San Bernardino Fire Department gives AMR 25% of 9-1-1 medical calls

October 26, 2014

San Bernardino County Sun

Blog note: we post this article because it references a grand jury report in another county that made recommendations that a San Bernardino County agency might consider (see red highlighted text below). Officials in one county read grand jury reports on other counties.

SAN BERNARDINO >> The Fire Department has handed off one of every four medical calls to a private ambulance company each of the past two months, part of a new program to reduce workloads and response times to reach a target the city has missed in recent years.

In both August and September, firefighters received nearly 2,800 calls for emergency medical service, and immediately gave about 700 lower-priority calls to American Medical Response, which works out to 26 percent of calls in August and 25 percent in September, said Battalion Chief Nathan Cooke, who oversees the program.

“The ultimate goal is to get our average response time down,” said Cooke, who doesn’t yet have numbers showing that happening but hopes he soon will. “The average response time from the time someone dials 9-1-1 is 9:50, and we want that within 8 minutes.”

San Bernardino used to have such a priority dispatch system, in which paramedics from AMR respond to nonlife-threatening calls so that firefighters aren’t stretched too thin. But the program ended in 2012, after AMR dropped out of an 11-year-old agreement because the city wasn’t meeting its contractual obligation to arrive at 90 percent of calls in less than 8 minutes.

The program revived Aug. 1, once the city got permission from the Inland Counties Emergency Medical Agency, as recommended in a report by Citygate Associates.

“The policy question becomes, ‘At what cost can the Fire Department respond to every call for assistance as if it is a life and death emergency?’ ” the report said. “In so doing, the Department is wearing itself and its equipment out. More importantly, while responding emergency medical incidents, the Fire Department is not available for an appropriate level of fire suppression, given the City’s risks, which unfortunately is an all-too-necessary service in San Bernardino.”

Medical calls account for 87 percent of the calls the Fire Department receives. That’s significantly higher than a national average of 67 percent reported in 2013 by the National Fire Protection Association, and it’s a number that’s increased in recent years as health insurance became more difficult to acquire and the Great Recession hit.

Priority dispatch is helping, Cooke said, as the Fire Department weathers spikes of incidents.

He said he’s unsure how it will fit in with the closure of Station 10, on the corner of Mill Street and Arrowhead Avenue, as well as a downsizing that will leave station 4 on E street north of Highland with medic capabilities but no hose. Those cuts were approved in June, as part of a budget that eliminated $2 million from the Fire Department but also added two dispatch positions (three dispatch hires and the elimination of a dispatch manager) to accommodate priority dispatching. The closures were then made part of a contract the city imposed this month, and went into effect Saturday.

“Citygate didn’t recommend closing those stations, and removing any station increases the call load on the others,” Cooke said. “You can never know ahead of time where emergencies are going to happen or when.”

While other aspects of the city’s approach to the Fire Department — closing a station, imposing benefit cuts, looking into outsourcing all paramedic services — rank-and-file firefighters generally say they approve of the priority dispatching switch, at least tentatively.

It’s also going well from AMR’s perspective, said Diana McCafferty, manager of administration for AMR San Bernardino County.

“The system is working very well in San Bernardino with their EMD program,” McCaferty said, referring to emergency medical dispatch. “We’ve not encountered any hiccups.”

McCaferty said San Bernardino was the only one of the agencies AMR contracts with locally that “triages” calls this way. But it hasn’t had a discernible impact on the agency, because they already responded to all calls — it’s just that now they’re sometimes the only ones there, instead of firefighter paramedics arriving just before or just after.

An ambulance will sometimes have to wait at a hospital, but there are plenty more available, she said.

Arguments against Measure Q, which would amend a section of the city charter that sets police and firefighter salaries, have said Measure Q would allow the city to outsource paramedic services.

Officials including City Attorney Gary Saenz, Mayor Carey Davis and City Manager Allen Parker have said they’re unsure what effect the ballot measure will have on that, but the city is studying the possibility regardless of whether it passes.

In August, City Manager Allen Parker asked for and received permission from the City Council to seek proposals from other agencies that might want to contract with the city for fire service, including paramedics.

And earlier, he asked the previous fire chief to study a Santa Clara Grand Jury report advising reorganization of fire services in light of the increasing role medical services play for fire departments.

But offloading some medical calls that don’t need to be handled by firefighters is a policy that makes sense on its own, which is why prior fire chiefs recommended it, Parker said.

“It’s appropriate,” he said. “It was recommended by the fire consultant. It’s something that needed to be done in order to focus on more relevant duties.”