SAN JOSE ; Memorandum CAPITAL OF SILICON VALLEY

Transcription

1 PSFSS COMMITTEE: 03/17/J6 ITEM: (d) 1 CITY OF & 2 SAN JOSE ; Memorandum CAPITAL OF SILICON VALLEY TO: PUBLIC SAFETY, FINANCE, AND STRATEGIC SUPPORT COMMITTEE FROM: Curtis P. Jacobson SUBJECT: FIRE DEPARTMENT DATE: March 8, 2016 ORGANIZATIONAL REVIEW ADDITIONAL INFORMATION BACKGROUND As approved by the City Council, the Mayor's June Budget Message for Fiscal Year included direction to the Fire Department and City Manager's Office to undertake a comprehensive organizational review of the Fire Department. The Fire Department contracted with Citygate Associates to conduct the Organizational Review, which included analyzing service delivery, response times, alternative service/staffing deployment options, and other potential changes that could positively impact operational and management performance such as technology improvements and changes in apparatus types and locations. On February 18, 2016, the Fire Department presented the Fire Department Organizational Review report to the Public Safety, Finance and Strategic Support Committee ("Committee") for review and acceptance. The full report can be viewed at: http: //san i ose. granicus. com/metav i ewer.php?meta id During the February 18, 2016, meeting the Committee asked staff to return with additional information: 1) An opinion from the Department of Transportation regarding the reliability of the traffic analysis presented in the report; 2) Information about the impact that emergency medical service (EMS) low acuity calls have on identified service gaps (these EMS calls involve patients who do not have time-sensitive clinical emergencies); 3) Analysis as to whether it would be possible for the City to secure grant funding to purchase and install Traffic Preemption Devices; 4) Information regarding the use of Three-Person Staffing Models in cities of comparable population size to San Jose; 5) Analysis as to why San Jose cannot pilot a three-person staffing model on an engine;

2 March 8,2016 Page 2 ANALYSIS Following is the information requested by the Committee on February 18, 2016: Traffic Analytics Reliability During the February 18, 2016 meeting, the Committee asked the Fire Department to work with the City's Department of Transportation (DOT) and report back with DOT's opinion on the reliability of the traffic analytics presented in the Organizational Review report. For this project, Citygate utilized the "FIERE" system, a real-time internet-based traffic map application, to analyze traffic data. HERE obtains real-time samples of traffic speeds from a variety of public and private sources and measures those speeds in 15-minute time blocks, measuring the speed between intersections (segments) 24 hours a day, seven days a week, 365 days a year, over a rolling 36-month period. The Fire Department and DOT met and discussed the request made by the Committee. At the time the memo was completed DOT was not done with its evaluation and was not ready to offer comment as to the reliability of the traffic analytics. Comment is expected to be ready and offered on March 17, 2016, at the Committee meeting. The Impact of EMS Low Acuity Calls on Identified Service Gaps During the February 18,2016, meeting the Committee asked the Fire Department to report back with information regarding the impact that EMS low acuity calls have on identified service gaps. It is important to note that while increasing call volume continues to challenge resource availability, workload is not the principal cause of service gaps identified by Citygate; rather, as shown in the completed analysis, distance between resources is the principal cause. In addition, traffic congestion, training demands, and temporary out of service occurrences when a piece of apparatus is due for mechanical servicing all contribute to slower response times. The following data covers the period used in the Citygate report and shows how many calls for service were dispatched under the Medical Priority Dispatch System (MPDS) from 5/1/2014 to 4/30/2015. Based on information at the time of dispatch, approximately 16% of these calls were lower priority (Priority 2). Medical Priority Dispatch System Code Incident Count Alpha - ((Non Life Threatening - Priority 2) 11,159 Bravo - (Unknown - Priority 1) 8,811 Charlie -(Possibly Life Threatening - Priority 1) 12,805 Delta - Life Threatening - Priority 1) 20,237 Echo - Full Arrest or Imminent Death - Priority 1) 714 NONE - Non-Triaged Call - Priority 1) 14,914 Omega - Lowest Priority (potential referral - Priority rity 73 2) Total 68,713* * Includes all calls that had an EMS component such as all fires, rescues, extrications, vehicle accidents, third party calls, etc. The Organizational Review report recommended that the Fire Department work closely with the Santa Clara County EMS Agency to design a multi-tier system that would refine the prioritization of medical calls and reassess dispatch procedures for possible efficiencies. During

3 March 8, 2016 Page 3 prioritization of medical calls and reassess dispatch procedures for possible efficiencies. During the development of the report, the County chose to extend the existing EMS Agreement with the ambulance provider for a period of three (3) years. However, the contract between County EMS and the City of San Jose (as well as all other Santa Clara County fire agencies), will expire on June 30, The Fire Department will be meeting with the County EMS Authority in March to begin discussions regarding the new contract that will become effective July 1, Traffic Signal Preemption Devices and Potential Grant Funding Opportunities The Organizational Review report noted that the Fire Department potentially could reduce total response times if the City were to install additional Traffic Signal Preemption devices. The report identified 932 intersections where installation of these devices may prove beneficial. During the timeframe of the report, the number of intersections, equipped with preemption devices was 332, that number has now increased to 349; however, their functionality needs to be reviewed with the Department of Transportation (DOT). The Fire Department and DOT will be evaluating the remaining 600 signals that lack preemption devices and developing a priority listing that includes signal locations and costs to install. As funding permits, preemption systems would be installed to improve routes used by all 33 fire stations. The current cost estimate for purchase and installation of Traffic Signal Preemption devices is between $1.6 million and $6 million, depending on how many intersections are completed. During the February 18, 2016 meeting, the Committee asked the Fire Department to identify whether or not there were opportunities to secure grant funding to pay for the preemption devices. Staff reviewed existing grant funds available for Fire programs, including the federal Assistance to Firefighters Grant (AFG) program, as well as regional grant applications through the Urban Area Security Initiative (UASI) and the funding priorities laid out in the grant guidelines for those programs. Typically, such grant programs prioritize equipment and staffing, and San Jose has been successful in obtaining more than $35 million in the last six years for those purposes. Signal preemption devices are an eligible project under the AFG guidelines; however, the grant guidelines give the devices a "Low Priority" rating. Due to the competitive nature of these grants, staff believes that signal preemption likely would not be funded by this source. There were no other funding sources identified, however the Fire Department and DOT will work together to review viable options for grant funding for signal preemption systems/devices. Three - Person Staffing Models During the February 18, 2016, meeting the Committee asked the Fire Department to provide additional information regarding major cities across the United States that staff engines with three (3) firefighters. The Organizational Review report determined that in the largest urban areas of the United States where population densities are the greatest, all of the departments provide a minimum of four (4) firefighters per engine and ladder apparatus. This is the case in every city that is equal to or larger than San Jose in population, hi addition, the report looked at other large cities in California and found that the City and County of San Francisco, as well as the cities of Oakland, Sacramento, and San Diego all staff with four (4) firefighters per engine or ladder company.

4 March 8, 2016 Page 4 Among the top 20 metropolitan cities in the nation, only two deploy engines staffed with three firefighters as shown in the table below: City (Engine Staffing) Estimated Population Sworn Personnel Staffing to Population New York (5) 8,336,697 10, per 1000 Los Angeles (4) 3,875, per 1000 Chicago (5) 2,714, per 1000 Houston (4) 2,160, per 1000 Philadelphia (4/5) 1,547, per 1000 Phoenix (4) 1,488, per 1000 San Antonio (4) 1,382, per 1000 San Diego (4) 1,338, per 1000 Dallas (4) 1,241, per 1000 San Jose (4) 1,046, per 1000 Austin (4) 842, per 1000 Jacksonville (3) 836, per 1000 Indianapolis (4) 834, per 1000 San Francisco (4) 825, per 1000 Columbus (4) 809, per 1000 Fort Worth (4) 777, per 1000 Charlotte (4) 775, per 1000 Detroit (4) 701, per 1000 El Paso (3) 672, per 1000 Memphis (4) 655, per 1000 Three-Person Staffing Pilot During the February 18, 2016 meeting, the Committee asked the Fire Department why San Jose could not conduct a pilot program with three (3) firefighters on an engine. The Organizational Review report considered three (3) verses four (4) firefighters per unit. As part of the analysis, considerable attention was given to the risk present in San Jose, staffing needed over time to control emergencies in the identified risks, the staffing per unit, available travel times, the applicable Occupational Safety and Health Administration (OSHA) safety standards, and a federal National Institute of Standards and Technology (NIST) study. The report states that under current deployment staffing conditions, the three (3) person staffing model is not recommended. The Fire Chief does not recommend that San Jose conduct a pilot.

5 March 8,2016 Page 5 Squad Placement in Oak Ridge Neighborhood The referenced gap area six (6) identified as "Oak Ridge" is defined by Highway 85, Santa Teresa Boulevard, Cottle Road, and Oak Ridge Elementary School near Lean Avenue. Dining the February 18, 2016, meeting the Committee asked the Fire Department to report back with information regarding the placement of squad units, particularly in the Oak Ridge neighborhood. The nine (9) identified service gaps require "all hazard" services, The squad resource is staffed and equipped to provide EMS response to lower level calls, however squads are not capable to provide other services such as fire suppression and rescue. The Fire Department concludes that additional squads in identified gap areas would not be an effective nor efficient model. Fire Department EMS Services During the February 18, 2016, meeting the Committee asked staff whether the City of San Jose could simply stop responding to "low level" EMS calls. Like virtually all major metropolitan cities in the nation, the San Jose Fire Department is staffed, equipped, and trained to provide firebased EMS services at the Basic Life Support (BLS) and Advanced Life Support (ALS) levels. The table below identifies the percentage of departments providing EMS service by community size*. Population Protected No EMS BLS ALS Total 1,000,0000 or more 0% 0% 100% 100% 500,000 to 999,999 0% 30% 70% 100% 250,000 to 499,999 0% 27% 73% 100% 100,000 to 249,999 3% 35% 62% 100% 50,000 to 99,999 7% 38% 55% 100% 25,000 to 49,999 18% 37% 45% 100% 10,000 to 24,999 28% 42% 31% 100% 5,000 to 9,999 40% 42% 18% 100% 2,500 to 4,999 42% 46% 12% 100% Under 2,500 46% 48% 6% 100% Nationwide 40% 45% 15% 100% 'Source: NFPA Fire Service Study, SJFD initiates patient care prior to on-scene arrival through Emergency Medical Dispatch (EMD), gathering critical information to accurately triage the call, dispatching appropriate resources, and providing life-saving pre-arrival instructions. Once SJFD resources are on scene, Emergency Medical Technicians (EMT) and Paramedics provide patient care and treatments until patient care is formally transferred to an ambulance paramedic or, in serious circumstances, maintaining care until delivery to an emergency room. The lowest MPDS triage level is the Omega level. At present, SJFD does not typically respond to Omega level calls. When they are in the first-due area of a call, squads respond to Alpha and Bravo triage level calls. For all other dispositions, SJFD dispatches the closest available engine or truck and provides patient assessment and care. Where SJFD arrives on scene, patients are 1) treated and transported, 2) refuse care (Against Medical Advice), or 3) treatment not advised based upon criteria of death.

6 March 8, 2016 Page 6 At present, the Fire Department has precise front end MPDS data. Data reflecting ultimate patient disposition is not readily available. The Fire Department recognizes opportunities for EMS system refinement. However, ultimately, providing the right level of patient and/or eliminating low acuity responses must be based upon reliable, industry accepted 911 call triage standards, and must conform to slate and county requirements. The City Attorney's Office will weigh in on the Fire Department's provision of EMS services. COORDINATION This memorandum has been coordinated with the City Attorney's Office and the Department of Transportation. /s/ Curtis P. Jacobson Fire Chief For questions, please contact Ron D'Acchioli, Deputy Director, at