HomeMy WebLinkAbout17 - Response to the 2021-2022 Orange County Grand Jury Report "Where's the Fire? Stop Sending Fire Trucks to Medical Calls"Q �EwPpRT
CITY OF
s NEWPORT BEACH
`q44:09 City Council Staff Report
August 23, 2022
Agenda Item No. 17
TO: HONORABLE MAYOR AND MEMBERS OF THE CITY COUNCIL
FROM: Jeff Boyles, Fire Chief - 949-644-3101, jboyles@nbfd.net
PREPARED BY: Justin Carr, Assistant Fire Chief, jcarr@nbfd.net and
Kristin Thompson, EMS Division Chief, khompson@nbfd.net
PHONE: 949-644-3040 1 949-644-3385
TITLE: Response to the 2021-2022 Orange County Grand Jury Report
"Where's the Fire? Stop Sending Fire Trucks to Medical Calls"
ABSTRACT:
Per California Penal Code Section 933, the City of Newport Beach (City) is obligated to
respond to the 2021-2022 Orange County Grand Jury Report "Where's the Fire? Stop
Sending Fire Trucks to Medical Calls" by August 29, 2022.
RECOMMENDATIONS:
a) Determine this action is exempt from the California Environmental Quality Act (CEQA)
pursuant to Sections 15060(c)(2) and 15060(c)(3) of the CEQA Guidelines because
this action will not result in a physical change to the environment, directly or indirectly;
and
b) Authorize the Mayor to sign the cover letter and remit the responses of the City of
Newport Beach and Fire Chief to the Presiding Judge of the Orange County Superior
Court.
DISCUSSION:
The 2021-2022 Orange County Grand Jury (Grand Jury) report "Where's the Fire? Stop
Sending Fire Trucks to Medical Calls" focuses on responses to 911 calls for medical
services by local fire agencies (Attachment A). The Grand Jury identified several areas in
which it believes the medical services provided could be triaged and deployed differently.
The Grand Jury's report was issued on May 20, 2022, with responses due within 90 days
from the governing body. Due to the deadline falling prior to the August City Council
meeting, a written request for an extension to August 29, 2022, was submitted and
approved.
The Grand Jury's report includes several hypotheses about fire departments and
emergency medical services and outlines a total of 10 findings and five recommendations.
Per California Penal Code Section 933, the City is obligated to respond to five of the
findings and three recommendations as outlined in the report.
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Response to the 2021-2022 Orange County Grand Jury Report "Where's the Fire? Stop
Sending Fire Trucks to Medical Calls"
August 23, 2022
Page 2
As detailed in the City's proposed response, the Newport Beach Fire Department (NBFD)
has integrated Emergency Medical Services (EMS) into its delivery system since
inception in 1911. With the City's statutory obligation to provide fire protection services,
firefighters are employed and strategically placed throughout City limits to provide rapid
rescue and fire delivery services. With fire protection services in place, EMS has always
been a natural fit for our fire department personnel. In addition to providing timely fire and
rescue response times in unique and challenging topography, our fire personnel can
effectively and efficiently deliver EMS. Our EMS delivery model has consistently
demonstrated higher than state and national averages for cardiac save rates.
While the NBFD consistently evaluates our service delivery methods with the highest
regard for safety and service to our customers and patients, efficiencies and cost/benefit
always play a vital role when considering how we deliver emergency services of any kind.
Evaluation and experience play a key role in determining the need for both a fire engine
and ambulance on most (not all) of our emergency medical responses. Typically, a fire
engine is first to arrive to an incident thus deploying rapid medical treatment when
needed. Ambulances follow up with additional personnel support and ultimately have the
ability to transport the patient to the hospital thus allowing the fire engine to remain
available for another service call in their immediate area. It is important to note that
geographically challenging areas such as the Balboa Peninsula, Balboa Island, narrow
streets of Corona del Mar and gated communities require a nearby fire engine equipped
with water, hose and firefighters should an emergency occur. Eliminating fire engines
would prove detrimental to our overall community's safety and well-being. Placing
certified Paramedics on those existing fire engines creates an efficiency in overall
employee overhead.
Also of note, the Grand Jury Report reports a "breakdown of communication and trust"
between the Orange County Office of Emergency Medical Services (OCEMS) and
Orange County Fire Chiefs. The NBFD does partially agree with this assessment in some
areas, but remains committed to open and honest dialogue with our partners from
OCEMS. Improved collaboration between the Orange County Fire Chiefs and OCEMS
will advance our abilities to better serve all communities within Orange County. NBFD
Chief Boyles has been appointed to serve on an ad -hoc committee to share information
and policy implementation with OCEMS managers.
Fire Department staff prepared the City's proposed responses to the Grand Jury.
Attached is a letter for the Mayor's signature and the City's proposed responses for
submittal to the Presiding Judge (Attachment B).
FISCAL IMPACT:
There is no fiscal impact related to this item.
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Response to the 2021-2022 Orange County Grand Jury Report "Where's the Fire? Stop
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August 23, 2022
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ENVIRONMENTAL REVIEW:
Staff recommends the City Council find this action is not subject to the California
Environmental Quality Act (CEQA) pursuant to Sections 15060(c)(2) (the activity will not
result in a direct or reasonably foreseeable indirect physical change in the environment)
and 15060(c)(3) (the activity is not a project as defined in Section 15378) of the CEQA
Guidelines, California Code of Regulations, Title 14, Chapter 3, because it has no
potential for resulting in physical change to the environment, directly or indirectly.
NOTICING:
The agenda item has been noticed according to the Brown Act (72 hours in advance of
the meeting at which the City Council considers the item).
ATTACHMENTS:
Attachment A — 2021-2022 Orange County Grand Jury Report
Attachment B — Letter and Proposed Response to the Grand Jury
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Attachment A
2021-2022 Orange County Grand Jury Report
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GRAND JURY 2021-2022
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Table of Contents
SUMMARY................................................................................................................................... 2
BACKGROUND........................................................................................................................... 2
The Evolution of Fire Departments Providing Medical Services ............................................
2
A Myriad of Acronyms: EMS, ALS, BLS, PAU........................................................................
3
REASON FOR THE STUDY...................................................................................................... 4
METHODOF STUDY................................................................................................................. 5
INVESTIGATION AND ANALYSIS......................................................................................... 5
The Vast Majority of 911 Emergency Calls Routed to Fire Stations Are Medical in Nature.
5
Orange County Fire Departments and Personnel...................................................................
6
Different Areas, Different Needs.............................................................................................
6
Anatomy of a Medical Call: Dispatch to Response.................................................................
7
FirefighterFatigue..................................................................................................................
7
The Different Approaches to EMS Response in Orange County .............................................
8
Independent City Fire Departments........................................................................................
8
San Bernardino County Fire Protection District....................................................................
9
Placentia Model for EMS — A New Approach.......................................................................
10
OrangeCounty Fire Authority..............................................................................................
11
Friction Between OCEMS and OCFA...................................................................................
13
COMMENDATIONS.................................................................................................................
14
FINDINGS...................................................................................................................................
14
RECOMMENDATIONS............................................................................................................15
RESPONSES...............................................................................................................................16
ResponsesRequired................................................................................................................17
REFERENCES............................................................................................................................
19
GLOSSARY.................................................................................................................................
21
2021-2022 Orange County Grand Jury Page ii
17-6
A
TYPES OF FIRE TRUCKS
& FIRE ENGINES
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Equipped with lightbars, sirens,
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radios, and other equipment.
WHERE'S THE FIRE?
Stop Sending Fire Trucks to Medical Calls
SUMMARY
In Orange County, nearly 80 percent of all 911 calls to fire departments are for medical services.
Efficient and effective responses to 911 calls are of utmost importance to every community. Even
though 911 calls are categorized by severity, responses by most Orange County fire departments do not
change accordingly. Current protocol requires sending multiple vehicles to the scene which involves not
only additional personnel but also expensive fire equipment. This is the case even when an ambulance or
rescue squad vehicle could provide all the necessary medical supplies and personnel. Sending a 36,000
to 60,000-pound fire engine or aerial ladder truck down residential streets for strictly medical calls is not
only dangerous and costly, but it also results in unnecessary wear and tear on our streets.
Our Orange County firefighters perform an exemplary job under extremely stressful circumstances.
They often work compulsory overtime hours. After considering the demands placed on our firefighters
and the importance of optimizing efficiency while maintaining a high level of care and response time,
the Orange County Grand Jury recommends the following: Fire departments implement a universal
tiered response system to dispatch ambulances or rescue squad units to most medical calls rather than
deploying larger fire equipment as the standard response.
While the Orange County Grand Jury sees distinct advantages to separating EMS from Fire
response, we are not currently recommending privatization of medical services. We applaud the
level of care provided by all paramedics, including firefighter paramedics. The Orange County
Grand Jury does recommend, however, that the emergency medical services response model
should change.
This investigation also revealed a breakdown in communication and trust between Orange
County Emergency Medical Service (OCEMS) and OC Fire Chiefs, which includes Fire Chiefs
of the Orange County Fire Authority (OCFA) and various city fire departments. Although their
mandated responsibilities are clear, there is a mutual reluctance to acknowledge their respective
spheres of authority, in particular the critical role of OCEMS as an independent regulatory body.
BACKGROUND
The Evolution of Fire Departments Providing Medical Services
Over 100 years ago, organized firefighting in America was established primarily to guard against
loss of property. Prior to the 1970s, emergency medical calls were transferred to either private
ambulance companies or hospital ambulance companies. By the 1970s, the number of calls for
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fire service declined due to the development and enforcement of stringent building codes and fire
prevention systems. As a result, the role of local fire department has changed substantially.
In conjunction with the development of the 911 emergency call system, fire departments
broadened their service models and capabilities, creating an all -hazards approach to emergency
services delivery. The strategic location of firehouses throughout their service area made them a
logical choice to respond to time critical calls. Fire departments now respond to any number of
emergencies, including but not limited to traffic collisions, hazardous spills, cat rescues, and
natural disasters as well as fires. However, 80 percent of all calls are for medical assistance.
An Explanation of Acronyms
This report looks at the ways in which fire departments respond to and provide emergency
medical services (EMS). There are two levels of support systems in any kind of medical
emergency: Basic Life Support and Advanced Life Support.
Basic Life Support (BLS) generally refers to the type of care that first -responders, healthcare
providers, and public safety professionals provide to anyone who is experiencing a non -life -
threatening medical event. BLS treatment is noninvasive and is usually performed by an
Emergency Medical Technician (EMT).'
Advanced Life Support (ALS) is a response to critical care patients who may require invasive
procedures such as injections, intubation, or the administration of medication. Due to the more
severe nature of the patient's condition, ALS calls require a response from a crew that includes
ALS-certified responders, specifically paramedics. All paramedics, including firefighter
paramedics, are required to undergo a higher level of training than EMTs. Paramedics are trained
to administer drugs, intubate patients, and insert IVs. EMTs are not certified to perform these
procedures.
California's EMS Act authorizes each county to develop an EMS program and to designate a
local Licensed Emergency Medical Services Agency (LEMSA) that oversees the delivery of
EMS within that geographic area. This level of governance allows for local control of emergency
medical services. In Orange County, the LEMSA is the Orange County Office of Emergency
Medical Services (OCEMS) which operates under the Orange County Health Care Agency.
OCEMS is responsible for the oversight of licensing all BLS and ALS responders, the
management and inspection of privately owned ambulances, and the creation of response
protocols including mass casualty incident response plans.
1 California Emergency Medical Services "Scope of Practice," (November 2017).
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A Paramedic Assessment Unit (PAU) provides initial field paramedic assessment and
interventions utilizing a minimum of one qualified paramedic and an EMT. A PAU may escort,
monitor, and treat patients during transport to a hospital in accordance with that paramedic's
provider agency policy.2
REASON FOR THE STUDY
Previous studies within Orange County and elsewhere have come to the same conclusion: there
is an over -deployment of equipment and personnel for non -life -threatening emergency medical
calls. For example, in 2014, the OCFA commissioned Emergency Services Consulting
International to conduct a study on OCFA deployment. One of their recommendations is as
follows:
To improve the overall response performance of the OCFA delivery system the number
of units sent to most emergency medical incidents must be reduced. Criteria -based
dispatch (CBD) protocols could be implemented allowing a single unit response to most
emergency medical incidents.'
Furthermore, as part of the Anaheim Fire & Rescue 2015-2020 Strategic Plan, at page 25, it was
recommended that a Community Care Response Unit be established as "an alternative and
innovative response model that will deploy a single vehicle utilizing a nurse practitioner and
paramedic to respond to non -urgent call requests in place of a standard paramedic engine/truck
and ambulance unit response."
Grand Juries in Orange County (2011-12) and Santa Clara County (2010-11) both delivered the
same message in their reports: re-evaluate your response model to enable an appropriate EMS
response, thereby reducing costs and equipment wear and tear.
Despite all these recommendations, the response deployment for medical calls remains
substantially unchanged. This Grand Jury will revisit concerns about the expensive deployment
of fire equipment and personnel for routine medical calls.
2 OCEMS Agency Policy #330.70
' Emergency Services Consulting International, OCFA Standards of Coverage and Deployment Plan, p. 147 (2014).
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METHOD OF STUDY
To understand the structure, staffing, and response models for various fire departments within
California, as well as the relationship among the fire agencies and OCEMS, the Orange County
Grand Jury engaged in the following:
• Reviewed statutes, articles, ordinances, reports, OCFA Memorandum of Understanding
(MOU), and commissioned studies.
• Interviewed OCFA leadership, Fire Chiefs inside and outside of Orange County, City
Managers, personnel from OCEMS, private ambulance company executives, and
firefighter union leadership.
• Reviewed a large volume of material from various relevant websites.
• Reviewed OCFA Board of Directors and various City Council meeting minutes, agendas,
and staff reports related to fire and medical services.
• Toured OCFA Headquarters and Training facility.
• Reviewed multiple written communications, deployment protocols, annual reports, and
financial reports.
INVESTIGATION AND ANALYSIS
The Vast Majority of 911 Emergency Calls Routed to Fire Stations Are
Medical in Nature
OCEMS data, as well as most fire department representatives interviewed, agree that of all 911
calls routed to a fire department for response, at least 80 percent are for EMS; the lowest figure
provided was an estimated 75 percent. In areas with older demographics, the EMS percentage of
medical calls as opposed to other emergencies is even higher. At least one fire department
reported that nearly 90 percent of its calls are purely medical in nature. Furthermore, it has been
estimated that up to 80 percent of those EMS calls can be classified as BLS.4
In an OCFA-commissioned comprehensive study, it was reported in 2018 that OCFA responded
to 139,287 incidents of which 77.39 percent were EMS. Only 1.47 percent of the 911 calls routed
to OCFA stations were dispatched as fire calls.5 The remaining 21.14 percent were classified as
"other," which included calls for persons in distress, smoke, odor problems, hazardous
conditions, electrical wiring arcing, false alarms, children or pets locked in cars, and calls that
a Emergency Consulting Services International, OCFA Standards of Coverage and Deployment Plan, p. 146 (2014);
interviews with OCEMS staff and several Fire Chiefs.
5 Citygate, Associates, Inc., Standards of Coverage Service Level Assessment OCFA, p. 53 (June 30, 2020).
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were resolved prior to OCFA arrival. Consistent with this report, the OCFA Comprehensive
Annual Financial Report for fiscal year ending June 30, 2021, provided statistics showing that
out of the 152,289 emergency calls directed to OCFA, close to 75 percent were classified as
EMS, while only 1.7 percent were considered fire calls.
Orange County Fire Departments and Personnel
Orange County cities are either part of the Orange County Fire Authority or have their own
independent fire departments. Founded in 1995, the OCFA is a regional fire service agency that
currently serves 25 cities in Orange County and all its unincorporated areas. The OCFA protects
nearly two million residents with 77 fire stations located throughout Orange County. The nine
Orange County cities that are not OCFA members each have a separate fire department and
collectively protect approximately 1,187,000 residents. These independent cities include
Anaheim, Brea/Fullerton, Costa Mesa, Fountain Valley, Huntington Beach, Laguna Beach,
Newport Beach, Orange, and Placentia.
OCEMS has established a minimum requirement that one paramedic and one EMT respond to
EMS calls. It is left up to the individual fire departments to determine how to deploy personnel
and whether to exceed these minimum staff requirements. According to several OCEMS
employees and its written protocols, one paramedic and one EMT are sufficient to provide
appropriate care in response to an EMS call.
In its June 4, 2019 presentation "Consideration of Placentia Fire and Emergency Service," the
City of Placentia reported that out of 43 fire departments surveyed in Los Angeles, Orange, and
Riverside Counties, 27 departments (67 percent) utilize a three -person engine crew. This was the
most common standard among the three counties. San Bernardino County and several Orange
County cities (including La Habra, Laguna Beach, and Huntington Beach) also allow three -
person engine companies. OCFA and several other independent fire departments within Orange
County staff their engines and trucks with four -person crews.
Different Areas, Different Needs
Based on local demographics, geographic features (for example: beaches vs. forest areas), and
other community differences, the needs of various individual communities are radically different.
Fire Station 22, located in Laguna Woods, serves a median resident age over 78 years old which
results in a very high number of medical responses. Fire Station 2, located in Los Alamitos,
operates within a very different demographic and a service territory that includes beaches, a large
military installation, as well as a large retirement community. And Station 18 in Trabuco Canyon
provides services to a wildland area as well as a `suburban' area with a much lower age
demographic than Fire Station 22. Different equipment and staff deployment models are
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warranted for each environment. The OCFA approach appears to be to add `engines and trucks'
to provide service, rather than taking a much more tailored approach. The trend within OCFA
has been to remove Paramedic Squad units and replace them with Engines and Trucks.
Anatomy of a Medical Call: Dispatch to Response.
The goal of any emergency responder is to arrive on site quickly with the appropriate equipment
and personnel needed to handle the emergency. The goal of a tiered dispatch system is to match
the emergency with the appropriate level of response in terms of urgency, personnel, and
equipment.
The most well-known of the tiered dispatch systems is the Clawson system of priority dispatch.
Emergency medical dispatchers use call screening to determine what level of response is
required by determining what Clawson refers to as the four commandments of medical dispatch:
1) chief complaint, 2) approximate age, 3) status of consciousness, and 4) status of breathing.
Several of the independent city departments are members of Metro Cities Fire Authority, also
known as Metro Net Fire Dispatch or Metro Net, a joint powers agency that provides
professional dispatch services for fire and emergency medical services. Metro Net uses a
modified version of the Clawson model software to triage medical calls. Once it has been
established that the call is for medical services, the dispatchers use a software package to walk
through triage questions.
OCFA uses a severity model based loosely on the Clawson system for assessing medical
emergency calls. Dispatch employees make a preliminary determination as to the nature and
severity of the medical emergency through a series of carefully designed questions and computer
applications. However, regardless of the preliminary assessment, a full ALS response is
dispatched. This means that an engine or truck staffed with four personnel, often in partial or full
firefighter turnout, is dispatched, at least two of whom are paramedic/firefighters. A transport
ambulance with two EMT trained attendants is also dispatched, regardless of the classification of
the medical emergency.
Firefighter Fatigue
Overworked and fatigued firefighters have been the topic of several articles and commentaries in
counties throughout the State, and Orange County is no exception. There are staff shortages due
to retirements. Firefighters have been forced to take extra shifts when voluntary coverage is not
available. This can occur when firefighters are out ill, injured, on workers' compensation, or
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absent for personal reasons. Absences have been exacerbated by the COVID pandemic and the
increased prevalence of wildfires. According to the OCFA, "The volume of vacant shifts is
substantially exceeding the overtime our firefighters wish to work."6 As publicly explained by
OCFA Fire Chief Brian Fennessy, "Workplace burnout is an occupational phenomenon marked
by exhaustion, negativity to one's job, and reduced professional efficacy."'
Compulsory overtime work, often referred to as "forced hiring," is not new. While an increase in
wildfires as well as the various reasons described above contribute to the firefighter shortage,
routinely and unnecessarily sending out fire engines and trucks with the fire personnel required
to staff that equipment is also a contributing factor. Using ambulances and other similar
paramedic assessment units (PAUs) or paramedic squad units that are more efficient, nimble, and
less personnel -intensive would substantially reduce the demand on firefighters leading to a
reduction in work time and stress for on -duty firefighters. This is especially important when they
are working compulsory overtime.
The Different Approaches to EMS Response in Orange County
Independent City Fire Departments
Several long-established cities in Orange County have independent fire departments. Examples
include Anaheim Fire and Rescue, Huntington Beach Fire Department, Fullerton Fire Department,
and Laguna Beach Fire Department. Most of these departments utilize Metro Net (described above)
as their dispatcher. Even though medical priorities are evaluated by the Metro Net dispatcher, in most
cases an engine or truck with firefighter/paramedics is dispatched to the incident, along with an EMT
ambulance, regardless of the severity of the medical call. OCFA and Metro Net communicate when
necessary.
To avoid competition and to ensure quality of service, OCEMS is also responsible for contracting
qualified ambulance companies to service a particular geographic area, known as Exclusive
Operating Areas (EOA) for patient transport to hospitals. However, some cities can own and operate
ambulances that are not subject to the EOA ambulance agreements provided by OCEMS. Under
California law, only cities that had their own ambulance services prior to 1980 (including cities
served by OCFA) have the option of purchasing or contracting for their own ambulances. Those cities
may also contract with private ambulance companies independently of OCEMS.
6 OC Register, Saavedra, T. and Licas, E., "OCFA Firefighters Burned Out By Overtime" (Oct. 29, 2021).
' Ibid.
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Huntington Beach and Anaheim are two examples of this. Both cities deploy city -owned and operated
ambulances which are based in fire stations; however, not all fire stations have ambulances. Where
available, the ambulance rolls concurrently with the fire apparatus and typically arrives at the same
time. The consensus among those interviewed indicated that this is a far better scenario in terms of
overall response than relying on contracted private ambulances. There are also significant economic
and long-term staffing advantages associated with this model. One example is that having EMTs
working within the fire department serves as a pipeline for developing qualified firefighter
paramedics. A disadvantage, however, is that city -owned ambulances are not subject to required
inspection and approval by OCEMS, which the Orange County Grand Jury finds problematic.
Other benefits to cities able to operate their own ambulances are potential economic and service
advantages for residents. In those cases, fees for ambulance services are payable to the city either by
individuals or through medical insurance. Those fees typically offset the costs and, in some cases,
provide marginal revenue. That excess revenue can be then provided to the overall city Fire/EMS
department budgets to enhance services.
Most of the independent city fire agencies within Orange County offer a paramedic subscription
service for residents and local businesses. An annual fee (around $60 per household) provides "free"
paramedic services to subscribers. Otherwise, there is a per -call fee charged which is not typically
covered by health insurance companies. Huntington Beach, Fountain Valley, and Anaheim are
examples of cities with subscription paramedic services. The fees cover many of the fire department
costs for paramedic services within the jurisdiction.
San Bernardino County Fire Protection District
For comparison, San Bernardino County uses a staffing model like many other counties in the
state. Engines are staffed with a crew of three: a captain, an engineer, an ALS
paramedic/firefighter. The captain and engineer are BLS certified. Each engine is considered an
AILS response unit. In some areas, depending on budget, there may be an additional paramedic
squad unit staffed by an AILS certified paramedic/firefighter and a BLS certified firefighter.
These units can participate in rescue activities and carry appropriate rescue equipment. Contract
EMS ambulances are provided in parts of the service territory by a private provider while the
other areas are covered by the San Bernardino County Fire Protection District Ambulance
Operator Program which staffs ambulances with a single function paramedic as well as an EMT.
Dispatch is staffed by Emergency Medical Dispatch (EMD) certified personnel. Each medical
call is screened to determine its category and severity. Based on that screening, appropriate
response units are dispatched. Typically for a critical situation an engine and an ambulance will
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be dispatched Code 3 (lights and sirens). In situations that are deemed to be less critical, the
response can be a single unit or a transfer to a nurse's hotline. Their current MOU allows for
single paramedics on engines, squads, or aerial ladder trucks.
Placentia Model for EMS — A New Approach
Due to severe economic pressures, in 2019 the City of Placentia notified OCFA that they would be
withdrawing from OCFA and forming their own fire department. To save money and become more
efficient, Placentia separated the paramedic EMS response team from its Fire Department personnel
and contracted with a private ambulance company to deliver EMS paramedic services.
Placentia also decided to keep dispatching responsibilities within its Police Department which
receives all 911 calls. The police dispatcher determines whether the police, the Fire Department, a
private ambulance EMS unit, or some combination thereof (as in the case of a serious traffic accident)
should be dispatched to respond. Based on preliminary reports, the system is efficient and results in
faster EMS responses, especially for coronary and stroke cases.$ This is attributed in large part to the
fact that "turnout time" for fire equipment and firefighter personnel (listed at over three minutes and
30 seconds for OCFA) is essentially eliminated with this model. Preliminary statistics show that not
only have City costs have gone down, the time taken to appear on site for an EMS call also has been
reduced by four minutes, from 9.5 to 5.5.9
Despite the positive results and cost savings, Placentia has withstood considerable criticism as well as
a lack of cooperation from OCFA and its union.10 The cost savings could be partially attributed to
several factors: its very small geographical area; fewer wildland fires to contend with; no fast -water
rescue requirements; and the City's firefighters do not earn the same salary or benefits that OCFA
firefighters enjoy. From a cost perspective, why should they be charged by OCFA for services they
do not require? Placentia should receive credit for attempting (and in many ways delivering) a new
and better approach to EMS.
8 City of Placentia Fire and Life Safety Department Inaugural Report FY 2020-21, pps. 8-9.
9 Ibid.
10 See, e.g., OCFA Board Meeting, May 26, 2020, comments by Craig Green; Fullerton Observer, Council and Fire
Dept. Clash Over Agreement with Placentia (June 24, 2020); California Policy Center, Ring, E. Firefighting in
Orange County, Part 3 - Placentia 's War for Independence (July 1, 2020); OC Register, Robinson, A., Placentia
Alleges Retaliation, `Unprofessional Behavior' After Vote to Quit OCFA (June 28, 2019); Correspondence between
OCFA, OCEMS and Placentia Fire Dept.; Interviews.
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Orange County Fire Authority
As noted above, OCFA makes an initial determination as to the nature and severity of the
medical emergency. Regardless of the preliminary assessment, a full ALS response is
dispatched. This means that an engine or truck company, staffed with at least two
paramedic/firefighters, two EMT trained firefighters, and a transport ambulance with two EMT
trained attendants is sent to the scene. While this approach means less time is spent with the
caller before the dispatch for services occurs, it also results in a minimum of six people and two
vehicles being dispatched for all EMS calls, even for minor medical events. The OCFA MOU
with the firefighter's union specifies a minimum of two paramedic/firefighters on each ALS unit.
OCEMS agrees that a single PAU unit staffed with a paramedic and EMT provides the service
needed for most types of emergency medical calls if the requests for service are properly triaged
and dispatched based on medical priority."
In a 2014 OCFA-commissioned report,12 recommendations included the following:
Formally establish "criteria based" dispatch protocols to allow a single unit response to
those incidents triaged as non -life threatening. Staff the majority of fire engines with
three personnel, one of whom is a paramedic; in areas considered hard to cover, or those
lacking an effective response force coverage (for example areas covered by stations 40
and 53), staff fire engines with four persons, two being paramedics. Response to a life -
threatening incident would be two units.
For nonlife -threatening incidents, any response unit can be dispatched. If for example, a
squad and engine are both available and the same distance from the incident the squad
can be dispatched preserving the engine in the event of a fire incident.
Because over 75 percent of all fire dispatch calls are for medical emergencies, dispatching an ALS
response with a truck or engine to every emergency medical call does not make sense and results in a
consistent over -deployment of equipment and personnel.
Avoiding the dispatch of fire engines and trucks offers an additional advantage. If one (or both)
of the responding firefighter/paramedics must accompany the patient in the ambulance to the
hospital, then their engine typically follows the ambulance to the hospital. The fire engine and its
crew must wait until the hospital staff takes charge of the patient and releases the paramedic to
11 OCEMS Policy #330.70
iz Emergency Services Consulting, OCFA Standards of Coverage and Deployment Plan, pp. 146-47 (2014).
2021-2022 Orange County Grand Jury Page 11
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rejoin their unit. The time the engine or truck is out of service waiting for the firefighter
paramedic to be released is referred to as "wall time." COVID-19 has made wall time longer as
many emergency rooms have not been able to deal with the high volumes of patients, resulting in
much longer wait times and potential degradation of service.
Within OCFA's jurisdiction, there are at least two geographic areas with even higher medical
emergency call volumes. One such area is Laguna Woods which is served by OCFA Station 22.
Laguna Woods comprises 3.1 square miles and is home to approximately 16,000 residents with a
median age of over 78. Notwithstanding its size, Laguna Woods has the same number of calls as
the City of Tustin, which consists of a service territory of 11.1 square miles and a population of
approximately 80,000. The table below depicts the high volume of calls and the proportion of
medical calls between the two areas with the overall same number of calls.13
SIZE
# EMS
# FIRE
# TOTAL
CITY
POPULATION
(Sq Miles)
CALLS
CALLS
CALLS
Laguna
Woods
16,000
3.31
4,876
24
5,000
Tustin
80,000
11.14
4,062
95
5,395
EMS
EMS
% FIRE
% EMS
CITY
CALLS/TOTAL
CALL/POP
CALLS/POP
CALLS/POP
CALLS/SIZE
Laguna
Woods
97.52%
31.25%
30.48%
0.48%
2.07%
Tustin
75.29%
6.74%
5.08%
1.76%
While averaging just two fire calls each month, Laguna Woods is equipped with two Type 1
Engines and one aerial truck. Given the size and weight of these large fire vehicles, there is
unnecessary wear and tear on the streets of Laguna Woods when Station 22 equipment is sent out
on such a high volume of simple medical calls. Replacement of one of the two Type 1 Engines
assigned to Station 22 with two paramedic squad vehicles would save the expense of wear and
tear, maintenance, equipment, and operating costs. It would also result in faster response times
since the time it takes for fire personnel to gear up and get the larger trucks to move out is at
13 OCFA Comprehensive Annual Financial Report, FY ending June 30, 2021, pp. 135, 142-43.
2021-2022 Orange County Grand Jury Page 12
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least two minutes longer than for the smaller vehicles to roll out.14 Although that approach adds a
fourth paramedic unit to the service area, causing a shift in assignments, additional staffing
would not be necessary. Additionally, the cost of two fully equipped paramedic squad vehicles is
less than the cost of a single Type 1 Engine. The typical cost for a fully equipped Type 1 engine
is between $750,000 and $1,000,000 as opposed to the typical cost for a fully equipped
Paramedic Squad vehicle (based on a Ford F-350 Super Duty Diesel chassis) which is under
$200,000. is
Friction Between OCEMS and OCFA
Fractures between OCEMS, the OCFA, and independent city Fire Chiefs are apparent. This is
exemplified in a letter written to OCEMS from the Fire Chiefs that pointed to OCEMS's "offensive"
action in implementing policy changes without prior notice or collaboration. This complaint was made
despite the Fire Chiefs' specific acknowledgment in the same letter that a joint advisory committee had
been formed and had been discussing the issues.16
Despite the OC Fire Chiefs' complaint about OCEMS overstepping its authority, the only example
provided to the Orange County Grand Jury was the emergency action taken by OCEMS in 2021 when
hospitals were backed up. This caused long wait -times for first responders who transported patients to
the emergency room and kept them unavailable to respond to other emergencies. In response, OCEMS
introduced an emergency measure which allowed EMT and paramedic transporters to leave patients in
the hands of the hospital on a portable cot provided by the ambulance squad.17 Although the change
addressed the fire departments' problem of extended "wall time" for fire paramedics, it resulted in a
strong rebuke from Fire Chiefs for failing to provide adequate notice to them or provide an opportunity
to collaborate. Although OCEMS could possibly have provided better notice to OCFA and the
independent Fire Chiefs, the OCEMS appeared to be working in the best interest of all parties involved.
This was a fact that was, at best, only begrudgingly acknowledged by a few OCFA union representatives
and other fire agency personnel.
Tensions have been further exacerbated by COVID and the demand placed on ambulances that,
reportedly, have failed to respond to calls in a timely manner. The extent of the problem is debatable.
However, the OCFA Fire Chief took the problem into his own hands. In December 2021, the OCFA
Chief directed that all EMS responses be classified as Code 3 to speed up ambulance response times. A
14 Citygate Associates, Inc., Standards of Coverage Service Level Assessment OCFA, p. 8 (June 2020)
15 OCFA Comprehensive Annual Financial Report, FY ending June 30, 2021, p. 148.
16 Letter from OC Fire Chiefs Association to OCEMS, November 8, 2021.
17 OCEMS Temporary Suspension of Diversion and Actions to Reduce APOTs, December 29, 2021.
2021-2022 Orange County Grand Jury Page 13
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Code 3 response requires lights and sirens.'8 Code 3 responses have been shown to pose a significantly
greater danger to the public and emergency personnel.19 The Orange County Grand Jury is concerned
that this OCFA directive and the power struggles existing between the Fire Chiefs Association and
OCEMS may be viewed as self-serving rather than serving the best interests of the public.
Similar acrimony was evident when OCEMS received pointed criticism for taking a position on 2021
proposed legislation that was pending in Sacramento that directly affected OCEMS without conferring
with the OCFA or independent Fire Chiefs. While Orange County fire leadership is free to disagree with
the position taken by OCEMS, OCEMS had no obligation to consult with them prior to advocating for
itself in Sacramento.
There is consensus from both sides that the problems between these entities have escalated over the past
year; however, there have been some recent signs of better collaboration and communication.
COMMENDATIONS
• Fire department personnel for their professional service and steadfast concern for public
safety.
• All Emergency Medical Services personnel for their tireless efforts on behalf of Orange
County residents.
• Interviewees for their cooperation and time spent with the Orange County Grand Jury to
explore these issues.
• Special commendation to the City of Placentia for innovation in the face of concerted
opposition.
FINDINGS
F 1 Despite fire departments throughout Orange County having evolved into emergency
medical departments, most have not updated their emergency response protocols
accordingly, but have simply absorbed emergency medical responses into their existing
fire response models.
" Correspondence from OCFA to OC Public Health, cc: County Executive Officer, January 25, 2022.
19 Joint Statement on Lights & Siren Vehicle Operations on Emergency Medical Services (EMS) Responses
February 14, 2022.
2021-2022 Orange County Grand Jury Page 14
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WHERE'S THE FIRE?
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F2 Despite use of a tiered dispatch system, OCFA's deployment of resources for medical
responses are the same for nearly all calls, resulting in unnecessary wear and tear on
expensive fire -fighting equipment and public infrastructure.
F3 ALS staffed ambulances or smaller squad vehicles are often the most appropriate
response to medical calls and do not compromise the quality of medical care.
F4 There has been a breakdown of communication and trust between OCEMS and Orange
County Fire Chiefs.
F5 Over -deployment of firefighters for medical calls contributes to the current climate of
forced hiring and firefighter fatigue.
F6 Code 3 response is over utilized by OCFA, unnecessarily putting the responders and
public at risk.
F7 Since the outbreak of the COVID pandemic, there has been an emergency medical
personnel shortage. The pandemic also has contributed to longer wait times at hospitals
resulting in firefighter personnel being out of service for longer periods.
F8 There are specific areas within Orange County, such as Laguna Woods and Seal Beach,
that have an extremely high percentage of medical calls which, under the current model,
results in the stations servicing those communities to require two engines.
F9 OCEMS has the authority and responsibility to inspect all for -profit ambulances
operating in Orange County; however, publicly owned ambulances are not automatically
subject to OCEMS oversight.
F10 Placentia's changes to the emergency medical response protocols after leaving OCFA
have resulted in improved medical call response times.
RECOMMENDATIONS
R1 As recommended in the 2012 and 2014 OCFA Standards of Coverage and Deployment
Plans, as well as other studies, the Grand Jury recommends that, by 2024, all Orange
County fire agencies utilize criteria -based dispatch protocols and send a single unit
response to those incidents triaged as non -life -threatening (BLS). F1, F2, F5
R2 By 2024, OCFA should station a paramedic squad vehicle, which is more nimble and less
costly to operate, in place of a second engine in stations with high volumes of medical
calls. F8
R3 OCFA should immediately stop the practice of requesting Code 3 responses on all non-
life threatening (BLS) calls. F6
R4 While OCEMS should recognize how certain policy changes may pose operational
challenges to emergency responders in the field, fire leadership should recognize and
respect the independent oversight authority and expertise of OCEMS. F4
2021-2022 Orange County Grand Jury Page 15
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R5 Departments with publicly owned ambulances should allow OCEMS to inspect their
ambulances for compliance with State EMS guidelines and adopt OCEMS
recommendations. F9
RESPONSES
California Penal Code Section 933 requires the governing body of any public agency which the
Grand Jury has reviewed, and about which it has issued a final report, to comment to the
Presiding Judge of the Superior Court on the findings and recommendations pertaining to matters
under the control of the governing body. Such comment shall be made no later than 90 days after
the Grand Jury publishes its report (filed with the Clerk of the Court). Additionally, in the case of
a report containing findings and recommendations pertaining to a department or agency headed
by an elected County official (e.g. District Attorney, Sheriff, etc.), such elected County official
shall comment on the findings and recommendations pertaining to the matters under that elected
official's control within 60 days to the Presiding Judge with an information copy sent to the
Board of Supervisors.
Furthermore, California Penal Code Section 933.05 specifies the manner in which such
comment(s) are to be made as follows:
(a) As to each Grand Jury finding, the responding person or entity shall indicate one of the
following:
(1) The respondent agrees with the finding.
(2) The respondent disagrees wholly or partially with the finding; in which case the
response shall specify the portion of the finding that is disputed and shall include an
explanation of the reasons therefor.
(b) As to each Grand Jury recommendation, the responding person or entity shall report one of
the following actions:
(1) The recommendation has been implemented, with a summary regarding the
implemented action.
(2) The recommendation has not yet been implemented, but will be implemented in the
future, with a time frame for implementation.
(3) The recommendation requires further analysis, with an explanation and the scope and
parameters of an analysis or study, and a time frame for the matter to be prepared for
2021-2022 Orange County Grand Jury Page 16
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discussion by the officer or head of the agency or department being investigated or
reviewed, including the governing body of the public agency when applicable. This
time frame shall not exceed six months from the date of publication of the Grand Jury
report.
(4) The recommendation will not be implemented because it is not warranted or is not
reasonable, with an explanation therefor.
(c) If a finding or recommendation of the Grand Jury addresses budgetary or personnel matters
of a county agency or department headed by an elected officer, both the agency or department
head and the Board of Supervisors shall respond if requested by the Grand Jury, but the response
of the Board of Supervisors shall address only those budgetary /or personnel matters over which
it has some decision -making authority. The response of the elected agency or department head
shall address all aspects of the findings or recommendations affecting his or her agency or
department.
Responses Required
Comments to the Presiding Judge of the Superior Court in compliance with Penal Code §933.05
are required from:
90 Da Res onse Required
F1
F2
F3
F4
F5
F6
F7
F8
F9
1710
OCFA Board of Directors
X
X
X
X
X
X
X
X
90 Day Response Required
R1
R2
R3
R4
R5
OCFA Board of Directors
X
X
X
X
X
90 Da Res onse Required
F1
F2
F3
F4
F5
F6
F7
F8
F9
F10
County of Orange Board of Supervisors
X
X
X
90 Day Response Required
Rl
R2
R3
R4
R5
County of Orange Board of Supervisors
X
90 Day Response Required
F1
F2
F3
F4
F5
F6
F7
F8
F9
F10
City Councils of Cities of Anaheim,
Costa Mesa, Fountain Valley, Fullerton,
Huntington Beach, Laguna Beach,
Newport Beach, and Orange
X
X
X
X
X
2021-2022 Orange County Grand Jury Page 17
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WHERE'S THE FIRE?
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90 Day Response Required
Rl
R2
R3
R4
R5
City Councils of Cities of Anaheim,
Costa Mesa, Fountain Valley, Fullerton,
Huntington Beach, Laguna Beach,
Newport Beach, and Orange
X
X
X
90 Da Res onse Required
F1
F2
F3
F4
F5
F6
F7
F8
F9
1710
City of Placentia City Council
X
X
X
X
X
X
90 Day Response Required
RI
R2
R3
R4
R5
City of Placentia City Council
X
X
X
Responses Requested
Comments to the Presiding Judge of the Superior Court in compliance with Penal
Code §933.05 are requested from:
60 Day Response Requested
F1
F2
F3
F4
F5
F6
F7
F8
F9
F10
Fire Chiefs for Cities of Anaheim,
Costa Mesa, Fountain Valley, Fullerton,
Huntington Beach, Laguna Beach,
Newport Beach, and Orange
X
X
X
X
X
60 Day Response Requested
RI
R2
R3
R4
R5
Fire Chiefs for Cities of Anaheim,
Costa Mesa, Fountain Valley, Fullerton,
Huntington Beach, Laguna Beach,
Newport Beach, and Orange
X
X
X
60 Day Res onse Requested
F1
F2
F3
F4
F5
F6
F7
F8
F9
F10
City of Placentia Fire Chief
X
X
X
X
X
X
60 Day Response Requested
Rl
R2
R3
R4
R5
City of Placentia Fire Chief
X
X
X
60 Day Res onse Re uested
F1
F2
F3
F4
F5
F6
F7
F8
F9
F10
OCEMS Director
I X
X
X
2021-2022 Orange County Grand Jury Page 18
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WHERE'S THE FIRE?
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60 Da Res onse Requested.
R1
R2
R3
R4
R5
OCEMS Director
X
REFERENCES
2010-2011 Santa Clara County Civil Grand Jury Report, "Fighting Fire or Fighting Change?
Rethinking Fire Response Protocol and Consolidation Opportunities."
2011-2012 Orange County Grand Jury Report, "Emergency Medical Response in Orange Co.:
Where Did All the Fires Go?"
Anaheim Fire & Rescue Strategic Plan 2013-2018.
Anaheim Fire & Rescue Strategic Plan 2015-2020.
Assembly Bill Nos. 389 and 450 (Oct. 10, 2021).
California Emergency Medical Services "Scope of Practice," (November 2017).
California Policy Center, Ring, E., "Firefighting in Orange County — Part Three, Placentia's
War for Independence" (July 1, 2020).
Citygate, Associates, Inc., Standards of Coverage Service Level Assessment OCFA (June 30,
2020).
City of Placentia Fire and Life Safety Department Inaugural Report FY 2020-2 1.
Correspondence between OCFA, OC Fire Chiefs, OCEMS, OC Health Care Agency and Orange
County Board of Supervisors September 202 1 -February 2022.
Emergency Services Consulting International, OCFA Standards of Coverage and Deployment
Plan (2014).
EMS Matters, The Code 3 Response: The Paramedic Perspective (Sept. 23, 2021).
Fire Rescue 1, McDonough, S., "Tucson Fire's Three -tiered Approach to Manage Increasing
Call Volumes" (May 11, 2020).
Fullerton Observer, Council and Fire Dept. Clash Over Agreement with Placentia (June 24,
2020).
2021-2022 Orange County Grand Jury Page 19
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Int'l. City/County Management Assoc., "Success Story: Manager Champions New EMS
Structure" (2021).
Joint Statement on Lights & Siren Vehicle Operations on Emergency Medical Services (EMS)
Responses February 14, 2022.
Journal of Emergency Medical Services, Wood, S., "Too Many Medics? Debating a Tiered
Response vs. All-ALS EMS System" (Apr. 16, 2019).
OC Register, Saavedra, T. and Licas, E., "OCFA Firefighters Burned Out By Overtime " (Oct. 29,
2021).
OC Register, Robinson, A., Placentia Alleges Retaliation, `Unprofessional Behavior' After Vote
to Quit OCFA (June 28, 2019
OCEMS Agency Policy #330.70.
OCEMS Temporary Suspension of Diversion and Actions to Reduce APOTs, December 29,
2021.
OCFA Board Meeting, May 26, 2020, comments by City Councilman Craig Green.
OCFA Comprehensive Financial Report for Fiscal Year Ending June 30, 2021.
OCFA Standards of Coverage and Deployment (2012).
The Reason Foundation, Stuart, A., "The Alliance Model for EMS Lacks Competition, Oversight
and Accountability" (Apr. 26, 2021)
2021-2022 Orange County Grand Jury Page 20
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GLOSSARY
ALS Advanced Life Support
ALL HAZARD Emergencies, including but not limited to traffic collisions, hazardous
spills, cat rescues, natural disasters, house and car fires
BLS Basic Life Support
CBD Criteria -based dispatch
CODE 3 The use of sirens and lights on emergency vehicles
EMD Emergency Medical Dispatch
EMS Emergency Medical Service
EMT Emergency Medical Technician
EOA Exclusive Operation Area
LEMSA Local Emergency Services Agency — California's EMS Act authorizes
each county to develop an EMS program and to designate a local EMS
agency (LEMSA) for local control of emergency medical services
METRO NET Joint Powers Authority agency that provides professional dispatch services
for fire and medical services
MOU Memorandum of Understanding
OCEMS Orange County Emergency Service -Certifies Ambulances, Paramedics
and EMTs
2021-2022 Orange County Grand Jury Page 21
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OCFA Orange County Fire Authority
OCGJ Orange County Grand Jury
PAU Paramedic Assessment Unit
PM Paramedic
SEVERITY MODEL A ranking, either alpha or numerical, on how critical the medical
emergency.
TIERED Calls are categorized by severity
TURNOUT TIME The time from the dispatch call and change their status to responding
TURNOUT GEAR Fire Fighters personal protective gear
TYPE 1 ENGINE Designed for structural firefighting. It will typically include a pump that
operates at 1000 gpm, a 400 gal/tank, 1200 ft. 2 1/2" hose, 400 ft. 1 1/2"
hose, 200 ft. 1" hose, 20 + feet of ladder, a 500 gpm Master Stream, and
minimum staffing of four firefighters. Some cities utilize Type 1 fire
engines with only three firefighters due to budget or other staffing issues.
WALL TIME The time the Paramedic or fire fighter spends at the hospital after
delivering a patient
2021-2022 Orange County Grand Jury Page 22
17-28
ATTACHMENT B
August 23, 2022
The Honorable Judge Erick L. Larsh
Presiding Judge of the Superior Court
Orange County Grand Jury
700 Civic Center Drive West
Santa Ana, CA 92701
Subject: Report of the Orange County Grand Jury — "Where's the Fire? Stop Sending Fire Trucks
to Medical Calls"
Dear Presiding Judge Larsh,
The City of Newport Beach (City) appreciates the time and effort the Grand Jury spent on the
development of their report, "Where's the Fire? Stop Sending Fire Trucks to Medical Calls.
The City Council has reviewed the report and authorized the attached response to the findings and
recommendations noted in the report. This response is submitted on behalf of the City of Newport
Beach and the City of Newport Beach Fire Department. The City values the opportunity to respond to
the report, share our perspective, and provide firsthand knowledge to each of the issues requested by
the Grand Jury.
If the City of Newport Beach can provide additional information or clarification of our response, please
do not hesitate to contact Fire Chief Jeff Boyles (jboyles@newportbeachca.gov).
Sincerely,
Kevin Muldoon, Mayor
City of Newport Beach
Enclosure: City of Newport Beach's Response to Findings and Recommendations
cc: Grace Leung, City Manager
City of Newport Beach Council Members
Fire Chief Jeff Boyles
17-29
NEWPORT BEACH FIRE DEPARTMENT
100 CIVIC CENTER DRIVE, P.O. BOX 1768, NEWPORT BEACH, CA 92660
IR]C�" PHONE: 949-644-3355 WEB: newportbeachca.gov
JEFF BOYLES
Fire Chief
DATE: August 23, 2022
RE: Response to the 2021-2022 Orange County Grand Jury Report
FROM: City of Newport Beach
BACKGROUND
The Orange County Grand Jury Report (Report) was publicly released on May 16, 2022. It is important to
note, since May 2020, a National Public Health Emergency Declaration, a Presidential National Emergency
Declaration, and a California State of Emergency Declaration remain in effect relating to COVID-19. These
extraordinary conditions are pertinent for providing context to the Grand Jury Findings and
Recommendations, and our response to the observations and information requests. Namely, an
unprecedented national emergency has severely stressed the hospital and 911 emergency medical
response systems throughout the nation, including the County of Orange. This has resulted in EMS
ambulance vehicle, EMS supply, and EMS personnel shortages throughout the country. However,
Newport Beach Fire was able to maintain 911 service levels at pre -pandemic levels during this challenging
time.
Thus, in many areas throughout the country, local 911 systems have collapsed due to hospital bed delays,
a lack of emergency ambulance transport capability for EMS personnel or both. In contrast Orange County
fire agencies, including the Newport Beach Fire Department, have effectively supplemented the existing
private ambulance transport capability and personnel deficits to maintain and satisfy the public's
expectation for an appropriate and timely 911 request for assistance.
The Report obligates the City of Newport Beach (City) to respond within 90 days. On June 13, Newport
Beach Fire Chief Jeff Boyles submitted a request for an extension to August 29, 2022. In addition, on
August 4, the City Manager, on behalf of the City of Newport Beach, requested an extension to August
29tn 2022. In compliance with the Report, the City and Fire Department are submitting its response to the
following:
• Findings: F1, F3, F4, and F5
• Recommendations: R1, R4, and R5.
GRAND JURY REPORT FINDINGS
Finding F1: Despite fire departments throughout Orange County having evolved into emergency
medical departments, most have not updated their emergency response protocols
accordingly, but have simply absorbed emergency medical responses into their existing
fire response models.
17-30
Response to 2021-2022 Grand Jury Report
August 23, 2022
Page 2 of 12
Response: The City of Newport Beach disagrees wholly with Finding F1 as it pertains to Newport
Beach.
The Newport Beach Fire Department (NBFD) has integrated emergency medical services since its inception
in 1911. For over 110 years, the primary mission of the department has been to preserve life and property.
Because of Newport Beach's topography and coastal waters with high surf, the City of Newport Beach
(City) has always needed to provide rescue and lifesaving services for its residents and visitors. The NBFD
is comprised of firefighters and ocean lifeguards who have emergency medical technician (EMT)
certifications and paramedics who are licensed emergency medical services (EMS) providers by the State
of California and the County of Orange.
As reported in the City's 2011-2012 Grand Jury response, the NBFD was presented with its first mechanical
resuscitation device that was used on one of the first fire apparatus in 1913. In September 1927, the
department's first rescue squad was placed into service for the sole purpose of providing life-saving
resuscitation in the case of drowning, smoke inhalation, or other medical emergencies. In 1937, the sign
in front of the NBFD headquarters read "Fire and Life Saving Depts."
It was not until the late 1960s and the early 1970s that pre -hospital emergency medical services became
more formalized. This was recognized in a document published by the National Academy of Sciences (NAS)
in 1966 entitled, "Accidental Death and Disability: The Neglected Diseases of Modern Society." The NAS
Report (1966) concluded that accidental injury was the "neglected epidemic of modern society" and "the
nation's most important environmental health problem." Importantly, The NAS Report (1966),
Recommendation #3, observed (italics added):2
Few are adequately trained in the advanced techniques of cardio-pulmonary resuscitation,
childbirth, or other life-saving measures, yet every ambulance and rescue squad attendant,
policeman, firefighters, paramedical worker, and worker in a high -risk industry should be trained.
Veteran medical experts returning from the Korean and Vietnam wars felt their chances of survival on the
battlefield were far better than on America's streets. The reduction in the death rates of war casualties
was directly attributed to how quickly medical care was initiated after injury.3 Congress reacted by
charging the Department of Transportation (DOT) with establishing federal funding and standards for
regions willing to develop emergency medical services (EMS) systems between 1966 and 1973. The DOT
went on to create national standards for the training of emergency medical technicians and paramedics
as well as defining the required components of an EMS system.
Recognizing the value of resources already in existence, such as strategically located fire stations and
response vehicles, as well as fire personnel already trained to respond to emergencies, the California
' Michael J. Novak, Images ofAmerica: Newport Beach Fire Department, (Charleston SC, Chicago IL, Portsmouth
NH, San Francisco CA: Arcadia Publisher, 2008), 16, 29, 95.
2 A.E. Kuehl. Prehospital systems and medical oversight, 3rd Edition, p. 5, National Association of EMS Physicians,
Kendal/Hunt Publishing (2002), citing Accidental death and disability: the neglected disease of modern society,
National Academy of Sciences, Washington, D.C., National Academy Press (1966).
3 Prepared by Committee on Trauma, Committee on Shock, Division of Medical Sciences, National Academy of
Sciences, and National Research Council, Accidental Death and Disability: The neglected Diseases of Modern
Society, (Washington D.C., Sept. 1966).
17-31
Response to 2021-2022 Grand Jury Report
August 23, 2022
Page 3 of 12
Legislature passed several important statutes. In response to the NAS Report (1966), the Legislature
enacted California Health and Safety Code 2194 in 1967, which mandated minimum first aid and training
standards for all public safety personnel.
The NBFD complied with the mandate and all fire personnel became certified in advanced first aid while
all captains became qualified first aid instructors. Also, during this time, three physicians in Los Angeles
County launched a pilot program that trained firefighters as "Mobile Intensive Care Paramedics"
(Paramedics) to provide advanced life support to the critically ill and injured.
The success of the program led to the California Legislature passing the Wedworth-Townsend Paramedic
Act (WTPA) in 1970. The Legislature enacts the WTPA (1970) as an "urgency statute," and actively
encourages California's local governments to voluntarily participate in the new "pilot programs."' On May
23, 1973, again as an "urgency statute," the Legislature amends the former WTPA (1970) to allow "public
employees" to be trained as paramedics at a reduced cost.6
The May 1973 WTPA (1970) amendment allowed the County of Orange to establish a Mobile Intensive
Care Paramedic Pilot Program in January 1973. The Orange County Board of Supervisors (OCBOS)
designated an Emergency Medical Care Committee (EMCC), through which all aspects of planning were
to be presented and coordinated. At the direction of their governing boards and councils, the Orange
County Fire Service took on a leadership role while working in collaboration with the EMCC to develop a
master plan for paramedic services. This document served as a guide for the implementation of a fire
based, EMS delivery system utilizing paramedics.' Each fire department funded their paramedic program
costs with local dollars. On May 30, 1974, the City of Newport Beach approved the implementation of a
Paramedic Program, which began with eight firefighters certified as paramedics on September 26, 1975.8
9 The NBFD's first paramedic ambulance was placed into service on October 8, 1975. The OCBOS
eventually adopted the Master Plan as policy in 1976.
Since the implementation of the paramedic program, the NBFD has steadily increased the number of
paramedics from the original eight to 42. The current operating EMS model deploys ambulances staffed
with two firefighter paramedics to provide emergency medical treatment and transport across the city's
24-square miles of land. In 2021, the NBFD completed a transition to place a licensed firefighter
paramedic as a member of every fire engine crew throughout the city. This enhancement expedites the
department's ability to provide advanced life support services to every community member in need of
medical services.
The historical timeline outlined above illustrates how the delivery of life saving services, now more
commonly referred to as EMS, was a primary responsibility of the NBFD since its inception. The evolution
4 Now California Health & Safety Code § 1797.182 (lifeguards & firefighters), 1797.184 (CH 1246, 1983) (police
officers).
5 Former Chapter 421, SECTION 2, as added by "Statutes of 1970," p.p. 832-834, SECS. 1-2, "July 15, 1970" (CH
421, 1970).
6 Former H&SC § 1481.3 (1973); as amended by "Statutes of 1973," p.p. 103-104, SECS. 1-2, "May 23, 1973" (CH
61, 1973).
7 Office of the City Manager, Paramedic Services Report, (City of Newport Beach, CA, May 1974).
'Newport Beach, CA, Regular City Council Meeting Minutes, May 28, 1974.
9 Orange County Medical Center, Graduation Program Class 1-75 (#6), (Orange County Mobile Intensive Care
Program Paramedic Training Division, Sept. 26, 1975.
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of EMS as a formalized system was a direct result of innovative planning over the decades. The NBFD has
long been at the forefront of collaborating with the state, county and other local agencies in advancing
EMS services and protocols. Therefore, we disagree wholly that fire departments have not evolved or
updated their emergency response protocols in response to community needs and best practices in
response to medical aids.
Finding F3: ALS staffed ambulances or smaller squad vehicles are often the most appropriate
response to medical calls and do not compromise the quality of medical care.
Response: The City of Newport Beach disagrees partially with the Finding F3 as it pertains to Newport
Beach.
Within the fire service, ambulances respond to medical calls, fire rescues, and traffic collisions, and, if
needed, transportation of patients to a hospital. The City partially agrees with the portion of Finding F3
stating, "ambulances ... are often the most appropriate response to medical calls." First, embedded in this
finding is the implicit recognition that ambulances and fire agency emergency response vehicles are
appropriate resources to be deployed when a 911 request for medical assistance is received. This response
capability is achieved by careful consideration, assessment, and planning that ensures that fire engines
are strategically placed throughout the jurisdictional area, thereby safeguarding that the engine typically
arrives on scene first. The geographical area which a fire station primarily serves is known as its "first -in."
Moreover, because fire department officers and personnel are very familiar with their first -in areas (e.g.,
the local traffic patterns, street configurations, and other factors that impede a timely response), a fire
engine captain knows the fastest way to reach an emergency incident location regardless of whether it is
a house fire or call for medical assistance. This first -in response of the engine's three crew members allows
them to initiate prompt medical aid to the patient when indicated. If there is a critical patient or patient
requiring additional stabilizing measures, fire engine crew members will accompany the patient in the
ambulance to the hospital. This level of response ensures that the quality of immediate medical care is
not compromised.
When experiencing a medical emergency, the patient's immediate care is a top priority for all involved
from those at the scene, to the dispatcher, to the responding agency and its personnel. Even with the
existing tiered dispatching through Metro Net, there are incidents that need to be upgraded for additional
support of personnel and/or equipment. The unpredictability of a dynamic emergency scene and the
unknown level of care a patient may require, warrants more than the response of two personnel in an
ambulance or squad vehicle.
The Grand Jury Report states, "OCEMS has established a minimum requirement that one paramedic and
one EMT respond to EMS calls."10 However, per OCEMS Agency Policy/Procedure, "a prospective EMT-P
service provider agency shall" commit "to provide ALS service meeting OCEMS staffing requirements for
each unit. (2 EMT -Ps per ALS unit; 1 EMT-P per paramedic assessment unit.)"11 Further, the OCEMS
Policy/Procedures defines an ALS unit as, "an emergency vehicle, such as a van, engine, company, truck
company, squad, helicopter or other emergency vehicle specially equipped and staffed."12 The
assumption of responding to calls with a "minimum" requirement put forth by OCEMS should not be
10 2021-2022 Orange County Grand Jury, "Where's the Fire?", page 6.
1 Orange County EMS Agency Policy/Procedure, Policy #700 EMT-P Service Provider Criteria, Section lll, B, 5.
12 Orange County EMS Agency Policy/Procedure, #090, Definitions.
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misconstrued to represent the actual dynamic needs of providing the most appropriate and quality
medical care to the public
The National Fire Protection Association (NFPA), the agency that provides standards for emergency
response and fire protection, recommends a minimum response of four personnel to provide for patient
care and safety and the safety of first responders.13 An incident runs efficiently and effectively when an
appropriate number of personnel are on scene, functioning as a high-performance team, to help assess,
treat, and move the patient toward definitive care. While on scene, even with four to five personnel to
assist, there can be untold obstacles for a patient that is injured, immobile, trapped, or in distress. Having
adequate personnel and equipment as part of the initial response prevents unnecessary delays in patient
treatment and transport. Additionally, safety is a factor for patients and responders particularly when
"entering an unknown situation that could be unpredictable and EMTs are taught priorities in a specific
order: 1) personal safety, 2) safety of their partners or colleagues, and 3) care of the patient. Any threat
to one prevents moving forward to the next."14 Thus, responses to busy highways, drinking
establishments, and even private residences can suddenly turn dangerous.
As noted above in the Response to Finding F1, fire departments have a long history of responding to
medical emergencies because they have strategically placed fire stations with highly trained personnel,
they are equipped to manage a multitude of assignments, and can provide the most comprehensive
service. Many agencies currently implement fire -based ambulances to assess, treat, and transport
patients from emergency scenes to hospitals while maintaining the ability to respond to numerous other
types of incidents. Removing fire engines and trucks from EMS -related responses could potentially create
an environment that has the potential to double current staffing and equipment needs while reducing
service levels to the community and delay in responding and compromise quality patient care.
The Grand Jury Report further states that sending a fire engine to medical calls is creating "unnecessary
wear and tear on the streets" and that replacing an engine with "paramedic squad vehicles would save
the expense of wear and tear, maintenance, equipment, and operating costs." As to wear and tear on
streets, the Grand Jury Report focused on the 5,000 average annual EMS and fire calls in the city of Laguna
Woods. The assumption that this volume of trips by fire apparatus is tearing up roadway infrastructure is
unfounded. According to the Laguna Woods General Plan,15 the highest average daily traffic (ADT) is
45,000 on Moulton Parkway with the lowest ADT of nearly 6,000 on Santa Maria Avenue. Of the streets
listed in the General Plan the average ADTs is 37,140, which equates to an average annual traffic volume
of 13,556,100 in Laguna Woods. Thus, the 5,000 annual trips by fire apparatus are only 0.037 of the annual
traffic volume on the streets of Laguna Woods.
While it is true that the cost to purchase a new fire engine is more than an ambulance, they serve different
purposes, and one could not replace the other. For the NBFD, the wear and tear and maintenance needs
of ambulances far exceed that of a fire engine. Because of weight, high usage/mileage and more,
ambulances have a shorter life expectancy and are replaced more frequently than an engine. Per the
Newport Beach City Council Policy Manual,16 ambulances are scheduled for replacement every eight years
13 National Fire Protection Association, Codes & Standards, NFPA 1710, 2020.
14 National Library of Medicine, EMS Scene Safety, Klein and Tadi, May 8, 2022.
's City of Laguna Woods, Laguna Woods General Plan, Circulation Element, 2002.
16 City of Newport Beach, City Council Policy Manual, F-9 City Vehicle Replacement Guidelines, 2016.
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and fire engines are replaced every 13 years. Thus, 1.6 ambulances are purchased for every engine. The
Grand Jury's hypothesis of cost savings is unsubstantiated.
The Newport Beach Fire Department continually reviews the changing needs of the community, and new
technology and equipment that becomes available. Fire agencies within Orange County, and across the
country, continually work to innovate response models focused on serving the evolving needs of
communities while not compromising fire protection or life-saving abilities. Adjustments for responding
to these changes are ongoing; however, fire engines will continue to be a part of the response. Therefore,
while we agree that ambulances are often the most appropriate response to medical calls, eliminating the
additional response of an engine (staffed with a paramedic and 2 EMT's) or truck (staffed with EMT's) will
compromise the quality of medical care, efficiency, and safely
Finding F4: There has been a breakdown of communication and trust between OCEMS and Orange
County Fire Chiefs.
Response: The City of Newport Beach partially agrees with Finding F4 as it pertains to Newport
Beach.
The Orange County Fire Chiefs Association (OCFCA) and NBFD seek collaboration with our Regulatory EMS
partners in providing optimal EMS services to our community. At the request of OCFCA, an EMS advisory
committee was formed over 2 years ago to facilitate communications and collaboration with Orange
County EMS (OCEMS). One of the goals of the advisory committee is collaborating on the implementation
of policies to ensure OCEMS intent is clearly understood, and policies are written clearly, with no
ambiguity, prior to being carried out by personnel. Frustrations understandably arose when the advisory
group was not utilized by OCEMS for the purposes with which it was created for. OCFCA has had a decades
long effective and strong partnership with OCEMS in putting policies, related to the delivery of optimal
medical services, into practice in the field, however those relationships have been strained the last 4 years
or so. This relationship, when based on mutual trust, respect, open communication, collaboration and
with reasonable expectations, results in straightforward implementation of OCEMS medical protocols, as
it had been done consistently over the past decades. Despite our sometimes -conflicting viewpoints, the
NBFD and OCFCA remains willing and engaged to continually improve the partnership with OCEMS
through collaboration and open communication to ensure optimal provision of EMS services in Orange
County.
Finding F5: Over -deployment of firefighters for medical calls contributes to the current climate of
forced hiring and firefighter fatigue.
Response: The City of Newport Beach disagrees wholly with Finding F5 as it pertains to Newport
Beach.
The NBFD's staffing model ensures the right -sized, highly trained, and prepared personnel respond to
each unique call for medical aid. This staffing model ensures that enough fire personnel, consisting of a
minimum of two paramedics and three EMT's, and the necessary equipment are deployed and available.
Fire personnel are trained to respond effectively, efficiently, and promptly, to a myriad of high risk, all
hazard conditions. Having multi -function personnel on scene allows for the safe management of scene
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hazards, bystanders, victims, and personnel. Often, patients are non -ambulatory, and care may involve
rescue, extrication, or complicated maneuvering that requires assistance from all responding personnel.
Providing the optimum level of service to the community, regardless of the nature or the circumstances
surrounding the emergency call for service has always been the goal of fire agencies. Firefighter EMT's
and firefighter paramedics are not "over deployed" on medical calls, and it is not a factor of forced
hiring or firefighter fatigue.
Force hiring is a mechanism to ensure minimum daily staffing levels are met. Daily staffing levels are
critical in providing a 24/7/365 timely response capability within the Newport Beach community as well
as providing mutual aid throughout the county and state. Force hiring occurs when a vacant position is
not filled voluntarily. Vacancies can occur when personnel are on approved leave, get sick or injured, are
deployed on an incident strike team or overhead assignment, or when there are open positions waiting
for the recruitment and hiring process to be completed. Force hiring does not occur because of
deployments to medical aids.
The current climate of forced hiring and fatigue is largely due to multiple contributing factors. The
Pandemic Emergency is still in effect and is continuing to affect first responders and healthcare
personnel. The surge periods significantly impacted firefighter personnel over the last two years, while
also responding to and fighting some of the largest wildfires on record for California.
Additionally, the demand for emergency services is increasing. Some contributing factors include
increased population, over -utilization of the 911 system, emergency departments being used in place of
a primary care doctor visits, decrease in preventative care strategies, delay in seeking care until a health
issue becomes an emergency, and increases in trauma -related incidents, mental health and substance
use disorders, as well as COVID-19 related health emergencies.
During these times of system stress, force hires were required to maintain daily operational capabilities,
with staffing levels at pre -pandemic levels, and services within our community, as well as the needs of
the public throughout the County and the State.
Conversely, during this period, many private ambulance companies faced challenges in maintaining daily
service levels, experiencing significant decreases in staffing due to challenges related to the pandemic.
These staffing challenges resulted in extended response times by private ambulance companies.
The NBFD manages its EMS response system to ensure, within the scope of our available resources, that
when a member of the public calls 911, they will receive rapid, optimal care from professionals. Therefore,
we disagree wholly on the Grand Jury's hypothesis that forced hiring and firefighter fatigue are due to a
perceived over -deployment of firefighters due to our EMS delivery model.
Finding F9: OCEMS has the authority and responsibility to inspect all for -profit ambulances operating
in Orange County; however, publicly owned ambulances are not automatically subject to
OCEMS oversight.
Response: The City of Newport Beach partially agrees with Finding F9 as it pertains to Newport
Beach.
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The Grand Jury correctly observes that public ambulances are not automatically subject to certain
regulatory inspections by OCEMS. However, this circumstance results not from the NBFD's actions, but
from a legislative determination that public safety agencies are exempt from certain regulatory
requirements applicable to private, commercial transportation companies. Thus, OCEMS has
comprehensive private ambulance provider oversight, including policies on licensing, ambulance design,
retention of state and county licensing records, and so forth.
Nevertheless, the NBFD agrees that OCEMS should conduct inspections of ambulances to confirm that
such units have the proper medications, supplies, and equipment as prescribed by OCEMSA Policies
#325.00 Advanced Life Support (ALS) provider Minimum Inventory and #720.30, Section V-Ambulance
Equipment. However, for public agencies, these medically related inspections are not for licensure or
permitting purposes as they are for private companies, but for medical quality assurance purposes. Lastly,
any associated Inspection related fees, if any, should be cost based.
According to the OCEMS Agency Policy/Procedure, "OCEMS may inspect any ambulance vehicle operating
in Orange County." Further, the "policy sets minimum acceptable standards, any exemptions for public
providers allowed by law.1117 The NBFD is a public provider of emergency services, prehospital medical
care, and emergency transport. The NBFD follows the requirements placed on public agencies by OCEMS
and the State of California, which has more stringent requirements.
The NBFD agrees that OCEMS does not currently automatically inspect all publicly owned ambulances.
GRAND JURY REPORT RECOMMENDATIONS
Recommendation 1:
As recommended in the 2012 and 2014 OCFA Standards of Coverage and
Deployment Plans, as well as other studies, the Grand Jury recommends that, by
2024, all Orange County fire agencies utilize criteria -based dispatch protocols and
send a single unit response to those incidents triaged as non -life -threatening
(BLS). F1, F2, F5.
Response: The Grand Jury's Recommendation #1 has not yet been implemented as it pertains to
Newport Beach as discussed below.
The Newport Beach Fire Department has been using criteria -based dispatch protocols for over 20 years.
The department's priority is to efficiently provide community members with the highest level of customer
service and medical care possible. The Grand Jury's recommendation to send a single unit response to all
non -life -threatening calls could be detrimental to the public. Recommendation #1 can be read to mean a
single ambulance or single first response unit. For the purposes of the City's response, we will assume the
Grand Jury desires a single ambulance vehicle response for a "non -life threatening (BLS)" request for
emergency medical assistance.
In Newport Beach, all 911 calls are screened through an Emergency Medical Dispatch protocol that has
been approved, and is continually reviewed and updated, by a team that includes the NBFD Medical
Director, the NBFD EMS Division Chief, the NBFD Operations Chief, a dispatch supervisor, and the dispatch
" Orange County EMS Agency Policy/Procedure, #720.50 Ambulance Rules and Regulations, Section W.C.
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manager. Thus, the NBFD is already implementing this portion of Recommendation R1. Nevertheless, we
offer additional observations related to criteria -based dispatch protocol discussion.
First, the Grand Jury's Recommendation #1 appears to assume that a "non -life threatening (BLS)"
emergency is synonymous with an emergency that does not require additional human resources and/or
equipment. In each incident, a patient must be placed on a gurney and the gurney must be placed into
the ambulance. In areas where gurneys do not fit (e.g., a typical bedroom, hallway, etc.) and/or a patient
cannot walk unassisted, it takes human resources to get the patient safely onto the gurney and the gurney
into the ambulance. In some circumstances, regardless of patient acuity, it takes a lot of human resources
to safely and efficiently move patients into the ambulance, regardless of "BLS" status.
For example, if a person has an unstable fracture that must be manually stabilized, a single paramedic in
the back of an ambulance would find it difficult to do anything else, even though this is a "non -life
threatening (BLS)" incident. Accordingly, one or more persons from the fire engine may also accompany
the patient to the hospital in the interest of good patient care. When confronted with a "life threatening"
emergency, having the ability to place additional fire personnel into the ambulance, who are already on
scene, can be essential to providing quality patient care and in a timely manner. Additional personnel can
be highly trained firefighter EMT's and/or paramedics as ALS patients can also require EMT level skills on -
scene and during transport.
Second, in both "non -emergency" and "emergency" dispatched incidents, if the patient needs BLS (e.g.,
CPR, AED use) or ALS emergency care, this care is made promptly available. Although not routine, crews
have been dispatched for a BLS level call only to arrive on scene and discover the patient needs ALS level
care. This circumstance can result because the EMD dispatcher can only react to the information the caller
requesting assistance provides. In these situations, patient care may be significantly compromised if
additional resources need to be dispatched. Providing proper patient care within the first 10 minutes is
critical to their outcome. Time is of the essence, as is having the proper equipment and personnel on
scene.
Third, emergency response crews do not simply show up on large or major emergency incidents and
seamlessly work to together. Working well together on complex or dynamic incidents such as an "active
shooter" incident, comes from working with each other on daily and routine incidents. The Grand Jury's
recommendation, if it implies a single ambulance only response to a "non -life threatening (BLS)" incident,
may be inconsistent with current practices which promote first responder cohesion on emergency
incidents. While we recognize that using the principles of the Incident Command System (ICS) to manage
routine medical aid calls is not necessarily essential, such principles and practices become vitally
important when managing incidents involving fire, medical and law enforcement. Numerous and recent
"after action" reports on major incidents undisputedly make this point.18
Fourth, for medically related incidents on the streets and roadways, the fire engine serves as critical
"blocking" role for all EMS and law enforcement personnel on -scene. Simply put, large fire apparatus are
carefully positioned on roadways, highways, and/or freeways to minimize injury to EMS personnel (public
" Active Shooter Incident and Resulting Airport Disruption, A Review of Response Operations, Los Angeles World
Airports, March 18, 2014; Robb Elementary School Attack Response Assessment and Recommendations, ALERT,
Texas State University, p. 19, July 6, 2022; Texas House of Representatives, Investigative Committee on the Robb
Elementary Shooting, p.p. 77-78, July 17, 2022.
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and private) and bystanders should an errant driver intrude into the emergency scene. This "errant driver"
hazard is not hypothetical, but unfortunately occurs due to driver distraction which is the cause of many
vehicle accidents in the first instance. Moreover, this life safety hazard exists on every roadway response,
regardless of severity.
Finally, there is safety in numbers. A "non -life threatening (BLS)" response is not necessarily an
appropriate response as far as personnel safety is concerned. There are numerous reports documenting
this. For example, patients with mental health related issue or under the influence of a substance, may
become combative and require restraints to prevent harm to themselves and others. Having the
capability to immediately implement any medically appropriate protective measures requires the
immediate availability of additional human resources.
In sum, although the decision on what resources to send on a request for emergency medical assistance
is affected by medical and operationally related factors, other non -medically related factors may also
come into play. The City will continue to assess and evaluate our deployment polices, including number
of responding personnel and units, for appropriate response levels, while maintaining a priority of safety
and providing the highest level of service to our community
Recommendation #4:
While OCEMS should recognize how certain policy changes may pose operational
challenges to emergency responders in the field, fire leadership should recognize
and respect the independent oversight authority and expertise of OCEMS. F4.
Response: The recommendation has been implemented as it pertains to Newport Beach.
The City does not challenge the independent medical control and regulatory authority of the OCEMS nor
its regulatory expertise in this area. Rather, the City's concerns arise when medical control authority is
used to unduly usurp the City's administrative control over the NBFD operations. OCEMS is not a first
response organization with expertise in executing day-to-day emergency response operations within their
sphere of influence.
A similar comparison can be made to the Orange County Health Care Agency's regulatory inspections of
restaurants. Inspections are conducted to ensure a standard of cleanliness to operate but does not include
advising the restaurant owner on how to operate their business. Using this comparison, OCEMS regulates
medical control but should not advise EMS providers on how to best provide services to their
communities.
Further, the NBFD agrees with statement in Recommendation #4 that the OCEMS processes for the
implementation of medical policies can pose operational challenges in the field. However, thru effective
collaboration and communication, those operational challenges can be mitigated.
Recommendation #5: Departments with publicly owned ambulances should allow OCEMS to inspect
their ambulances for compliance with State EMS guidelines and adopt OCEMS
recommendations. F9.
Response: NBFD partially agrees with the Grand Jury's Recommendation #5 as it pertains to Newport
Beach.
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The NBFD partially agrees and as such, looks forward to developing a workable and cost-effective
ambulance inspection plan with OCEMS. Refer to comments in Finding F9 regarding licensure and
permitting purposes by OCEMS for public providers.
The NBFD is a public agency providing 24/7/365 response to fire, rescue, ALS and BLS medical care, and
emergency transportation services. All fire apparatus follows the State of California's strict regulations to
ensure compliance with safety and service. The City of Newport Beach employs trained professionals to
service the apparatus and performs annual preventative maintenance, and as needed repairs,
installations, and upgrades.
Private, for -profit ambulance providers have contractual "agreements with the County of Orange to
provide for the County of Orange to license and regulate ambulance services operating in" the listed
contracted cities.19 OCEMS is the regulating authority with the responsibility of providing permits to
operate, annual inspections, and all oversight of these private, for -profit ALS and BLS service and patient
transport providers. OCEMS is not the regulatory authority over publicly owned ambulances for licensing
and permitting purposes.
19 Orange County EMS Policy/Procedure, section #720, Appendix 11. Ambulance Contract Cities.
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