1. Reconfiguration Update San Francisco Fire Department EMS Division

2. Collaborative Process Under the Direction of the Chief of Department, Deputy Chief of Operations, and the Deputy Chief of Administration –Department of Human Resources –Division of Training –Bureau of research and Planning –EMS Division: Admin., Ops, QM –H-3 Committee / PMs & Local 798

3. This Presentation Transition of Static to Dynamic Deployment Posting Locations Workload Transition Logistics Support Center Patient Care & Performance Management Challenges to Response times in the City & County of San Francisco What is next?

4. Project Goals Operate within County mandated response time guidelines Stabilize / equalize workload across static ambulances Complete Truck training Data Driven Measurable and Controlled changes Limit Risk exposure Fire / EMS Industry Best Practices

5. 19 - 24 hour Ambulances

6. Transition of Static to Dynamic Deployment Static Deployment = Fixed facilities / stations Dynamic Deployment = System Status Management [SSM] SSM matches the Service Demand (calls) with Resources (ambulances/medical units) and moves these resources in the system/City to where the service is needed

8. Phase 1 Close Medics [24 hour]: Station 1, Station 3, Station 36 Add: Ambulances on 10 hour shifts Develop posting location in the center of the highest Demand for service Develop Business rules to assist dispatch with placing the ambulances where they are needed

9. Highest Call Volume Per Mile 2

11. Workload per District 11/06

13. Comparison of Nov 06 & Aug 07

14. Phase 4 Close Medics: 11, 21, 28 Add additional shifts Deploy a combination of 2 paramedic ambulances & 1 EMT + 1 paramedic ambulances Continue to monitor performance metrics

16. Static Layout Phase 4

17. Logistics Support Center 1415 Evans Street Best Practices for the Center –Sunstar – Pinellas County –AMR - Alameda County Nine Fuel / Supply Hubs at Firehouses Mobile Supply caches Performance Management –Section Chief EMS Operations –Captain –Lieutenants –Field RC’s –Quality Management

18. Patient Care Comprehensive Performance Management Program approved by the EMSA 1.Each new PM surveyed regarding course content 2.Surveyed a second time after 30 days regarding course content applicability 3.90, 180, 270 & 360 day skills testing Critical failures addressed with remediation 4.Paramedic Captain ride-a-long with performance narrative regarding each new member in a data base 5.Interview with EMS-1 regarding Division performance and career path forward

19. Good Reports From RC’s Field crews [suppression] they work with From their new colleagues in the ambulances From the Hospital staff EMSA Medical Director SFFD Medical Director Citizens at large Patients

20. SFFD Outreach Programs HOMETEAM –Work with Department of Public Health to mitigate Demand… while getting the patient connected with services Asthma Outreach –Healthy communities / dealing with illness as a child or young adult McMillan –Alternative transport facility / sobering center Mental Health receiving facility alternatives

21. What is Next? Continue with Performance Management Plan Continue Outreach Interoperable training with Firefighter paramedics and the new members Interoperable training with Private sector

22. Align DPH Policy & Planning for system implementation with SFFD Department of Public Health: Surge capacity & Mass Care –Planning, Policy –Patient tracking –Equipment specs & purchases w/HLS support –Interoperable exercises

23. Pinnacle 2007 EMS Leadership Conference 400 EMS Leaders Best Practices SFFD is On Track! –SSM –Mission driven, employee collaborative/transparent, & patient focused –Data validated process –Local and Regionally interoperable –Living process with constant monitoring and input

24. Intentionally Blank

25. Response Time Challenges Supply & Demand is the issue Supply –can be monitored and adjusted –Hospital diversion Demand –Difficult to predict sudden changes –Trend analysis ongoing –Workload monitoring daily –Hospital diversion –Working on Special programs Wellness programs Dispatch efficiencies Performance management at the street level

26.  CHN  VA  PMC  STF  KSF  STM  UC  RKD  SFGH  STL  STN B - 10 B - 9 B - 8

28. Ambulance Destinations

29. Hospital Diversions in 06 - 07 SFGH 19% UCSF 8 %

30. Location of the Hospitals