The Department supports integration and consolidation of all training and education functions whenever possible. The Department is in the process of developing a three phase plan for integration of all training and relocation at a common site. The Department recognizes that it is critical to maintain the current EMS Continuous Quality Improvement link to its EMS training programs and plans to develop a similar link to its suppression and rescue programs. The Department does not support elimination of any currently budgeted training positions. Training is one of the most critical functions in Fire and EMS, and the Department will require all of its existing training resources to meet its goal of improving and expanding training programs over the next several years.

· Recommendation of Auditor"s report

1.4.1 Transfer the EMS Academy Section and EMS In-Service Training Section to a renamed Division of Fire and Medical Training during FY 2001 - 2002.

·Assessment of Department

The Department disagrees with the recommendation of the audit as presented.

The Audit notes that there is a "potential to (a) complicate management accountability, (b) permit uneven training and education quality standards, and (c) reduce opportunities for strategic alignment¹." However, the Department finds it important to note that the Audit does not describe any specific instance in which Fire or EMS training has been negatively impacted by a lack of accountability, uneven standards, or lack of strategic alignment. In fact, the Department believes it currently provides high quality Fire and EMS training that meets or exceeds all federal, state, and local standards.

As an example, the Department provides a minimum of twelve hours of in-service EMS training for over 1400 firefighter/first responders and firefighter/EMTs. Each of the Department"s 250 paramedics receives a minimum of 24 hours of training per year. This training is also mandated by the Firefighters Local 798 MOU. All EMS training meets the standards mandated by the Department of Transportation and California Title 22 Health and Safety code. Additional specialized training is provided for "nationally registered" paramedics, paramedic preceptors, and Rescue Captains. Since the merger, the EMS in-Service training program has consistently been found to be in compliance with regulations related to record keeping and training standards through regular audits conducted by the DPH EMS Section, the American Heart Association, and other regulatory agencies.

No deficiency has been documented in the audit related to the fact that the EMS training program is developed and conducted by the health care professionals that staff the separate EMS Division.

EMS training programs are developed with two major factors in mind: (a) mandatory (required by local State or Federal regulations) topics, and, most importantly, (b) training as a major component of the EMS CQI program. Problems are identified and solutions developed by the EMS Medical Director, EMS CQI team, field supervisors, field providers, and/or managers. Changes in standards protocols or practice must be communicated to the EMS care providers through training programs. Development of the EMS training curriculum is a complex and on-going process that involves virtually every member of the EMS Division staff. Training curriculum is based on modern adult learning principles and developed by instructors who have completed instructor training programs. The actual training is done using experienced EMS personnel to ensure that the program is credible and enthusiastically received by the target audience. The Department intends to ensure that field paramedics, Rescue Captains, EMS CQI staff, and the EMS Chief Officers will continue to have responsibility of development of the EMS training curriculum.

The Department plans to consolidate and integrate its training programs in three phases. The timeline for the first phase of this program is based on the successful deployment of a fully operational Rapid Paramedic Response System (RPRS). Implementation of the RPRS program, began January 5, 2002, requires maintenance of some of the elements of the current system to ensure adequate training and quality assurance during the evaluation phase of the pilot project. During this phase, the Division of Training will assume the following responsibilities:

· Scheduling of all training programs, including EMS training, must be approved by the Division of Training (DOT)

· The program coordinators of the EMS In-Service Training Section and EMS Academy Section will work closely and cooperatively with the Director of the DOT to ensure that there are no scheduling conflicts

· Depending on availability, the DOT and EMS training programs will share classroom space

· All training records including, suppression, EMS, technical rescue, and management training shall be stored on a centralized database shared by the Division of Training and the EMS Division

· All training staff, (Fire and EMS), shall create training programs based on modern adult learning methods including behavioral objectives, interactive training, with an emphasis on job-related materials

· The current EMS CQI program will be maintained and planning will begin to develop a similar program for suppression and rescue functions

Phase two of the training integration program will take place after successful implementation of the Rapid Paramedic Response System. The Department intends to provide as much training as possible at a consolidated training site during this phase. The Department is exploring development options at its Treasure Island facility, but a number of major site improvements will be required. During this phase of the consolidation, the Division of Training will assume more of the administrative responsibilities related to the management of all training programs. The EMS CQI process will be maintained and a CQI link for suppression and rescue functions will be implemented.

Phase three of the training integration program will require consolidation of all training activities at a common site under a unified Division of Training. The Department has not yet determined the best site for such a consolidation, but the Department will be exploring development options at a number of sites in the City and possible bond financing for improvements. All training will be based on modern adult learning methods with strong quality improvement links to suppression, rescue, and EMS providers, supervisors, and managers.

The Department also disagrees with the recommendation of re-naming the Division of Training. Training should imply all training undertaken within the Fire Department. Changing the name to the Division of Fire and Medical Training would just underscore the artificial differences and separations that the Department is attempting to eliminate.

· Department Action Plan and Timeline

The Department plans to integrate its training programs in three phases as described. The first phase is expected to be completed by July 2003. Phase two is expected to be complete between July 2005 and July 2006. Phase three is expected to be complete between July 2009 and July 2011.

· Recommendation of Auditor"s report

1.4.2 Recruit widely for the new Director of Fire and Medical Training position, advertising for someone with both fire suppression and emergency medical services training experience.

·Assessment of Department

The Department will analyze the recommendation of the audit.

In Fire-EMS departments such as Phoenix, where EMS has been an integral function for many years senior management positions, including the training director, are commonly staffed by personnel with EMS and fire suppression backgrounds. The Department agrees that when EMS and Fire training are consolidated under the Division of Training, it would be essential that the director have both a Fire and EMS background including EMSA licensure requirements. Additionally, the three phases proposed for the consolidation of training may provide the Department the opportunity to develop this level of professional expertise in-house.

· Department Action Plan and Timeline

Workflow and business process analysis for the position of Training Director will be completed as part of phase one of the Consolidated Training project and should be finalized by January 2003.

· Recommendation of Auditor"s report

1.4.3 Restructure the Division of Fire and Medical training during FY 2001-2002 to integrate training and education for fire suppression and emergency medical services, and to reduce the number of direct reports to the Director of Fire and Medical Training by FY2002-2003

·Assessment of Department

The Department disagrees with the recommendation of the audit.

The Audit recommends the elimination of two Chief Officer level positions (H39 and or H43) and the addition of one H33 Rescue Captain position in order to create a new management structure at the Division of Training and save $152,620. A combined training center might be configured in several ways. Before a final configuration is determined, however, a more detailed analysis will be performed to determine the actual workload and responsibilities of the existing staff. All of the H39 Captains and H43 Section Chiefs spend a considerable amount of time teaching. Both Fire and EMS managers often participate in various committees both within and outside of the Department that require specific expertise. Fire and EMS managers attend professional training programs, conduct performance reviews, meet with students, review class evaluation forms, and schedule instructors. Combining training functions does not reduce the amount of this activity. Before the Department could agree to the elimination of what is currently viewed as critical positions, the Department will conduct its own review and analysis of the impact of reduction of staff on the training mission.

· Department Action Plan and Timeline

Workflow and business process analysis for all training positions will be completed as part of phase one of the Consolidated Training project and should be finalized by January 2003. The Department also must consider the DPH EMS Section requirement described in the Audit mandating that the managers of any programs with an EMS training component must hold a current paramedic, nursing, or medical license.

· Recommendation of Auditor"s Report

1.4.4 Direct the Director of Fire and Medical training to (a) work with the new Strategic Policy, Planing and Analysis Unit to ensure appropriate performance measures are developed for all training courses delivered by the Division of Fire and Medical Training and (b) monitor all training managers" performance against those performance measures.

·Initial Assessment of Department Staff

The Department concurs with the recommendation of the audit.

The Audit has recommended many responsibilities and functions for the new Planning Unit. These include development of multi-year strategic plans, new organizational goals, new performance measures, CAD data analysis, research, continuous quality improvement programs, risk management, adoption of new technologies, improved service outcomes, grant writing, policy and protocol revision and development of new training standards. All of this is reportedly to be accomplished by three or four civilians who may have little or no experience with the operational aspects of the San Francisco Fire Department. The Department supports working with the Planning Unit to ensure that appropriate performance measurements are developed and put in place. Development of the actual standards should be done by uniformed professionals who possess operational experience and knowledge of the San Francisco EMS/Fire Service.

· Department Action Plan and Timeline

The Department supports the development of training performance standards with a Planning Unit. The analysis and action plan will be part of the Department"s five (5) year strategic plan and is expected to be complete by January of 2003.

¹Management Audit of the San Francisco Fire Department, 2001, pg. 1.4-3