill and with the he wants lastly news about his policy como to demonstrations we had demonstrates oversees quite a bit of people at the airport stalking the pears but we're anticipating something in the next couple of weeks and making presentation with that, i'll be happy to answer any questions you may have. >> and in the future i'll have more of a power point something else to hand out and give you. >> thank you. we appreciate that. >> chief gonzales. >> at the end of the my report i want to talk about the clarification it is great news

that was clorox with dhr our department and 798 and have a meeting with the city attorney and others we have talk about it but if we have 2 of them doing the work like h-33 shouldn't be that difficult but hammer out some of the finer details as well. >> thank you very much any public comment on item this report? seeing none, commissioners any questions >> commissioner vice-president nakajo thank you, mr. president thank you chief gonzales you're report one question in terms of the airport on station 3 grand

opening chief is there a projected dated we might be able to look for scheduling. >> the 28. >> march 28. >> thank you very much chief. >> thank you very much chief gonzales and mr. president. >> thank you commissioner vice-president nakajo. >> thank you, mr. president, and commissioner hardeman. >> thank you, mr. president. >> good report as usual chief gonzales thank you, sir. >> just not has nothing to do with with our report but smoke alarms interesting the molt fires displaced 14 units the east bay then investigated and fined $2,400 yesterday it is really hard to imagine that such a large motel so many units i think 44 units that are habitable in the 12 or 14 that

burned about 1/3rd of them non-functioni non-functioning smoke alarms that goes with the trend of the multiple smoke alarms are non-exist that is something i thought i'll bring up while you were on the floor and had a question of airport directors busy but go ahead finish up okay. i saw you busy looking up something and all brass are allowed so to have their phones and whatever the commissioners are not but the brace brass has got to be prepared. >> i was curious how did the people get assigned to 9 new house was seniority. >> the members of the old station 3 remained.

>> oh, they went to the same station. >> no big (multiple voices) >> thanks for your great report. >> thank you commissioner hardeman a few questions chief and for the chief when you're talking about quick response vehicles and the need for the department to have that work with the traffic and everything being as bad and getting a full truck or ambulance to a location can be difficult are you looking into alternatives for quick responses like bicycle or mopeds or go we can drive. >> similar to a buggy one or two personnel and clustered in the areas most dense with our

most calls maybe they'll take care of the code too low calls and be able to take care of the patient trotters m a and tropts the ambulance will not, stuck at we'll get our unit in service quicker and if we have three or four in the busiest area might take 190 off of the long-term vehicles. >> have we factored any non-use for this expense i mean have we put this into the budget is that budgeted into the future. >> it is look at by the ems group but put a number on anything that is a matter of what we on the system need most i think that department of emergency they don't want to have anything if effects your time we don't want to waste our

equipment how do we do that note necessarily more personnel on the rigs or the a m a personnel. >> the traffic will be worse it is important for the ability to respond around traffic jams and a blocked intersections. >> a lot of the code 3 is hampered obviously but code 3 we get to what was holding us on the ambulances it is code 3 returns they have a code 2 transport to the hospital; right? you're going by the legal law of the lapsed have to go back to our post after the hospital it is addressing that

it is a code 2 it is code 2 we want to go to the code 2 that are high activity we need to go ♪ the aclu but that's a different story i think the b l s >> commissioner president cleaveland at quick response vehicles has been bringing it to my attention and i've seen other jurisdictions utility bicycles or mopeds or motorcycles building in smaller jurisdictions in the united states i'm not convinced at one point as long as i'm the fire chief will not put a paramedic on a bicycle i've concerned the safety of our employees from

point a to point b recognizing congestion we're looking at ways to manage what we manage and program at the airport the bicycle program is excellent but no vehicles mostly bicycles in the terminals at this time it's been brought up to whether or not we'll put our members own mopeds or things like that at this time i'm not convinced that a great solution we're open. >> as long as we get more congested we may have to seriously implement that. >> quick question on the hotel it is being built the hilton hotel will they cover the costs for additional equipment and personnel to address a potential hundred emergency.

>> clearing we're in the early stages of opening up dialogue with the fire department it is my job to bring the difficulties of the structure will create for the number of personnel we have they've been very, very open to the suggestions i've brought up recently, we put our h 28 training at the airport there make our training more robust we've had rider xhchgs and the dialogue about that hotel and what will be needed to effectively approach the high-rise incident right now again, we could a have the sentencer or the apparatus if we have a major incident it is 12 stories it is a high-rise you mentioned traffic we can't depend on the latter response

from san bruno over this area takes 15 or 20 minutes something we're looking at instead of a request for a mutual aid two engines automatically incident we have at the hotel to cut down delay we'll be looking at approaches how to best service that particular building at the airport. >> thank you chief i look forward to a full report on the airport as a future date appreciate that and one final question for you chief gonzales dealing with the response time and the issue of speed bumps versus speed humps. >> who makes that final decision the department says we don't want dp t or sfmta putting a speed hump open this street

and you obsess there an arrest transmission board some body you appeal to who makes the final decision. >> we've met with director reiskin and myself fire marshall de cossio and some of the director reiskin staff regarding we're going to work together they gave us a list and have our members in those areas we know that themselves their practical or not regarding the fire response. >> so no body that makes the final determination but sit down and discuss it case by case. >> the mta has agreed to work with us. >> that is good i don't know if there is a formalized way for the mta. >> maybe the finally arbiter. >> yes. chief. >> we try to work with them

and try to be reasonable for major corridors we are transfersing and they've been and they're good to work with a major area we are k34567b9 responding to no back and forth. >> i'm glad to hear and defer to the fire department if it impacts the response time they do defer. >> i'll say they do and a give and take and push back if they need something we'll come to a resolution and i applaud mta and director reiskin ray hart for san francisco open government. that and chief francisco might know better than i know know there a difference between speed hump and speed bump. >> speed cushion has space for your who's also. >> my understanding is mta is

going more towards speed bumps than speed hump no breaks people can angle it and work it so they don't feel the impact they're big advocates for speed bump we prefer the speed humps. >> we prefer the cushions. >> thank you very much i see schauk would like to make a comment or has a question. >> an acknowledgement time thank you, mr. president before you conclude this report king's and chief gonzales i wanted to first of all, thank you for arranging my ride loan with station 49 for a point of information only march 24 and targeting somewhere within 5:00 p.m. to midnight so we can be part of learning curve of the dialogue we've had most recently i'll comment on the visits with

the communication center so thank you very much for that as well but tooimentd i want to acknowledge our fire marshall de cossio for his cooperation and attendance trying to deal with issues that are part of our oversight and our responsibility of the department thank you very much for that meeting chief and want to thank you comes and goes and kijdz for that support in terms of that thank you, mr. president. >> thank you, mr. president. >> madam secretary thank you chief gonzales madam secretary. >> item 6 commission report on commission activities since last meeting of february 22nd including commissioner president cleaveland and commissioner vice-president nakajo rights or recent tour at development communication division.

>> thank you, madam secretary i'll call on the vice president to give his comments. >> thank you, thank you very much commissioner president cleaveland colleagues we wanted to give you an update thank you chief gonzales and chief joanne hayes-white for the tour and david from the decision of emergency communication we were met with the deputy director of emergency services mike and also part of that tour and description of robert deputy director of emergency communications colleagues that was a fruitful tour myself i've been in the visitation on that communication center there will be my 4 or 5 visit the president the commissioners have also had

interaction part of it was for us to develop more knowledge on the discussion of code 2 and 3 and ambulance response time when the citizen picks up a phone and hits the emergency communication 0 how does that tilt itself of those work compared to the old days we say had personnel from the fire department and police department that actually worked the communication center and the dr personnel on the board that's changed with the uniformed members out of that particular emergency servicing communication and services agency a point of information any of you outburst there to provide public services beyond the police department and fire department i'm going do with wholeheartedly urge you encourage you to look at

becoming an emergency dispatcher a reputable profession they work extremely hard they're trained and trained both to handle police calls and fire calls i hesitate in terms of bringing it up statistical numbers because of accuracy but my recognition brings me a report that the majority of calls for police calls all that majority of police calls a high percentage homelessness relayed calls in the plod calls it was interesting to hear that the medical service calls and the fire department are part of that but the awesome responsibility of dispatchers they don't have the luxury of separating the duties on fire or police indeed

thoseeve.

>> - the president and myself have several of the questions this was answered as a point of information i asked what the average of personnel they said 14 on the board and we had the tour 8 members talking about under the staffing of the emergency communications center thusly i heard from them that the mayor's office and the city has currently them to hire so while we were there, there was a training of 32 new dispatches a new exam was given i asked how long for them to fully staff up i believe the scenario was between one year and a fully staffed 3 years that is quite a

bit of hiring, if you will, in terms of career goals with think outside the box stressful full and challenging job but demanding i keep a look out help mitch with the president to thank those various members who are working the board but thusly a question of coordination between when a call comes the judgment of the dispatch all the sheet of dissemination on calls of is he feigned is she conscious is he conscious does it sounds like a heart attack systems kick in theretofore to look at it and continue to analyze code 2 and code 3 and the discussion mr. president, and colleagues coming up with other initiative expects i am creative and supportive of

department and offered up conceptions never mind of moving towards the directive i wanted to say to you commissioners and mr. president, and chief and the rest of department that we have always an open agenda invitation for any of us to continue to go dot communication department it was a great help for us to realize i thought amp correct me if i am wrong chief you said it sound as the dispatch gets the call and they make a decision on what to send out it is a human decision but sounded like ones that protocol is in the system the system makes a determines i don't know if it is accurate to what i picked up. >> if so call whatever call type chosen it is going to the hot seat the hot seat will look

at if it is supplemental they might i couldn't ask for different units or that information they might automatically add a unit based on the supplemental information. >> i wanted to share that challenging complexity we ask questioned if this person is in a panic or didn't speak english he often get when i worked through senior citizens will excuse me - why do they keep on asking me why not hurry up and get an ambulance dispatched bottom line they're responding an ambulance dispatched i think trying to make a determination is that accurate chief. >> make a determination or determination of the call line i don't understand the last part of your question. >> i think i got it chief gonzales and i, we worked at

radio it evolved a bit i believe depending on the nature of the call a non-medical call you're getting as much information from the reporting party and chief gonzales stayed there you - whatever you category it is it linked response partial hearten for medical we utilize the equipment it is capture that means and there can be frustration on the reporting part why do they keep on asking me those questions they're important how you initially present i have somebody i've witnessed them fall down a series of question by which the dispatch is dpietd and needs to ask to send the appropriate resources there are cases i wish there were more at times you send and can get more information but a brief

description of cb d. >> that's right our coming center uses a protocol it was developed called the medical priority dispatch system uses what the call reporting party says and changes that both a response pattern with the idea if someone says a person unconscious or a person changing color or choking we have an immediate dispatch but they need help but are talking and 3wr50ek9 normally or standing and walking we can send a lower cuing i cue unit helps us to triage a - they do to a masking to determine what equipment needed and the priority. >> thank you chief gonzales.