Introduction

The Budget Analyst is pleased to present this Management Audit of the San Francisco Fire Department. This report, which was prepared in accordance with a request of the San Francisco Board of Supervisors in January 2000, assesses the combined operations of fire suppression, fire marshal and emergency medical services functions of the Department.

The management audit was conducted in accordance with Government Auditing Standards, 1994 Revision promulgated by the Comptroller General of the United States, United States General Accounting Office (as revised). In accordance with these standards, certain procedures were followed to ensure the factual accuracy of the report, and to provide the management of the Fire Department with an opportunity to comment on the report content. A written response from the Chief of the Department is attached.

The management audit report contains 23 findings which address a variety of issues related to the Department"s organization, administration and operations. Included are findings which provide recommendations to reduce middle management by realigning various functions, improve the management of staff and equipment resources, provide alternatives for service delivery, enhance fee determination and collections, manage fixed assets and supplies, and other improvements. We conservatively estimate that the implementation of these recommendations will produce approximately $7.0 million in annual savings for the City and County of San Francisco.

Management Audit Scope

The management audit was initiated on February 17, 2000 while the Department was managed by Chief Robert L. Demmons. As directed by the Board, the audit was comprehensive in scope, and looked at all aspects of the Department operations. In a letter of introduction submitted to Chief Demmons on February 10, 2001, the Department was advised that the study would "evaluate the economy, efficiency and effectiveness" of the "Department"s programs, activities and functions;" and, "assess departmental compliance with applicable State and federal laws, local ordinances, and City policies and procedures."

During this study, the Board of Supervisors also directed the Budget Analyst to conduct a zero-base budget analysis of the Fire Department. That work was completed in June 2001 and submitted in draft form to the Department. Although not released as a final report to the Board, we incorporated the results of our activities supporting the Zero Base Budget Analysis into our annual budget review and this management audit.

Issues of immediate budget concern in FY 2001-02 were incorporated into our annual budget report, and issued to the Board of Supervisors in July 2001. This report incorporates many other longer term strategies identified during the zero base budget exercise, including issues related to the Department"s organization, and the base level of staffing that is required to provide Fire and EMS services within the City.

Further, since the Board assigned this management audit to the Budget Analyst, some members have expressed ongoing concern regarding the effectiveness of the merger of Emergency Medical Services (EMS) with Fire Suppression Services, which occurred in 1997. Consistent with the concerns expressed by members of the Board, a referral was made by the Board of Supervisors requesting that the Budget Analyst "compare the current status of the Health Department and Fire Department EMS merger to the Budget Analyst report done prior to the merger." This analysis is embodied in many of the findings contained in this report. Nonetheless, we have included a summary budanalyst in this Introduction, which serves also as a guide to EMS related findings included in this report.

Current Fire Department Operations

Since this management audit was initiated, there have been three chiefs of the Department. Chief Demmons retired in July 2000, and the Department was managed by Acting Chief Paul Tabacco until August 2001. In that month, the City hired a new Chief of the Department, Mario Treviño, who reports that he is independently evaluating the Department"s organization and operations, and plans on making several changes during the coming months, with the concurrence of the Mayor and the Board of Supervisors. Nonetheless, the following discussion describes the San Francisco Fire Department as it functioned during the period of our study.

The mission of the San Francisco Fire Department is to "protect the lives and property of the people of San Francisco from fires, natural disasters, and hazardous materials incidents; to save lives by providing emergency medical services; to prevent fires through prevention and education programs; and to provide a work environment that values cultural diversity and is free of harassment and discrimination."

To accomplish this mission, the Department is organized into two major bureaus:

In addition, the Department operates a Public Information Office with a staff that reports directly to the Chief of the Department. Summary descriptions of the primary functions within each of these major divisions is provided below.

Exhibit 1
Organization Chart of the San Francisco
Fire Department Provided April 2001

Operations

Fire Suppression

The San Francisco Fire Department has a total of approximately 1,933 budgeted Full Time Equivalent positions (FTEs), with approximately 1,518 budgeted in Fire Suppression. Fire Suppression includes 42 engine companies, 19 truck companies, 20 ambulances, two rescue squads, two fireboats, and several other specialized units. The companies are deployed in three regular divisions, and further organized into ten battalions. A fourth division is deployed at the San Francisco Airport and is comprised of three firefighting companies, emergency medical services, training, and fire prevention services.

The primary Fire Suppression units of the San Francisco Fire Department are deployed at a total of 42 firehouses in the City, including one firehouse located on Treasure Island. Each firehouse is assigned one first-line engine. Nineteen of the firehouses are assigned a ladder truck, and Fire Station Numbers One and Seven are each assigned a Heavy Rescue Squad.

Regular Fire Suppression units are organized into ten battalions and three divisions. Battalion Chiefs, who work 24-hour shifts (A, B, and C shifts), command each battalion on a daily basis. An Assistant Deputy Chief, who works one of the three 24-hour shifts, commands each of the three divisions. An Assistant Chief works the other two shifts.

All Fire Suppression units, as well as all of the EMS Division, report to the Deputy Chief for Operations, known as CD2, who is the Fire Department"s second-in-command to the Department Chief.

Emergency Medical Services (EMS)

In 1997, Emergency Medical Services (EMS) functions, which had been part of the Department of Health Services, were merged with the Fire Department. As a division within Operations, EMS currently functions as a service, which is separate from Fire Suppression.

The staffing and assets of the EMS Division within the Operations Bureau of the San Francisco Fire Department are deployed on the following basis:

In addition to the foregoing, six engine companies are staffed with a Firefighter/Paramedic as a part of the regular complement of one officer and three firefighters assigned to each engine company. These engine companies are known as Advanced Life Services (ALS) engines, and each has the full medical services capabilities of ambulances, with the exceptions of certain equipment and vehicles.

Airport

The Fire Department provides a full range of fire suppression, fire prevention and specialized aviation related fire services at the San Francisco International Airport. There are approximately 95 FTEs assigned to the Airport Division, which has an annual operating budget of approximately $9.2 million in FY 2001-02. Fire Services at the Airport are fully funded by the Airport Enterprise Fund, resulting in no net cost to the City General Fund.

Fire Prevention and Investigation

The Division of Fire Prevention and Inspection has two distinct functions. The Bureau of Fire Prevention is responsible for reviewing development plans and conducting building inspections to ensure that all construction in the City conforms with the Fire Code. The Bureau also conducts annual inspections on all high rise buildings, and serves as the City"s fire marshal by inspecting certain residential, commercial and other high occupancy buildings. In FY 2001-02, the Bureau is budgeted for 55 FTEs, and received an expenditure appropriation of approximately $5.0 million.

The Division also provides Fire Investigation services for the Department. Fire Investigation operates with a total of 14 FTEs, and received an expenditure appropriation of approximately $1.7 million in FY 2001-02.

Communications

A total of 61 uniformed members of the Fire Department are assigned to the Fire/EMS Dispatch organization. A Battalion Chief, who is assisted by an Administrative/Training Officer, commands Fire/EMS Dispatch. The remaining staff are organized into four teams, each led by a Paramedic Captain. With overtime, which is often required to perform the dispatch function, the Fire Department spends approximately $6.0 million annually to provide this service.

Although staffed by uniformed members of the Fire Department, Fire/EMS Dispatch is under the operational control of the Emergency Communications Department (ECD), which operates the Combined Emergency Communications Center. The Battalion Chief in charge of Fire/EMS Dispatch reports to the ECD Chief-of-Staff, on operational issues; and, to the Fire Department"s Deputy Chief for Operations, on administrative issues.

The Emergency Medical Services Agency (EMSA) has expressed concern about dispatch problems related to the current transient workforce of sworn personnel. The civilianization of dispatchers will be advantageous because it will promote a more stable workforce of professional dispatchers with the appropriate skills (such as the ability to type swiftly and accurately). The Emergency Communications Department should move expeditiously to civilianize its dispatch workforce.

Administration

Administration is comprised of multiple administrative and support functions for the Department. In total, there are 40 FTEs assigned to this area, dispersed among various functions. In FY 2001-02, Administration received an expenditure appropriation of approximately $10.3 million. Following are descriptions of the major functions included in Administration.

Support Services

The Support Services Division includes the Bureaus of Equipment, Engineering and Water Supply, Clothing, Management Information Systems, Facilities Renovation, and the "911 Project." In total, there are 49 FTEs assigned to the Support Services Division. In FY 2001-02, the Division received expenditure appropriations of approximately $12.0 million.

Training

The Division of Training, comprises 17 FTE budgeted positions under the Director of Training, plus an average of ten light duty staff. The Division is responsible for (a) the Classification H-2 Fire Fighter and Classification H-3 Fire Fighter Paramedic Recruitment Program, (b) the Cadet Program, (c) in-service fire suppression training, (d) the Officer Candidate Program, and (e) the Treasure Island Regional Training Center.

Separate from the training functions provided by this division, are others that are located in the EMS Division:

¬ The EMS Academy Section, which comprises 3.5 FTE budgeted positions;

¬ The EMS In-service Training Section, which comprises 5.5 FTE budgeted positions.

The Division of Training received an expenditure appropriation of $12.8 million in FY 2001-02. This did not include expenditures for training activities located in other areas of the Department.

Management Services

The Division of Management Services has 13 budgeted FTEs, (six of which were vacant during this study). In addition, there are two light duty staff and two filled but unbudgeted positions assigned to the Division. In total, the Division includes eleven filled positions responsible for the following functions:

· Assignments Office,

· Community Affairs,

· Investigative Services,

· Mail and Reproduction,

· Records, and

· The Neighborhood Emergency Response Team (NERT).

All of these functions, except the Assignments Office, are one-person bureaus. The Assignments Office has nine budgeted positions, five of which are vacant.

Other Functions

Other functions include the Finance and Human Resources functions, as well as the Department Physician and medical leave supervisor.

Operating Budget

The San Francisco Fire Department received an operating budget of over $210 million in FY 2001-02, which is expended primarily for personnel. In FY 2001-02, the Department received authorization for 1,933 FTEs, which is 69 FTEs more than the 1,864 FTEs that were approved in the original FY 2000-01 budget (a 3.7 percent growth in authorized positions).

The Department is funded primarily from the City"s General Fund. However, the Department receives Public Safety State Sales Tax revenues which are designated for police and fire services in local jurisdictions, and certain funding from voter approved Fire Bonds. The Airport funds a separate Airport Division, and the Fire Department receives Interdepartmental Recoveries from several other City Departments for which it provides services.

The following is a summary of the sources of funds used to finance the Fire Department in FY 2000-01 and FY 2001-02. This summary shows a 3.8 percent increase in costs over the course of these two years.

Sources of Funds for FY 2000-2001

Table 3 shows that, despite the increased resources devoted by the Fire Department to EMS during the first four years of the merger, the average response times for both Code 3 and Code 2 dispatches grew longer between FY 1999-2000 and FY 2000-01, thereby worsening the Fire Department"s performance against the response time standards for dispatch.

In order to address the problems caused by an incomplete merger of EMS and fire suppression services and an uneven workload, our management audit of the Fire Department makes a number of recommendations regarding future structural arrangements and EMS service provision.

Future Structural Recommendations

EMS Special Operations Section

We recommend that the EMS Special Operations Section become a direct report to the Deputy Chief of Operations, to reflect its organization-wide role.

EMS Training and Education Function

Fire Department training and education functions are currently spread between the Division of Training, which is responsible for fire suppression training, and the EMS Division which is responsible for paramedic and emergency medical technician training. Such structural and management fragmentation hinders integration of the Department"s fire suppression and EMS responsibilities, complicates management accountability, creates the potential for unevenly applied training and education quality standards, and increases costs.

We recommend, therefore, that the Fire Chief:

· Transfer the EMS Academy Section and the EMS In-service Training Section to a renamed Division of Fire and Medical Training.

· Restructure the new Division of Fire and Medical Training to (a) integrate training and education responsibilities, and (b) reduce the number of direct reports to the new Director of Fire and Medical Training position through rationalization of management positions which have overlapping areas of responsibility.

· Recruit widely (both within the Department and externally) for the new Director of Fire and Medical Training position in order to appoint someone who has both fire suppression and EMS training experience.

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

Rationalization of management positions would result in an estimated annual net saving of $152,632 in personnel costs.

Recruitment Strategy and the EMS Academy

The Fire Department only recruits Classification H-2 Fire Fighters. This does not reflect the Fire Department"s actual workload which is dominated by EMS. To avoid Classification H-3 Fire Fighter Paramedic staffing shortages, the Fire Department has been forced to directly hire Classification H-3 Fire Fighter Paramedics from other jurisdictions. These "lateral hires" addressed a staffing shortage that is not being addressed through a recruitment process which prioritizes applicants with paramedic training.

We recommend, therefore, that the Fire Chief:

· Develops a recruitment process which recruits applicants with prior EMT or paramedic training, and/or advanced science education, and which gives preferences to applicants with advanced education qualifications.

We recommend, therefore, that the Fire Department recruit people with prior fire science, EMT, paramedic, and/or advanced education qualifications, and formalize career development programs for staff. The Fire Department should also incorporate external review panels into the recruitment process, expand the Cadet Program course content to include paramedic experience, expand recruits" field probation experience to include an ambulance assignment in order to assess their aptitude for advanced EMT training, and develop formalized career development programs for staff. These recommendations would result in the recruitment of staff members more suited to the Fire Department"s actual workload. We also recommend that the Fire Department review the deadlines for recruitment diversity goals to ensure that the Fire Department has sufficient Classification H-3 Fire Fighter Paramedics to meet its service obligations.

In-house paramedic cross-training is provided by the EMS Academy. The EMS Academy has added only 27 fully cross-trained Classification H-3 Fire Fighter Paramedics to the Fire Department workforce from its first three programs, at a cost of approximately $72,833 per graduated student.

The Fire Department needs to analyze future paramedic training options so that the Fire Department can prepare a cost benefit comparison between undertaking its own paramedic training and utilizing paramedic training provided by other public and private sector agencies. The Fire Department also needs to analyze the costs and benefits of requiring staff to undertake their cross-training off-duty. These analyses could potentially lead to cost savings if the Fire Department determines that there are cheaper ways to provide paramedic cross-training.

EMS Administrative Functions

The Fire Department manages its EMS administrative functions separately from its fire suppression administrative functions. The EMS Administration Section is responsible for managing EMS billing and revenue collection, medical records, fee amendments, data collection and reporting, the continuous quality improvement program, and biomedical equipment. Concurrently, the Division of Finance handles departmental purchasing, billing, and salary payments, while the Division of Equipment is responsible for the procurement, distribution, and repair of equipment and supplies. By structurally separating its EMS administrative functions from its fire suppression administrative functions, the Fire Department divides the management accountability for various administrative functions, creates potential overlap, and reinforces the current inappropriate distinction between fire suppression and EMS.

We recommend, therefore, that the EMS Administration Section"s responsibilities for:

· Data collection and reporting, continuous quality improvement program, and risk management be integrated into the new Strategic Policy, Planning and Analysis Unit.

· Billing and revenue collection, medical records, and fee amendments be transferred to the Division of Finance.

· Biomedical and other EMS equipment be transferred to the Bureau of Equipment.

This consolidation would streamline the Fire Department"s administrative structure and processes and require two less positions, for a total saving of $193,267.

Restructure the Residual EMS Division

Based on the above recommendations, the current scope of the EMS Division would be reduced by (a) relocating the EMS Special Operations Section as a direct report to the Deputy Chief of Operations, (b) transferring EMS training and education functions to the new Division of Fire and Medical Training, and (c) eliminating the EMS Administration Section. While these structural adjustments are being implemented, the EMS Division would retain residual policy development, implementation, and evaluation functions, and operations management functions.

We recommend, therefore, that the Fire Chief:

· Convert the EMS Division into a smaller EMS Unit as a first phase of restructuring.

· Eliminate the Classification H-43 EMS Operations Section Chief position.

· Create a new Classification 1824 Principal Administrative Analyst position to focus on EMS policy development. (The total personnel savings would be $22,713.)

· Convene a working group to establish a completely integrated chain of command for fire suppression and EMS by FY 2003-2004 as a second phase of restructuring. Once a completely integrated chain of command has been established, the Fire Department should transfer EMS policy development, implementation, and evaluation functions, and sufficient staffing resources, to the new Strategic Policy, Planning and Analysis Unit.

Recommendations About Future EMS Provision

The Fire Department implemented the initial phase of the One and One Response Program on January 5, 2002. Under this program, the Department would deploy 19 ALS ambulances staffed with one firefighter/paramedic (H-3) and one firefighter/EMT (H-2), and 25 ALS engines staffed with one paramedic (H-3), two firefighters (H-2), and one officer. The Fire Department will also deploy 10-hour ambulances, staffed with civilian paramedics (2532) and fire rescue paramedics (H-1). On January 5, 2002, the Department converted four ALS ambulances, six ALS engines, and six ALS trucks as part of the initial phase of the One and One Response Program. Under the current One and One Response Program proposal, however, the Fire Department would incur increased salary and fringe benefit costs of approximately $641,710 annually, based on the current staffing proposal for the One and One Response Program.

The proposed One and One Response Program is intended to reduce ALS response times by increasing the number of ALS units, whether ambulances or engines deployed in San Francisco neighborhoods, and by dispatching ALS engines as a first response unit. As part of the One and One Response Program, the Department will increase the number of short-shift ambulances deployed.

Currently, the Department deploys 20 ALS ambulances on 24-hour shifts, six ALS engines, and approximately two short-shift ambulances, depending on available staff. Under the proposed One and One Response Program, the Department would deploy 19 ALS ambulances on 24-hour shifts, 25 ALS engines, and approximately four 10-hour ambulances. Other goals of the One and One Response Program include decreasing workload by increasing the number of available ALS units, both ambulances and engines, and increasing opportunities for paramedics who are newly-trained as firefighters to work on engines, and for firefighters/EMTs to work on ambulances.

We find that the Department could reduce costs, without forfeiting the Department"s goals of reducing ALS ambulance response times, decreasing workload per ambulance, and increasing opportunities for Department staff to gain experience on ambulances and engines, by deploying 10-hour ALS ambulances during the periods of greatest medical call volume and by considering the deployment of some BLS ambulances.

We recommend, therefore, that the Fire Chief:

· Deploy sixteen 24-hour ambulances and seven 10-hour ambulances when implementing the One and One Response Program. We recommend that the Department deploy 13 of the 16 24-hour ambulances as ALS ambulances and that the Department consider deploying three of the 16 24-hour ambulances as BLS ambulances.

The BLS Ambulance Pilot Program was initially implemented to decrease ALS ambulance workload in neighborhoods with high call volume and to utilize resources more efficiently, by dispatching BLS ambulances to Code 2 medical calls, which make up 40 to 45 percent of all medical calls. The Department"s evaluation of the BLS Ambulance Pilot Program concluded that the BLS ambulances were able to safely deliver care for Code 2 medical calls. The deployment of BLS ambulances frees up ALS ambulances to respond to Code 3 calls and provides ambulance experience for firefighters/EMTs (Classification H-2). To deploy the BLS ambulances, the Department would need to address concerns regarding the training of dispatchers to appropriately identify the need for BLS or ALS ambulances, improve quality assurance, and obtain legal advice from the City Attorney regarding the City"s liability under the Bronzan Act.

Until now, the Department has generally deployed the same number of ambulances around the clock, although medical call volume varies by time of day.The Department should convert some 24-hour ALS ambulances to 10-hour ALS ambulances to cover the periods of high medical call volume. By converting 24-hour ALS ambulances to 10-hour ALS ambulances, the Department could increase the EMS resources available during the time of highest need and reduce costs. In total, our recommended staffing model (discussed in more detail in the body of this report) would result in $1,284,699 in cost savings, compared to the Department"s proposed One and One Response Program staffing model.

Accomplishments of the Fire Department

During the period of this study, the management of the Fire Department has been somewhat unstable. In addition to the transition of the Department through three chiefs, management has been required to coordinate the merger of EMS, which is a major service activity, while continuing to provide high quality fire suppression activities in the City.

Management audits tend to concentrate on the areas of least efficiency and effectiveness in an organization, and this report is no different. Nonetheless, we recognize the recent challenges that have been faced by the Department, and have independently identified many management accomplishments over the course of the past several years. We also requested the Fire Commission and the Department to submit written statements of the accomplishments that they perceive have occurred in recent years, which we have reviewed in detail. The Fire Commission"s response to our request is attached. The Fire Department"s comments are included in its written response which is also attached.

As a result of these efforts, the following discussion summarizes the major accomplishments of the Department which we recognized during the course of this management audit.

¬ Diversification - The Fire Department has made a significant effort to recruit and employ women and minorities. Based on information received for this study, approximately 40 percent of the Department"s employees are now women and minorities.

¬ Staffing Model - Prior to FY 2000-01, the Department used a rudimentary model for estimating its minimum staffing needs for budget purposes. In FY 2001-02, the new Finance Director implemented a staffing model which generally meets standards in the industry for estimating base level and relief staffing in public safety organizations. While we identified several changes during this management audit which would make the model more precise, the first effort by the Department is commendable.

¬ Sick Leave - The Department continues to make efforts to control sick leave use among firefighters. In recent contract negotiations, the Department was able to obtain agreement for a "Wellness Incentive Program," which provides employees with cash payment incentives upon retirement for unused sick leave, based upon the employees" salary rate and years of service.

¬ Administrative Reorganization - The Department reorganized several of its human resources functions under a single division, including the Fire Services Examination Unit, the Equal Employment Opportunity Unit, and the Stress Unit, which were previously administered in separate areas of the Department. We commend the Department for its efforts to more rationally organize its administrative and support functions, and believe this effort is a good model for achieving the further administrative reorganization recommended in this report.

¬ Emergency Communications - The Department has taken the first steps toward fully integrating the fire and EMS dispatch function into the City"s new 9-1-1 System, by transferring and integrating the Fire Department dispatch function into the City"s Combined Emergency Communications Center. Once fully integrated, dispatch services should be more cost-effectively provided with a professionally trained civilian staff.

¬ Emergency Medical Services - EMS fragmentation has been reduced by (a) the Fire Department providing all EMS except for some private ambulance company services, and (b) increased cross-training of Fire Department personnel. There is now increased EMS coverage in most San Francisco neighborhoods. Four Classification H-33 Rescue Captains per shift provide increased medical oversight of EMS field operations, supported by an Incident Management System which identifies and investigates unusual occurrences. As a result of these initiatives, the Department reports that since the merger, the number of EMS complaints has steadily decreased and the number of legal claims has decreased markedly.

This provides only a partial list of the Department"s accomplishments during the period of this study.

Acknowledgements

We would like to thank the management and staff of the Fire Department for their cooperation during this management audit. We hope the findings contained in this report provide a useful tool for the new Chief as he improves the operations of the Department during his tenure.

¹ As the designated first responder for all Code 3 emergency calls (medical conditions which require an immediate ambulance response), the Fire Department is required to staff a minimum of one Classification H-2 Fire Fighter/Emergency Medical Technician (FF/EMT) on each piece of fire apparatus. FF/EMTs are trained to provide basic life support (emergency first aid, cardiopulmonary resuscitation, and defibrillation, a procedure used in cardiac arrest cases in which an electric shock is administered to the heart to restore its normal rhythm).

² "Advanced life support" treatment, which requires approximately 1,200 hours of paramedic training per individual paramedic, includes advanced levels of budanalyst and treatment, and the administration of medication.

³ Under Chapter 4 of the California EMS and the Pre-hospital Emergency Medical Care Personnel Act of 1980, counties which develop an EMS program "shall designate a local EMS administration, or a joint powers agency created for the administration of EMS by agreement between ... cities and counties." The duties of this local EMSA include (a) planning, implementing, and evaluating the EMS system, (b) developing a formal plan for the system, (c) coordinating and facilitating arrangements necessary to develop the EMS system, and (d) providing medical control through the EMSA Medical Director who may designate certain hospitals as "base stations" to provide medical direction to EMS providers. In the case of San Francisco, the base station is San Francisco General Hospital.

⁴ The criteria-based dispatch system used by the City"s Combined Emergency Communications Center is based on the criteria-based dispatch guidelines developed by King Country for its own use. The criteria-based dispatch system is a tool which assists EMS dispatchers to triage incoming emergency medical calls, so that they can dispatch the most appropriate medical response.

⁵ On December 1, 2001, the Like Work, Like Pay incumbents of the current Classification H-43 EMS Section Chief positions will have been provisional hires for four and a half years, despite a Department of Human Resources requirement that management position probation last only six months.

⁶ The 95.05 FTE increase in uniformed staff available to deliver EMS is not an absolute growth in the number of EMS personnel in that Classification H-3 Fire Fighter Paramedics are able to work in both EMS and fire suppression roles. However, a major complaint related to Classification H-3 Fire Fighter Paramedic is that cross-trained H-3s have not been allowed to work on fire suppression apparatus but have instead been assigned to ambulances full-time. It should also be noted that the figure of 285.05 FTEs does not include Classification H-2 Fire Fighters who use their EMT skills in their role as first responders.

⁷ The amount of $1,653,393 was $254,954 less than the $1,908,347 projected in the 1997 Phase II report.

⁸ These estimated increases assumed that by FY 2000-01 there would be 243 FTE employees. However, in FY 2000-2001, there were 285.05 FTE employees available to provide EMS.

⁹ This amount was subsequently presented as the slightly lower amount of $1,685,145 by the Budget Analyst in his report to the Board of Supervisors for a November 11, 1999 hearing to consider the EMS transfer costs.

¹⁰ This amount was subsequently presented as the slightly lower amount of $2,471,851 by the Budget Analyst in his report to the Board of Supervisors for a November 11, 1999 hearing to consider the EMS transfer costs.

¹¹ Fire Department staff are eligible to receive a number of different premiums, depending on specialist skills and qualifications. The most significant premium payment is the 5 percent of base pay for paramedic cross-training. According to the EMS Chief, however, some premiums do not represent significant costs. For example, only a couple of Fire Department staff have received the full training required to be eligible for the hazardous materials premium, while no Fire Department staff member currently receives the bilingual premium due to a delay in determining the bilingual testing procedure. Only day shift staff are eligible for the administration premium.

¹² According to Mr. Kieran Murphy of the Retirement System, the cross-training of former DPH paramedics has had two cost impacts on the Retirement System, both of which have been absorbed by the Retirement System due to its current overfunded status:

(a) A one-time liability increase of approximately $7,000,000. This funded the increased liability generated by the voter-approved Proposition C Charter amendment in 1998 which permitted former DPH paramedics to transfer their prior DPH service from the Miscellaneous Retirement Plan to the Fire and Safety Retirement Plan which has higher benefits.

(b) An ongoing cost of 11 percent of former DPH paramedics" salaries, representing the additional cost of transferring their status from civilian members of the Retirement System to uniformed members.

¹³ In FY 1999-2000, BLS ambulances were dispatched 7.57 times per 24-hour shift and ALS ambulances were dispatched 9.97 times per 24-hour shift, for a weighted average of 9.61 dispatches per 24-hour shift.

¹⁴ Memorandum, dated July 7, 2000, prepared by Russell McCallion, Operations Section Chief, EMS Division.

¹⁵ The Department defines "response times" as the amount of time required for the Department to respond to an incident, including both queue time (or the time that the call is held in the Communications Center) and roll time (or the interval between the time of dispatch and the time the unit reports arrival at the incident). Because the Department measured queue time differently at different times, our report uses response time data for FY 1999-2000 and FY 2000-2001 (through March of 2001).