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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. 17-1 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. 17-2 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 3 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 17-3 Attachment A 2021-2022 Orange County Grand Jury Report 17-4 WHERE'S THE FIRE? Stop Sending Fire Trucks to Medical Calls GRAND JURY 2021-2022 17-5 WHERE'S THE FIRE? Stop Sending Fire Trucks to Medical Calls 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 Has a water pump and Fire �e��,, ,. �° hoses. Typical tank capacity is Engines n 500-750 gallons with pump g `,� o flow of 1500 GPM far Carries fire fighters and tools, Fire Trucks WNWT--�+`�� like ladders, extinguishers, floodlights, and rescue tools. Designed to traverse rough Wildland terrain and transport more to their Enginesii`Im_ `- water relative size. Carries as much water as /r~ possible to the scene for Water = ® another firefighting apparatus. Tenders Has weak pump and less hoses than fire engine. y � Has an attached telescopic ladder to reach upper stories TrurckS —,9 of buildings. Has an aerial ladder, water Quints ram^ .4 tank (at least 300 gallons), and at least 40 cubic feet for equipment storage. Tiller +---P Has an aerial ladder that is mounted to the rear of a Trucks :Z O semi -trailer truck. Heavy Designed to carry a lot of Rescue ` - •, — � equipment for traffic collisions, Trucks 'r' building collapses, and other disasters. /r 04"M'oun.. Similar to an ambulance and Paramedic y comes with advanced life Unit support (ALS) equipment. Fire /Jr= Often driven by a fire chief. Command =.®�^— Equipped with lightbars, sirens, Vehicles 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 2021-2022 Orange County Grand Jury Page 2 17-8 WHERE'S THE FIRE? Stop Sending Fire Trucks to Medical Calls 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). 2021-2022 Orange County Grand Jury Page 3 17-9 WHERE'S THE FIRE? Stop Sending Fire Trucks to Medical Calls 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). 2021-2022 Orange County Grand Jury Page 4 17-10 WHERE'S THE FIRE? Stop Sending Fire Trucks to Medical Calls 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). 2021-2022 Orange County Grand Jury Page 5 17-11 WHERE'S THE FIRE? Stop Sending Fire Trucks to Medical Calls 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 2021-2022 Orange County Grand Jury Page 6 17-12 WHERE'S THE FIRE? Stop Sending Fire Trucks to Medical Calls 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 2021-2022 Orange County Grand Jury Page 7 17-13 WHERE'S THE FIRE? Stop Sending Fire Trucks to Medical Calls 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. 2021-2022 Orange County Grand Jury Page 8 17-14 WHERE'S THE FIRE? Stop Sending Fire Trucks to Medical Calls 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 2021-2022 Orange County Grand Jury Page 9 17-15 WHERE'S THE FIRE? Stop Sending Fire Trucks to Medical Calls 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. 2021-2022 Orange County Grand Jury Page 10 17-16 WHERE'S THE FIRE? Stop Sending Fire Trucks to Medical Calls 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 17-17 WHERE'S THE FIRE? Stop Sending Fire Trucks to Medical Calls 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 17-18 WHERE'S THE FIRE? Stop Sending Fire Trucks to Medical Calls 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 17-19 WHERE'S THE FIRE? Stop Sending Fire Trucks to Medical Calls 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 17-20 WHERE'S THE FIRE? Stop Sending Fire Trucks to Medical Calls 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 17-21 WHERE'S THE FIRE? Stop Sending Fire Trucks to Medical Calls 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 17-22 WHERE'S THE FIRE? Stop Sending Fire Trucks to Medical Calls 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 17-23 WHERE'S THE FIRE? Stop Sending Fire Trucks to Medical Calls 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 17-24 WHERE'S THE FIRE? Stop Sending Fire Trucks to Medical Calls 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 17-25 WHERE'S THE FIRE? Stop Sending Fire Trucks to Medical Calls 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 17-26 WHERE'S THE FIRE? Stop Sending Fire Trucks to Medical Calls 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 17-27 WHERE'S THE FIRE? Stop Sending Fire Trucks to Medical Calls 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. 17-32 Response to 2021-2022 Grand Jury Report August 23, 2022 Page 4 of 12 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. 17-33 Response to 2021-2022 Grand Jury Report August 23, 2022 Page 5 of 12 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. 17-34 Response to 2021-2022 Grand Jury Report August 23, 2022 Page 6 of 12 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 17-35 Response to 2021-2022 Grand Jury Report August 23, 2022 Page 7 of 12 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. 17-36 Response to 2021-2022 Grand Jury Report August 23, 2022 Page 8 of 12 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. 17-37 Response to 2021-2022 Grand Jury Report August 23, 2022 Page 9 of 12 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. 17-38 Response to 2021-2022 Grand Jury Report August 23, 2022 Page 10 of 12 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. 17-39 Response to 2021-2022 Grand Jury Report August 23, 2022 Page 11 of 12 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. 17-40