insisted us with one of the inspectors, mary saye, and she went out to a lot of these areas, and we took care of it before the fourth of july. they did a very good job. >> chairwoman: it's good that you anticipate these possible problems and get out there and solve them. i applaud you for doing that. on page three, you mentioned a month-long local coastal rescue drill. can you give us more details about that, please. >> let's see. >> chairwoman: under "functions," on page three. >> that's all month long

that we've been doing coastal rescue drills. that's consistent. we have our p.l.o. go out and hand out materials, and we talked about that in the past because this is a heavily travelled area for visitors. and so we do a lot of handouts and fliers, and also, all of the companies that are on the coastal stations, they've been doing constant drilling out there. so they're doing rope rescue drills, they're doing water drills -- i'm sorry -- low-angle drills, high-angle drills, boat drills, everything that involves coastal drills. i can list them for you next time, if you like. i have some of the pictures in the slides that i gave you. i knew this was a little bit of a longer presentation, so i shortened it and took some of that out. >> chairwoman: no problem at all. then...let's see.

at the chase center, are you going to have an after-action report for that, you know, when you have the drill? >> we will. we will. we will have the take take-aways from it, for sure. >> chairwoman: i think all of the commissioners would be interested in seeing that, as well as areas of deficiencies, in order for everyone to be able to sleep well at night, atim any time there is poll when iparticularly for a lf the musical events. at sports events, i think they don't drink as much as they do for musical events. and things can go wrong

for that reason. egress and ingress can get a lit scary. i would like to see any concerns memorialized from m.t.a., saying these are the things that we think really need to be addressed. and if you feel that you cannot do what it is that we're asking you to do, then please tell us why in writing. >> i agree. we have a report with a lot of questions that jay center and s.f. m.t.a. is going to have to answer for us. and not only that, it is not just the full box for a fire, but once we get locked in there, we need an ambulance to get out of there. and we have the fire engines blocking the fire lanes, and then we have another issue. so we're going to not only throw a full box, we might

do what we would send to an active shooter. so we can see if the first ambulance that comes in, how is that first ambulance going to get out when we've got five ambulances behind it? we're going to try to give them some of our toughest scenarios. we'll show them. after we show them our response, we're going to sit down and do a table talk and try to discuss it. so this is a first of a series of drills that we'll be doing with them. >> chairwoman: i think it is very important for the public to know that the fire marshal and our homeland security expert are both expressing concerns. and i don't know why anybody would argue with these two people? [laughter] >> chairwoman: about anything. >> and there are 200 events. >> chairwoman: yes. >> and a large number of them coincide with the ballpark at the same time, so... >> chairwoman: yes.

>> i stay awake at night because of this. >> chairwoman: that's why i said i want everybody to be able to sleep well at night, when everything is in place and, you know, we have a plan that we think will work. so if you need me to knock on a door or two, then please let me know. because the first events are going to be happening very, very soon. it is already july. >> yes. >> chairwoman: all right. well, i'll save my medical questions for captain thomas. thank you. >> thank you. >> thank you, vice president. vice president covington. commissioner varinisi. >> the president's comments a moment ago, i think i know where he was

going. i would hate m.t.a. to clear the bus lines because you guys are coming through -- it just doesn't make for a realistic scenario. so to the extent we can keep everybody out of the loop, i think that would be best. in other wordin regards to -- tu for identifying the homeless address. i wanted to see if maybe you could do this for me -- so on page 21, you have station one, and station one received 409 calls on one month. and it's next month it was 423. and the next month it was 427. >> yes. >> there was recent news that the homeless population in san francisco had gone up by 30%. that was probably a

surprise to a lot of people, but i believe if we were to look at these numbers, we would probably see that. you can see how the percentages go from 39% to 37% to 36%. so the percentages are going down, but the actual calls are going up. so -- do you see what i'm talking about? >> correct, yes. >> so i wanted to see if you could add just a single column at the bottom of each one of these that adds them all up, so that we can actually see the actual calls are going up as well. because if we're saying, oh, well, the average city-wide is 38%, and it's been consistently 38% for the last three years, but if you actually look at the numbers and the homeless-related calls are up by 30%, that is a pretty important number to know as well. >> okay. >> because you can stay consistent at 38% of the calls, but if the

homeless-related calls are going up by 30%, then i think that's an important number to maybe share with the department of homelessness. saying, hey, by the way, there is probably a good chance that your homeless population has also gone up by 30% because our calls have gone up by 30%, and everything in proportion. in other words, have somebody take a look at this statistically. that was not my strength in college. i think that is a significant number, and this chart doesn't show the actual increase in calls, or, for that matter, if it is a decrease, then that's a good thing because somebody is definitely doing their job. >> i definitely will have that for you. >> thank you. >> thank you, commissioner. commissioner hardiman? >> the best news in your report, chief, is i love to see all of those ones

in the multi-- no multi-alarms. everybody knows we have the right to do a second alarm, but the fact they didn't have to, that's good. i hope every month to see that. that would be the best thing in the world. anyway, i hate to do this on your time -- again, great report. the whole report is fantastic, the details that you presented are, from you and your staff. >> thank you. >> i guess i have to run this through the chief. the significant number of promotions that you just did within the last few days is very encouraging. there are a lot of deserving people on that list that you have promoted. i was just wondering, the number of retirements since the last meeting? did july 1st have a significant number? does anybody have that

off-hand? >> i'll look it up and get it for you today. >> i'm just curious. thank you. thanks, chief. >> thank you. >> thank you very much, commissioner hardiman, and thank you, chief, for your comprehensive report. madam secretary? >> i'm five, update from assistant deputy chief, sandra tong, on an overview of the e.m.s. division. >> thank you very much, madam secretary and chief tong, welcome. as in the tradition, since chief nickelson has been part of the administration as chief of the department, periodically we're able to have the various deputy chiefs present as well. and in the flavor of that for this commission, and with the subject matter that is very important, we thought it would be appropriate for you, assistant deputy chief tong, to come and make a

presentation in terms of the data from your perspective. i also wanted to note that dr. clemen yea is in the audience as well. >> good morning vice president and commissioners, chief nickelson, maureen, thank you for inviting me. let me try to get my power point going here. so just to give you a

little bit of a background about myself, really quickly, i worked at d.p.h. as a medic for about 10 years, and then we merged with the fire department. at that time, i started working in the dispatch center as a rescue captain, and that was a great opportunity for me to learn the ins and outs of the fire department, and how some of the things work, the command structure, the organizational structure. so i was there for about four years, and then i went into the field as a rescue captain. and then during the course of my career, i pretty much worked in dispatch, in the field, and then also at station 49, when that opened up. during the time i was here in the fire department, i was able to go to graduate school, and that was one of the benefits of having the kind of schedule that we have. and then after 28 years, i retired for about 16 months or so. and after relaxing and kind of wondering what i'm going to do, chief

nickelson called me and i've been very honored to have been accepted into this position. so thank you. i just wanted to give you sort of my approach to management, and i really believe in sort of creating a participatory process. one that recognizes and respects the chain of command, but then also solicits the expertise of the people that work for us. i think we have a lot of people who know a lot about the work that they do, and being able to garner that information and expertise i think makes for better decision-making. i also believe that decisions should be data-driven, but also person-centered. i think it kind of gives us a balanced approach in how we look at issues. so my two top goals, and maybe the first one is really more of a kind of

visionary thing. i really want us to provide the best emergency services possible. but i want it to be based on gathering information, soliciting participation of the stake holders, identifying and determining best practices, revising bet policies and procedures, and finally implementing them. i also want us to create e.m.s. strategic plan, something that will give us a framework to plan and provide the best service possible. where we identify priorities, support funding requests, and implement changes. those are the kind of things we can do with a nicely developed strategic plan. so i want to talk a little bit about some of my objects. the first is to examine and improve how we provide hospital care in san francisco. aside from looking at some of the metrics, such as response times and system

management, i want to look at how we can deploy our resources in more efficient and affective and creative ways. and we're starting to relook at all of the data, how we collect it, all of the parameters we use to collect it, and all of the assumptions we have when we're trying to look at the data. we're researching different ambulance schedules, and we're going to continue to expor explore alternative vehicles. another way we can improve how we provide pre-hospital care, i want to increase opportunities to learn. one of the things is with training. i've been working with chief payne with e.m.s. training, to create more opportunities for us to do hands-on training. we have opportunities to work with some of the hospitals to do clinical skills practice, and he is working on trying to include the ambulance crews in training

exercises for suppression. and next to that is trying to do more research. there is really a motivated workforce that we have, and with that kind of a workforce, and with the diverse population we have in the city, we would be actually an ideal place to develop research projects that identify and address pre-hospital issues, and hopefully can improve pre-hospital care. and then the other area that i would really like us to explore, and we have an expert in both captain pang and then chief tangerlini in regards to paramedics. there is a trend towards global-integrated health care. with e.m.s., we've been able to reduce our call volume, and we're also being able to address some of the various needs that they have. by also expanding into community paramedic programs, we have another

area, patient-centered type of services. and we can improve the health of the community. one of the other areas i wanted to look at is to address the morale at station 49. it is a very hard-working workforce, and they're interested, and they want to get involved in things. some of the things they want to do to garner the optimism that they have at this moment, especially with the inclusive messaging of our chief, is to increase the two-way communication. we're having forums, we're having some focus groups. they had a townhall meeting which chief nickelson and two other chiefs did at station 49, which was very well-received. and we also want to increase opportunities for the members to participate in providing input and recommendations on the things that matter to them. so we have already -- i think you saw in the report -- work group on schedules. and we also want to include them in deciding

at what kind of vehicles we want to look at, uniforms, supplies, and how we want to continue with research and training. and i also want to keep the members safe and healthy. as you know, because it is such a difficult job that they have, i just want to make sure that we address their stress and their burnouts and the injuries that occur working on these ambulances for such long shifts. and then the other area that i really have concerns about is just really improving our disaster preparedness. i would like us to really develop our search capacity. right now we want to look at what our available suite is, what kind of equipment and supplies we need in order to be able to address any kind of surge in call volume, whether it is a disaster or the heat emergency we had recently, really to determine what are the needs we have and how we can go about funding those and making sure we have the appropriate resources.

i also want us to, as soon as possible, develop check lists that i think can help people in the field to be able to immediately look and see, what are they responsible for, what are their duties, what are the things they need to think about, just cues for them when something is happening in the moment, that you have something to refer to. and then we need to plan and train for different types of disasters and levels of response. so when i first was asked to come in, and i was thinking about what i needed to do, i wanted to do an assessment with all of the members of the r.c.s, the command staff, i wanted to get all of that stuff done. and i still have that plan, but i also got immersed in a lot of the other work that came about, such as meetings and discussions to deal with some of the immediate concerns that we had,

operationally, working on the schedule and on the ambulance fleet, and on the m.t. hirings and stuff. so those things happened. some of the other things i did during the first 60 days, the first couple weeks was an orientation that i received from andy zanoff, and that was very helpful for me to kind of get a lay of the land of what was happening. and we selected a section chief, neil tangalini, and we were providing some budget support with the chief, data gathering and research, and some of the immediate needs working with the e.m.s.a. and we got some ambulances on board and permitted, and as you've heard, the level one ambulance e.m.t. process. also in that time, we had the heat emergency, and i think i have a little bit of information in the e.m.s. report around that. i've gotten some orientation into our new

station 49, a.d.f., and working on the pride parade preparations. i would like to identify the issues that need to be addressed in the e.m.s. division, and working and conducting 101 interviews with the members, having small group discussions. and looking at the data, and looking at what additional data needs to be reviewed, identifying the gaps, investigating those further, prioritizing the issues and then deriving solutions. and the most important thing: hoping to implement some of them. some additional areas that we also want to be looking at is continuing to compile supportive data to justify the staffing needs we have on the e.m.s.

side. looking at alternative service models, continue to review our clinical performance, look at alternative funding sources, and explore the use of green technology, possibly, in our vehicles. so right now there is a lot of energy, as well as a mandate to get things done. i want to harness that enthusiasm, and in the words of the chief "get to work." thank you. >> thank you very much, chief tong. at this moment, i'll call for public comment on item 5. any member of the public? seeing none, public comment is closed. commissioners, in terms of questions and comments. commissioner cleveland. >> thank you, mr. president, and thank you, chief tong, for your report. it is great to have you back on board. >> thank you. >> a couple of questions on the strategic plan: are you pulling out of the

larger department of strategic plan, pulling the e.m.s. spies ou piece out ad expanding on it? >> yes, i'm looking at those points as well. i actually participated in that process. so pulling from those and looking at other areas as well. >> i think it is a great idea. we need to update our strategic plan in every aspect of the department, but certainly e.m.s. is probably the top priority in my personal opinion. so i applaud you. so do you have any sort of timetable for when you have those recommendations and revisions for the strategic plan for e.m.s. ready to be reviewed? >> i mean, i would love to have something in the next six months or so, but i think that that might be too fast given all of the things that happen in the day to day -- >> you have a lot of day-to-day responsibilities? >> yes. >> but you would say in the next six to 12 months,

perhaps? >> that sounds fair. >> and please share it with the commission. >> definitely. >> you mentioned alternative vehicles responses, and i think that's an interesting idea. and i would like to have you expand on it. >> i'm sorry? >> the alternative vehicle response? >> yes. we have the q.r. v.s right now, and it is not just necessarily the vehicles, but how we staff them. i think in england, they have nurses that respond with the ambulance crew. it expands the way you can offer services. you can go to people's homes or you can provide suturing or you can do other types of things that might prevent having to take a patient to the hospital. there are alternative ways that you can provide care, aside from just taking them to the emergency room, which you had spoken about earlier. >> has there been any discussion about maybe utilizing privately-owned vehicles to transport?

>> like uber? >> yeah. >> i don't know. i think that would have a lot of considerations. it may have been, or maybe is being, explored in some of the other areas. i think there may be opportunities to garner funding from them to help support maybe what we do. but in terms of utilizing them, i think there is a liability aspect to it they may not want to take on. >> and obviously, it would have to deal with only less severe calls. >> correct. >> maybe some of our frequent fliers -- >> perhaps. >> -- that are overutilizing our system. thank you very much. it is good to have you back. >> thank you very much commissioner cleveland. >> chief, i know you're still kind of getting your feet wet in the job, and i appreciate everything that you're doing. it is not an easy one.

your department is a very essential department to this department, and i appreciate everything that you're doing. you mentioned a couple of things, the alternative vehicles that commissioner cleveland had mention andeandthe community paramedics. what about community paramedics? what's the idea behind that? >> community paramedics really looks at having a specially trained group of people, that we've been training in the v.m.s. focuses on as well, and being able to provide other kinds of social services, and being able to address and understand sort of the other kinds of needs that the frequent-user population has, and being able to make those connections. there are other ways they can enter into the system in terms of being able to provide different kinds of services that are beyond sort of just doing an emergency, urgent kind of

care and immediate transport to the hospital. there are opportunities for them to work with these patients, whether it is in their homes or at other residential facilities to be able to help manage some of their issues. >> here is something i'm really struggling with, because as i understand it, we're a team player in this city, and we work closely with the department of health. but what i really struggle with is understanding the problems that the department of health is having in staffing and taking care of the health and welfare of this city and adopting them. because what i see us doing, we're doing it with em6 -- our job, as i understand it -- and maybe it is not, and if it is not, let's be very clear about it and go to the mayor and ask for a budget for it, but if our job is

to respond to emergency medical situations, then that should be our focus. and there should be a line that we draw where we say, this is now a department of health issue. and if it's not, let's push that line further, adopt those problems in the department of health, but get the funding to. actually do it, right? >> uh-huh. >> let's be clear of what our mandate is. i see us adopting some of the problems that the department of health is having. we're now talking about putting nurses in our q.r. v.s. are we hiring nurses now? i'm just saying that is something that can be done. there are programs where there is telemedicine, so there is a monitor in the rig or there is a doctor that is accessible to us. and dr. yee might be able to speak a little more to some of these other ways of providing care. because we're a mobile vehicle, we can outreach

to patients in a different kind of way, other than somebody who has to find their way to the hospital by a vehicle -- >> i get what you're saying. is our mandate to provide emergency medical care -- >> for sure. >> -- or is now our mandate to provide all of these other city services, which there are other departments in this city that should -- it's a part of their mission to actually do that. it's like we're seeing that these patients are having certain problems, and there are these other resources out there, but now we're throwing our resources at fixing those departments when other departments actually have those resources. >> i would agree that a partnership is very appropriate in some of these scenarios. because i don't think that we're going to be able to get rid of our eliminate, but we can mitigate some of the kinds of calls we have with these more vulnerable populations. so by utilizing sort of

these other ways of dealing with them and adjusting them and responding to them, i think we can work with our hospital providers, we can work with d.p.h., to start helping and working with us and funding some of these efforts. >> i totally agree, and maybe partnership is the key word here. i just don't feel like we're in a partnership right now. it is like a one-sided deal, where we're just fixing everybody's problems. >> i think that's what the chief is working on as well. >> and she mentioned it and some of her meetings, too. but there is one commissioner here who feels like every year our resources are being strained and strained and strained. and, really, we're being penalized because we do one thing really good in this department: we get things done. no matter what, we find the resources and get things done. so the rest of the city looks at us and thinks, oh, they're fine because they're getting stuff down. they're getting all of the important stuff done. really, we're stretching ourselves thin. you mentioned it yourself,

the e.m.s. decision, their morale is low and they're overworked. i think it is about time this partnership actually shows itself in the way that the department of health is sending their own vehicles out to deal with the non-emergency issues, and it takes the relief off of us. i'm saying that is going to be a really big challenge of yours in this new job of yours and the chief's. i think it is important to turn this into a real partnership, and i don't currently see it and it certainly didn't happen in the last administration. >> i think chief nickelson wanted to chime in as well, and perhaps dr. yee as well. >> so i absolutely hear what you're saying. and we've only been doing this for two months, and so i'm making the connections with people. and i am -- i get the

frustration. i have it as well. and you know it's a lot of what i talked about during my interview process with you all. and so i am moving forward with what i think is the best way to get to a solution, to get to some solutions on this. so i am having the conversations with dr. caldwell, dr. colfax, and seeing what we can put together. and i am also telling the story that has not been told by our department, whether it is to the border of supervisors or to the mayor's office or to d.p.h. i'm telling the story of how this is impacting us. i really believe this is the first step in how we cooperate with one another and really are able to move this forward. but i absolutely understand and get the frustration. i've seen it with our members of station 49, with our members at fire

houses running call after call after call and nothing changing. so i hear it and we're definitely working towards changing some things, and i know we're also working on state bills so that we can expand our community paramedics. and i believe we should expand our community paramedicine. >> i hear you and i understand you. i would add a couple of things. first of all, i would say how wonderful it is to be working with a person with the wealth of experience as chief tong, and also bringing a kind of systematic approach to looking at some of the issues-yeaissues you're highlighting. you hit the nail on the head, which is, i think what we need for a lot of our patients in this

system is an all-hands approach. and i think we're trying to foster that as much as we can with programs like e.m.s. 6 and some other programs. as to where the responsibility lives and how that happens, i think that is what we're all trying to advocate for. because at the end of the day, honestly, there is a lot of ownership challenges that marginalize and make it harder for patients to get care. and what we think of as not an emergency right becomes one very quickly. i think that is in the name and spirit of prevention of emergencies, and that's what we'll really trying to do. to your points about the collaboration, indeed we have a lot to improve on, but i would actually say that in the last few years of, you know, a lot of our initiatives, there has been a very large amount of support that hasn't been there before mostly because people have seen the results that our teams have been able to do. and i would say that it is not single-handedly that

we accomplish anything. when it comes to a patient that has been seen 300, 400 times in the system, that is an indication there is a big gap that person is falling through. they found the giam tree tgeometry tomake it in there. sometimes we need a lot of help of partners to close that gap and to make sure that does not keep happening. i can logically say that that is kind of one of the reasons why people are frequent users because there isn't a collaboration. in that spirit, i applaud the work of the department. i think there has been a lot of leg work and accomplishments that is happening. to your point, there is a lot more to be done. point very well taken. >> i just want to say this is not a criticism of you at all, or of you, chief tong, or of you, doctor. this is just a red flag to

the rest of the city. we're working our butts off over here and we need some real partnership help. i know we do do stuff with other departments. i appreciate that you're starting those conversations, and i think this is a really important conversation to have. if we don't have these conversations, we just go years and years and years and just continue to do what we do and just take on other tasks are our budget doesn't grow and we end up in these situations. so i really appreciate you guys and what you're doing. i probably can't fully appreciate it because i'm not in it every day the way you guys are. but i see it from the outside, and as a commissioner, i want you to know you have my support in anything i can do. i can't speak for the rest of them, but i'm sure they feel the same way. but a more collaborative approach i think is necessary. we need an all-hands on some of this stuff. i'll leave where you draw that line up to you guys. i'm just saying, let's be clear about where that line is, so we understand

when the budget comes around, who is responsible for what and how we're able to pay for it. >> thank you, doctor. just a couple more questions for the chief. i think it would be really important, chief, for your department to report on the health of the city. because your department is the one that is going to see the trend in, like, the uptake in fentanyl and the downtake in opioids. if there is a report, like an internal letter that you can send to the department of health, hey, this is what we're seeing on the street, because i think then they will be able to say, oh, maybe we have these resources we can help with. or, we didn't see that coming because we aren't seeing it in the hospitals. you guys are dealing with it on the streets. if there is maybe a quarterly letter we can send them to give your take on the health of the

city, i think it would be important because then we can kind of gauge if things are getting better or things are getting worse in certain areas. you can include how many times narcan is used. i think that is a telling marker of, you know, how much opioids are being used. if narcan is down, why is narcan down? is it because fentanyl is up? we saw the news article about this in the paper, i think it was last week, that wrote about this. i don't know if you're doing this already, but if not, it would be an important way to educate them what you're seeing on the street because they may not be seeing it. one issue, as you know, that is really important to me is mental health. i think your department is probably the ones that see, you know, more of the bad stuff on a more regular basis. and i believe -- and i've said this to the chief before, so this is not going to be a surprise, but there are small things that we can do.

and some people think this is a really stupid thing, but i think it is actually an important thing: if we could consider getting that cat back to station 49. you're smiling, and i see it is a really important thing to a lot of people. and maybe it is not the cat, but it is small things like that that tells the members of the department, while you guys are working really hard, it is small things that say, we really care about you. and it may be insignificant to say, yes, you can have a cat at station 49, but at the same time, i'm sure it is really significant to the people that are there. if it were up to me, i'd put the cat back. thank you very much. >> thank you very much. >> thank you, mr. president, and thank you for your presentation, deputy chief tong. you know, i have heard

commissioner vernanisi speak of these things for quite some time, and i support you and i support him. and i think it is necessary to keep banging that drum, to let people know that because members of the department do close to miraculous work every day, that that should not be the normal thing to expect. it just should not be, and that's where we are now: people expect miracles from the department every day. i want to say that i am encouraged. we have a new chief of the fire department. and we have a new chief of the health department. so i think them being in this same class, that meaning -- by that i mean

the 2019 incoming class of department heads -- i think that they will be able to work well together. i see a new day on the horizon. i think that things are going to improve by quite a bit, and new channels of communication will be developed. at least that is my hope. and i know that our chief is working towards that, and that our commission president has even mentioned having a joint meeting with the health department commission and the fire commission. so i think a lot of people are working in their particular areas and thinking about how best to improve things. so that's good. i also wanted to mention -- let's see. i saw a very disturbing

figure -- i guess it was two weeks ago -- that there are 50 million homeless people in america. 50 million. it was on the cbc evening news. and i said -- first of all, i say to myself very often, how did this happen? how is it that we've really praise ourselves for being the richest nation in the world, and we have 50 million citizens on the streets. and i only bring it up to say that we're not the only ones in this fight. all across the country departments of health and the fire departments, churches, synagogues, temples -- everybody is trying to do something. but it has come upon us so

quickly, that everyone has been caught flat-footed, and nobody knows what to do. so because we're not the only ones grappling with this, it would really be good to know what best practices are in other cities. in other towns, other hamlets. how are people handling this? and i understand that a lot of it has to do with drugs and reunification for a lot of people is not possible. because, you knowin know, you call and you say, we'll pay, the city and county of san francisco will pay, the airfare, the bus fare, whatever it is. and the family says, no, the last time he was here, he stole grandma's wedding

ring and he hocked it, and we just can't take a chance. there are so many things and so many reasons this is happening. so deputy chief tong, please also beat the bushes and do whatever else you have to do to find out how other departments here in america -- i know you mentioned england -- but here in america are handling this. because the sharing of nfghts wilinformation will be of the things that will keep us sane, or close to sane, anyway. can you talk a little more about the new technologies that you mentioned? >> one of the things that we were looking at -- and, actually, there is a different kind of pilot that is happening right now -- but just even in terms of the disperse. dispersement of the patients we take to the hospital, and how they're determined in terms of their

destinations, there is technology that exists that we have over at the d.m. that is called readiness, and it identifies what kind of capacity hospitals have. there are ways we can maybe access that kind of information and have that available for the crews to be able to see if a hospital is impacted with a lot of patients, that they may be able to go to a different hospital that the patient night choose, thereby reducing the time they have to wait, reducing the load on the hospitals, and that there are sort of these ways that we can possibly utilize those kinds of things. i've also -- before i came back to work, i thought about trying to do web design, like an application design, because in my passion for trying to deal with emergency situations, i wanted to create an app, you know, that could easily be used to look at what your goals are, what units are where, and i know that some of those things exist, but i don't

know anything that exists for e.m.s. so i think there are ways we can look at being more effective and more efficient and even more detailed and how we can drill down on certain kinds of issues and problems by using technology. >> that's very good. thank you. i really like the fact that you're addressing the low morale at station 49. that's very important. i think that the morale is going to be greatly lifted when the new facility is up and running. >> it is already lifted. there is a lot of optimis optimism. >> chairwoman: very good. i'm sorry that the members of 49 have had to work out of a facility that was not built for the job that they have to do. so it's coming online very

soon. >> yes. >> chairwoman: so that's very good. and when you were going over your bullet items regarding how to increase morale, you were mentioning increasing two-way communications, which i think is great -- i think all of them are great, actually -- and increasing opportunities. i would like for you to consider adding increasing educational opportunities. >> uh-huh. >> chairwoman: for people who want to learn more, do more, be better. that's always something -- there are people, and i count myself among them, who are perpetual students about something, something of interest. and i don't know how the funding would work for that. but it is certainly something that should be included in the budget for e.m.s.

okay. and then, let's see. we already talked about community paramedics. so i think that is it for me. thank you. >> thank you. >> thank you very much, vice president covington. commissioner hardiman? >> thank you. it is interesting to hear everybody's comments, so i'm not going to do too many comments on my opinion about the situation in society, except that we have a lot of addicts out there who are not to be confused with homeless. they're addicts, whether it is drugs or alcohol. and this city is always -- has always almost welcomed that type of situation, which is really a fact. we increase our population because we almost feel obligated to -- for wherever anybody comes

from. i know there are statistics that show that the majority are recently from san francisco, but i don't know if those statistics are too accurate. anyway, i don't want to talk about that because it doesn't help anything. but i'm so happy that the chief picked you. and i think one thing i learned when we did the interview for the candidates for the chief, the five commissioners working as a panel like the chief had in selecting her new candidates for firefighters, and you learn more when everybody talks. and you learn so much listening to all of the candidates who were very good. they made us very encouraged to be working as commissioners with such a tremendous staff. but one of them mentioned something that stuck with me that i really liked. he felt that he wanted to be chief because he was at

the top of his game. and everybody that was applying to be chief is at the top of their game, and i think you're at the top of your game. your experience and knowledge and wisdom that you have, i'm really happy that the chief picked you. you're in a good position for us. i hope you stick around a while. you're the perfect person, i think, for the job, so congratulations. >> thank you. >> thank you very much, commissioner hardiman. commissioner cleveland? >> thank you, mr. president. just a couple of followup questions, chief tong. when you have diversions, when a hospital says "divert," have we ever done any quantcation of quant q? how many times times we're

diverted from st. francis or from the other hospitals. >> do we count how many times we're diverted from a particular hospital? >> yes. >> i'm not sure -- not offhand. we may be able to find that information out. i'll have to look. because we would probably have to match when the times that a hospital is on diversion to when -- i think there may be something in the patient chart that might say that a hospital is on diversion, and so we can kind of track it that way. >> i just wondered because it might also indicate which hospitals are slow in terms of intake, slower than others. >> i sensed that. >> it is just another piece of data that might be useful in our collaboration with the hospitals. >> true. >> i had a question earlier, and i didn't really ask it, but what is the number one reason for our 9-1-1 calls? other than we know there are medical calls. but within that medical

call, what is the number one reason we get called to the streets? >> i'm going to get that for you because i think i saw something that identifies that. you want to know what is our number call type? >> right. is it a drug overdose, somebody passing out from alcohol? is it -- just what? i mean, i think we need to know that. >> i'm going to have to catch up on that data. >> i have a question that probably will involve dr. yea. you mentioned paramedicine, and the fact we might need some state legislation to help us on that. can you collaborate on that? >> yes, i can. one of the reasons that the e.m.s. 6 program and the sobering center entered into the pilot project was because existing statute does not allow for paramedics to transport patients to

acute centers, so non-hospitals. and there is controversy if the existing statute allows for activities outside their usual transport. so the things they do so well, out reac outreach of clie, might be considered out of their scope of practice, and they would not be permitted to do that. the reason i mention that is because we've been trying to change the statute. because of the customs we've seen not only here but in other places in the state, bills such as ab1544 and then also i will say that the state e.m.s. authority has sort of taken this into consideration and made some administrative changes within their own interpretation of the statute that i think is more flexible than in the years prior. so not only is there a

movement to change statute explicitly, but also in the way it is interpreted, all over the state. >> right now, to divert a patient to the sobering center, it is only through the e.m.s. pilot program that that is being allowed, correct? >> correct. >> only just in san francisco? >> there are a couple of other places that are doing this. since then, san francisco is one of the longest standing, and it has been in operation i think since 2003. we became a pilot when pilots were created, but it is certainly much more of a -- i would say ahead of the curve intervention. >> is there a state paramedics organization that is lobbying to get this legislation passed? >> yes. there are a number of organizations. i'm a little reluctant to get into opinions and

stances on particular legislation, but there is quite a lot of activity -- a large number of organizations have taken various stances on the current situation. >> it seems like we certainly do need more flexibility, where we take patients and where we pick them up. >> i wholeheartedly agree with that. >> thank you very much, doctor. and i would also like to second commissioner veranisi's idea that we need to bring edna back. the morale is important, and if that cat will give us morale at station 49, we need to bring the cat back. thank you. >> thank you very much, commissioner cleveland. while dr. yea is still in the chamber, i wanted to make sure that the commissioners that the opportunity to address dr. yea s related to e.m.s. 6, and

even to afford you, doctor, opportunity to comment on some of the questions that perhaps came about that you might want to give some information on. dr. yea? >> certainly. i'm happy to answer any questions, as always, that the commission commissioners may have. i would say in terms of the e.m.s. 6 program, we're very appreciative of the commission's support and all of the outreach. it really takes a village with a program like this. we've had to overcome some historical obstacles, but i think that, you know, the results speak for themselves. and i think that in terms of the department's activities and the commission's support of it, i'm very optimistic and very excited about both an expansion, as well as exploration of more things that we can do in partnership with other departments. so that's kind of generally what i would say about that. and i think we have the right team in place to make the right things

happen. and i'm also happy to take any questions. >> thank you very much, dr. yea. do any commissioners have any comments or questions? >> chairwoman: thank you again. i didn't have a specific question for dr. yea, but in response to my fellow commissioner cleveland's question regarding what types of incidents -- in our packet, there is a long list of incidents by call type, medical incidents, over 2000 sick calls, and then there is a break down. subject is unconscious, medical nature unknown, chest pain, seizures, assault, gunshot wounds, and on and on, psychiatric

problems, so there is a good breakdown of that. and it also provides a very good overview of all of the different kinds of emergencies that people in the department have to respond to. i wish i could cite a page number for you, but it's in the back. it's like the fourth to the last page. do you see that, chief tong? >> i do. >> chairwoman: okay. so that might be helpful in discussions. >> i was just asking dr. yea because the first one they have is the most number of counts, which is medical incidents, but i'm not sure what that refers to, if it is sort of the generic x.m., that we call

a medical call. >> chairwoman: my question is: if there is medical incidents at 2000, and sick call at about 1500, is that in addition to all of the other things that are broken out, like hehemorrhage and abdominal pain -- >> right. these would be unique call types. >> i can clarify that. so these are based on the 9-1-1 call complaint types. and to answer your question, vice president covington, yes, they are all in addition. so a medical incident, i believe, in this breakdown is when an ambulance is requested off of the radio channel by other unit, whether that is law enforcement or one of our units that is involved and sees that there is a need for ambulance. sick call is when the reporting party

basically -- basically, all of the other medical needs that meet these criteria, they can be lumped into a, quote, "stable call." it can be from feeling unwell and dizzy -- actually, that might fall under a different category, but the majority of the complaints we see in an emergency department actually fall into these types of complaints. so it is sort of a catch-all. whereas the other breakdowns are for specific terminology that the reporting party uses when they call 9-1-1. >> chairwoman: thank you for that. so i did have a question for you after all. thank you, dr. yea. i don't have anything else. >> thank you dr. yea, and thank you chief tong. just a couple of questions of myself: how many numbers of our workforce are paramedics at this