Recruitment

The Fire Department only recruits Classification H-2 Fire Fighters. According to the EMS Chief, this is because (a) Classification H-3 Fire Fighter Paramedic is regarded as a promotional opportunity for current Fire Department employees, and (b) the Fire Department is attempting to ensure racial diversity for its workforce at a time when paramedics are primarily white. However, we consider that restricting recruitment to Classification H-2 Fire Fighters inappropriately limits the Fire Department"s recruitment program for the following reasons:

· Approximately 70 percent of dispatches are for emergency medical services. While all new Classification H-2 Fire Fighter employees receive Emergency Medical Technician (EMT) training so that they can provide first responder care, many emergency medical service calls require a paramedic response.

· 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, resulting in a net increase of 75 FTE Classification H-3 Fire Fighter Paramedics between FY 1999-2000 and FY 2000-2001. These "lateral hires" addressed a staffing shortage that has not been addressed through a recruitment process which prioritizes applicants with paramedic training.

We recommend that the new Division of Fire and Medical Training, in conjunction with the new Strategic Policy, Planning and Analysis Unit, develop a recruitment process which:

· Recruits applicants with prior EMT or paramedic training, and/or advanced science education, to enable direct recruitment into Classification H-3 Fire Fighter Paramedic.

· Gives preference to applicants with advanced education qualifications to ensure the highest quality recruits and to reduce the length of recruit training provided by the Department¹.

In order to broaden the focus of the Fire Department"s recruitment and training efforts, we further recommend that the new Division of Fire and Medical Training, in conjunction with the new Strategic Policy, Planning and Analysis Unit:

· Develop policies on incorporating external review panels into the recruitment process.

· Expand Cadet Program course content to include paramedic experience.

· Expand recruit field probation experience to include an ambulance assignment, to assess aptitude for advanced EMT training.

· Develop formalized career development programs for staff.

In 1997, by transferring the responsibility for emergency medical services to the Fire Department, the City committed itself to the integration of fire suppression and emergency medical services. In addition, due to the Consent Decree under which the Fire Department previously operated, which had ongoing requirements to recruit a diverse workforce, the City is also highly sensitive to its obligations for diversity. While the future number of Classification H-3 Fire Fighter Paramedics required by the Department will depend on the future configuration of emergency medical services, recent hiring of lateral Classification H-3 Fire Fighter Paramedics from other jurisdictions suggests that the Fire Department has been unable to train sufficient numbers of its own Classification H-3 Fire Fighter Paramedics. In particular, the low graduation rate of the EMS Academy, discussed in more detail below, indicates that the Fire Department has been unsuccessful in ensuring racial diversity among those Classification H-3 Fire Fighter Paramedics who have been promoted from Classification H-2 Fire Fighter. In the first four programs to cross train Classification H-2 Fire Fighters as Classification H-3 Fire Fighter Paramedics, 60 percent of the 83 Fire department students entering the program were white and 40 percent were from minority classes, consistent with the overall ethnic distribution of the Department. Nonetheless, because of the low graduation rate to date from the first four programs, the Department has failed to achieve increased racial diversity in Classification H-3 Fire Fighter Paramedic.

We recommend that the Fire Chief review the deadlines for the Fire Department"s recruitment diversity goals to ensure that the Department has sufficient Classification H-3 Fire Fighter Paramedics to meet its service obligations.

EMS Academy

As part of the transfer of emergency medical services to the Fire Department, the Fire Department established an EMS Academy to provide EMT and paramedic training for Fire Department recruits and staff. The EMS Academy is affiliated with the City College of San Francisco (providing training to fee-paying City College students), which no longer provides paramedic training directly. However, according to the Paramedic Program Director, paramedic training is provided by a small number of other community colleges in the Bay Area, and by a variety of fire departments and community colleges elsewhere in the states of California and Washington. The Paramedic Program Director also noted that there is a private sector paramedic training program provided by American Medical Response"s Northern California Training Institute.

The EMS Academy"s Paramedic, Continuing Education, and EMT-1 Training Programs were audited by the Emergency Medical Services Agency (EMSA) in FY 1998-99 and were found to be good, despite persistent problems with tracking the training and certification of Fire Department personnel. The next external audit is scheduled to be performed by the EMSA in 2003². Since April 3, 2001, the EMS Academy has been under review by the Fire Department, City College, and San Francisco General Hospital due to (a) a new paramedic training curriculum set by the United States Department of Transportation, and (b) the need to revisit cost allocation between these three training partners since San Francisco General Hospital will no longer provide site coordination or preceptors free of charge.

According to the EMS Chief, on-duty cross-training has not produced as many cross-trained Classification H-3 Fire Fighter Paramedics as projected. This is in spite of the fact that San Francisco is one of the few Californian fire departments to fully pay for the costs of cross-training its staff by offering cross-training on-duty, rather than requiring staff to undertake cross-training courses off-duty, either at their own cost or with tuition reimbursement³. The graduation rates from the EMS Academy cross-training programs held to date are shown in the following table.

Table 1.6.1

San Francisco Fire Department EMS Academy Graduates

A fourth program began in February of 2000 with 23 Fire Department students and 21 non-Fire Department students. Of the 21 non-Fire Department students in the fourth program, 11 of the students, or 51 percent, completed the program and four transferred to the fifth program which began in March of 2001 with 26 Fire Department students and 17 non-Fire Department students. One fully cross-trained Fire Department student is now out in the field as a Classification H-3 Fire Fighter Paramedic, while a further six are awaiting their paramedic licensure. Another seven Fire Department students are still working through their internships or paramedic licensure examinations. Therefore, a total of 14 Fire Department students have graduated or are working to graduate from the EMS Academy"s fourth program, which represents an approximately 60.9 percent completion rate if all 14 finally graduate.

According to the EMS Academy Section Chief, a 40 percent attrition rate is standard for paramedic training courses. The attrition rate for Fire Department personnel in the three completed programs varied from 32 percent in Program 2 to 76.9 percent in Program 1, an average of 55 percent over the three completed programs. This compares with an average attrition rate of 23.8 percent for non-Fire Department personnel. The reasons given for the higher than average attrition rate for Fire Department personnel are as follows:

· Poor academic performance. Former Fire Department managers had been opposed to testing because they saw it as a barrier to recruiting a more diverse workforce. However, this opposition hindered the Department"s ability to identify applicants" true academic needs. According to the EMS Chief, the EMS Academy has now imposed more stringent course prerequisites to improve the applicant selection process.

· Conflicts with personal life (study time versus family time).

· Negative peer pressure from other fire fighters.

· Fire fighters" concerns about the heavy emergency medical services call volume and the lack of rotation between ambulances and fire engines.

· A relatively small salary differential between the top step of Classification H2 Fire Fighter and Classification H-3 Fire Fighter Paramedic, when the heavier emergency medical services workload is taken into account. We note, however, that this salary differential actually ranges considerably. While a Classification H-2 Fire Fighter at the highest salary step who is eligible for a 5 percent EMT premium earns approximately 90.9 percent of a Classification H-3 Fire Fighter Paramedic salary, a Classification H-2 Fire Fighter/EMT at the lowest step who is eligible for a 5 percent EMT premium earns only 64.9 percent of a Classification H-3 Fire Fighter Paramedic salary.

As a result of these problems, the EMS Academy has only added 27 cross-trained Classification H-3 Fire Fighter Paramedics to the Fire Department from its first three programs. Based on FY 2000-01 cost information provided by the EMS Division, the total cost of the first three programs was approximately $1,966,503 for Fire Department employees⁴. Therefore, it effectively cost the City each approximately $72,833 to cross-train each of the 27 graduates of the EMS Academy ($1,966,503 divided by 27). By contrast, non-Fire Department students were charged only $5,000 by the EMS Academy.

Conclusions

The Fire Department only recruits Classification H-2 Fire Fighters. This does not reflect the Fire Department"s actual workload which is dominated by emergency medical services.

The Fire Department should recruit people with prior fire science, Emergency Medical Technician (EMT), paramedic, and/or advanced education qualifications, and formalize career development programs for staff. The Fire Department should also expand Cadet Program course content to include paramedic experience, and expand recruits" field probation experience to include an ambulance assignment, in order to assess their aptitude for advanced EMT training. These recommendations would result in the recruitment of staff members more suited to the Fire Department"s primary work activities.

On-duty paramedic cross-training is provided to Fire Department staff through an in-house 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 classes (since December 1996), at a cost of approximately $72,833 per graduated student.

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

Recommendations

The Fire Chief should:

1.6.1 Direct the new Division of Fire and Medical Training, with support from the new Strategic Policy, Planning and Analysis Unit, to:

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

· Incorporate external review panels into the recruitment process.

· Expand the Cadet Program course content to include paramedic experience.

· Expand Classification H-2 Fire Fighter recruits" field probation experience to include an ambulance assignment.

· Develop formalized career development programs for staff.

1.6.2 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.

1.6.3 Analyze future paramedic training options so that the Fire Department can prepare a cost benefit comparison between an in-house EMS Academy and utilizing paramedic training provided by other public and private sector agencies.

1.6.4 Analyze the costs and benefits of requiring staff to undertake their cross-training off-duty.

Costs and Benefits

There would be no costs to implement these recommendations because each of these recommendations could be performed by existing Fire Department staff.

These recommendations would result in (a) the recruitment of staff members more suited to the Fire Department"s actual workload, which has been increasingly dominated by emergency medical services since July 1, 1997, (b) a recruitment process which takes more account of applicants" prior qualifications, which would both improve the caliber of recruits and reduce the length of training they require, and (c) training which provides recruits with the EMT and/or paramedic skills they need. Analysis of future paramedic cross-training options, and the costs and benefits of requiring staff to undertake their cross-training off-duty, could potentially lead to cost savings if the Fire Department determines that there are less costly ways to provide paramedic cross-training.

¹ The current educational requirement for Classification H-2 Fire Fighter recruits is a high school diploma or equivalent. Recruits must go on to graduate from the Fire Academy, and some also go on to complete the EMS Academy. In addition to fire and EMS training, lateral H-3 hires must have at least one year"s experience as a fire fighter paramedic in another jurisdiction.

² The EMS Academy Section Chief advises that, in the interim, the Fire Department informs the EMSA of all changes made to EMS Academy training programs. Furthermore, EMSA staff teach in EMS Academy courses.

³ By requiring Fire Department personnel to undertake cross-training off-duty, the expectation would be that (a) participation in training courses would be in addition to staff members" regular work shifts, which could be scheduled to accommodate their course commitments, and (b) staff members would not be compensated with overtime for the time they spend training.

⁴ The amount of $1,966,503 comprises (a) three years of the EMS Academy Section Chief"s 0.75 FTE involvement ($272,880), (b) three years of a Classification H-33 Rescue Captain instructor ($303,123), (c) $15,000 per class for San Francisco General Hospital site coordination ($45,000), and (d) 60 students at $22,425 per student ($1,345,500), The $22,425 per student comprises: $1,750 for skills instructors working on overtime (to ensure the one instructor per six students required by law); $1,100 for ambulance preceptor premium; $18,500 for ambulance overtime backfill; $300 for classroom supplies; and $775 for registration fees.