The Combined Emergency Communications Center (CECC) located at 1011 Turk Street is the City"s designated Public Safety Answering Point (PSAP) for answering 9-1-1 calls for assistance. For calls requiring a police response, PSAP Call Evaluators verify the phone number and street address of the incident, enter specific incident information, assign a priority code (A, B, or C) into the Computer Aided Dispatch (CAD) system, and transfer that information to a Police Dispatcher who dispatches a specific unit or units to the incident. PSAP Call Evaluators transfer calls requiring a Fire/EMS response to the Fire/EMS Administration of the EOC, which houses Fire/EMS Call Evaluators, Dispatchers, Division Controllers, and Team Chiefs.

Civilians staff all PSAP Call Evaluator and Police Dispatcher positions. Uniformed Fire Department personnel staff all of the positions assigned to Fire/EMS Dispatch.

Fire/EMS Call Evaluator/Dispatch Process

Fire/EMS Call Evaluators receive calls for assistance transferred from the PSAP Call Evaluators. Fire/EMS Call Evaluators verify the call-back telephone number and street address, and determine the nature of the call. For fire/rescue type calls, the Call Evaluator enters specific incident information into the CAD system and transfers the information to the fire incident "hot seat" for dispatch.

For medical assistance calls, Call Evaluators triage the incident by asking questions specified in a Criteria-Based-Dispatch (CBD) flip-chart binder, assign an incident-code to the incident, and transfer the information either to the "hot seat" for Code-3 (high priority) calls, or to the "fleet seat," for Code 2 (lower priority) calls.

A flowchart of the Fire/Emergency Medical Service call evaluator/dispatch system is shown on the following page.

Fire/EMS Dispatch Organization

A total of 61 uniformed members of the Fire Department are assigned to the Fire/EMS Dispatch organization. Of that total, 54 members are available for duty; the remaining seven members are on extended sick leave or other long-term absence.

A Battalion Chief, who is assisted by an Administrative/Training Officer, commands Fire/EMS Dispatch. The remaining 52 members are organized into four teams, each led by a Paramedic Captain. Teams One and Three staff the day shift on a three-day on, three-day off, basis. Teams Two and Four staff the night shift on a like basis. An organization chart of the Fire/EMS Dispatch unit follows the flowchart on the next page (Exhibit 1.12.2).

Exhibit 1.12.1
Fire/EMS Dispatch Process

 

Exhibit 1.12.2
Fire/EMS Dispatch Organization

Although staffed by uniformed members of the Fire Department, Fire/EMS Dispatch is under the operational control of the Emergency Communications Department, which operates the CECC. 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.

Cost of Staffing Fire/EMS Dispatch

Cost of Fire/EMS Dispatch with Fire Department Staffing

With the exceptions of the Battalion Chief and the Training/Administration Officers, who work a regular 40-hour workweek, all Fire Department members assigned to Fire/EMS Dispatch work a day or night schedule of three 12-hour shifts followed by three days off. The average workweek for that schedule is 42 hours. Members are paid four hours of overtime per two-week pay period. The regular salary and mandatory fringe benefit costs of the 54 positions currently authorized for Fire/EMS Dispatch are as follows:

	Classification	Salary & Benefits at Top Step	Number of Positions	Total for FTE Count
	H 40 Battalion Chief	$131,695	1	$131,695
	H-33 EMS Captain	110,661	4	442,644
	H 30 Captain	110,661	1	110,661
	H-20 Lieutenant	97,661	10	976,110
	H-2 Firefighter	84,892	38	3,225,896
		Total Positions	54	$4,887,006

Built-in Overtime of four hours per pay period results in an additional planned cost of approximately $250,000 per year. However, because Fire/EMS Dispatch includes approximately seven members who are on disability or long-term illness, and because of additional overtime required to compensate for absences, actual costs for FY 2000-01 were $6,047,600, including basic salaries, overtime pay, premium pay, and mandatory fringe benefits.

Planned Cost of Fire/EMS Dispatch with Civilian Staffing

The Emergency Communications Department"s financial officer has developed a cost table for staffing Fire/EMS Dispatch with 54 civilian positions, as shown below:

	Classification	Salary & Benefits at Top Step	Number of Positions	Total for FTE Count
	Sr. Police Comm. Dispatcher*	$80,535	2	$161,070
	Police Comm. Dispatcher**	71,630	52	3,724,760
		Total Positions	54	$3,885,830

* Classification 8239: Senior Police Communications Dispatcher

The current plan is for the Call Evaluators/Dispatchers to work an eight-hour day, as is currently the practice with the civilian Call Evaluators/Police Dispatchers.

Cost Comparison of Uniformed and Civilian Staffing

On a cost basis, it is much more advantageous for the City to employ civilians in Fire/EMS Dispatch. As previously stated, basic salary, overtime, premium, and mandatory fringe benefit costs for Fire/EMS Dispatch in FY 2000-01 were $6,047,600 whereas the planned annual cost for civilian Call Evaluators/Dispatchers is $3,885,830, not including overtime. Therefore, average annual savings after full civilian staffing should be approximately $2 million. However, a consideration other than cost also strongly favors replacing uniformed members of the Fire Department with civilians. Based on interviews conducted for this study, the uniformed members of the Fire Department generally don"t want to serve at the EOC, and that attitude reportedly pervades the organization. The type of duty and the duty schedule are viewed with disfavor by line personnel. The Fire/EMS Dispatch supervisors advised the Budget Analyst that almost none of the members serving at Fire/EMS Dispatch wish to be there, and we encountered none who were enthusiastic about the duty.

Plan to Civilianize Fire/EMS Dispatch

In response to an information request from the Budget Analyst to the ECD regarding plans to replace uniformed staffing with civilians, the Director of the Emergency Communications Department provided the letter dated October 5, 2001, that we have included as Attachment 1.12.1. Therein, the Director states that the "ECD is prepared to replace 16 SFFD call-takers by September 30, 2002 if we are able to obtain the necessary dollars to hire an academy of 20 civilians for a start date of November 1, 2001. By September 2003, the remaining 38 SFFD Fire/EMS dispatchers can be replaced if the associated dollars are committed to ECD for that purpose."

The ECD Director has provided other details of the plan to replace uniformed members with civilians, including training existing public safety communications dispatchers in Fire/EMS functions. Further, according to the Director, success of the effort hinges on $2.3 million in funding to train sufficient personnel to staff the Fire/EMS Dispatch function. The $2.3 million figure assumes a 50 percent attrition factor for trainees, which according to the ECD, is supported by past class attrition factors.

Once full staffing is achieved, the uniformed firefighter personnel currently assigned to the dispatch function can be returned to fire suppression duties, reducing the Department"s expenditures for overtime. Therefore, the $2.3 million funding being sited by the ECD, as well as future funding to train up to the 52 civilian dispatchers, would represent one-time costs for the Department.

Criteria Based Dispatch

The system used by Fire/EMS Call Evaluators to triage emergency medical calls for assistance, since the spring of 1998, is a manual system known as Criteria Based Dispatch (CBD) that consists of a binder with multiple pages of directions keyed to specific medical problems. Use of the CBD has been problematic in the San Francisco Fire Department almost from its inception. The following excerpts from evaluations and observations made by the EMS Administration of the Department of Public Health, which provides oversight of all pre-hospital medical services in the City, exemplifies some of the problems with the CBD system:

· On October 9, 2001, the Administrator informed the Budget Analyst that the EMS Administration has recently become aware of repeated failures of Call Evaluators to follow CBD protocols, which may have contributed to "untoward" medical outcomes. The EMS Administrator stated that the EMS Administration is determining what specific actions will remedy the current situation and will be meeting with the ECD to address the situation.

· A January 12, 2001, memorandum from the EMS Administrator to the Chief of the Fire Department contains the following comments:

"While there has been some improvement in the use of CBD, call takers are not consistently or correctly using this system."

The Fire Department"s EMS Chief states that it is now widely agreed by the Fire Department, the Emergency Medical Services Agency (EMSA), the ECD, and each Advanced Life Service (ALS) provider (AMR and King American) that the City should adopt the Medical Priority Dispatch System (known as the "Clawson" system, after its inventor). The Clawson system is favored because:

· The system is computerized, has a comprehensive support network, is user-friendly for the operators, and would be easier for civilian dispatchers to operate because of the compulsory computer fields. The Clawson system is a computerized system, which guides the dispatcher through pre-determined screens, thereby minimizing dispatcher discretion. Further, the Clawson System would facilitate data capture that would allow the Fire Department to make changes to dispatch criteria in the future.

· The system includes a state-of-the-art quality improvement component that would help ensure compliance by call takers.

· The system has successfully withstood legal challenges throughout the country.

· The system is compatible with the new CAD/AIS.

As shown in Attachment 1.12.1, the Executive Director of the Emergency Communications Department has stated that the cost of procuring the Clawson dispatch system was included in the Department"s FY 2001-02 Budget and that the ECD intends to purchase the Clawson System this fiscal year. The Executive Director has also stated that the ECD is in the process of developing operational plans necessary to phase Fire/EMS Dispatch call-taking function using the Clawson product, and that the ECD, barring any unforeseen events, expects to complete the installation, testing, and training by the 4^th quarter of FY 2001-02.

Until such time as the Clawson system is procured and becomes operational, the Fire Department and the ECD must install and operate the controls to ensure that CBD protocols are adhered to.

Transitioning from CBD to the Clawson system would also enable a significant potential benefit: the possibility of savings in Call Evaluator positions. As previously discussed, all 9-1-1 calls are initially answered by PSAP Call Evaluators who process the call if it is police related, but transfer Fire/EMS calls to Fire/EMS Call Evaluators. It is possible that all Call Evaluators could be trained to process fire-related calls and, with the use of the Clawson system, also be trained to process medical calls for assistance, which are the most complicated to process. The ECD currently plans to allocate 16 of the total 52 civilian Fire/EMS Dispatch positions to call taking. The annual salary and mandatory fringe benefit costs of those positions is approximately $943,280. Savings of up to that amount, depending on call volumes, could be realized after all PSAP Call Evaluators are trained to process fire-related, medical-related and police-related calls for assistance.

Standard Operating Procedures

San Francisco Fire/EMS Dispatch does not have a standard operating procedures (SOP) manual that provides Call Evaluators/Dispatchers with a single reference that addresses departmental rules and regulations, personnel issues, dispatch policies, and operational procedures. Fire/EMS Dispatch does have separate binders covering such topics as hazardous materials and BART operations, but most of those individual procedures are located at the supervisors" station. A January 12, 2001, memorandum from the EMS Administrator to the Executive Director of the Emergency Communications Department contains the following comment concerning policies and procedures:

"Policy and procedures need better organization. Employee standards, reporting relationships, and work processes are described in a confusing myriad of SFFD manuals, policies, and general orders. Many employees are not aware of these policies and procedures. Without a functional table of contents, these manuals are difficult to use."

Some Fire/EMS Dispatch supervisors have advised the Budget Analyst that a single manual SOP would be an aid to enhancing operations. The Fire/EMS Dispatch Battalion Chief concurs with that opinion.

The Budget Analyst obtained an SOP manual from the Phoenix Fire Department and provided the Battalion Chief with a copy. We also discussed the manual with Fire/EMS Dispatch supervisors who stated that such a manual, adapted to the City"s needs, would be very helpful.

The Fire/EMS Dispatch Battalion Chief has stated that he intends to adapt the Phoenix Fire Department manual to the needs of the San Francisco Fire Department.

San Francisco Fire Department and Emergency Communications Interdepartmental Agreement

The Budget Analyst has been advised that although the need for an Interdepartmental Agreement between the ECD and the Fire Department has been discussed and draft Interdepartmental Agreements have been circulated, as of the writing of this report no Agreement between the parties exists.

The Budget Analyst believes that a signed Agreement between the Fire Department and the ECD would be useful in the operation of the Fire/EMS Dispatch unit. The development of the Agreement would require that each party carefully determine the values it wants included in the document and the process of negotiating the details of the Agreement, would be worthwhile.

Therefore, the Budget Analyst recommends that the Fire Department and the ECD undertake the responsibility to develop, sign, and work for the public good within the parameters of an Interdepartmental Agreement.

Further Considerations

Effective emergency communications are an absolute necessity to effective emergency operations. Currently, everyone is acutely aware of the need for effective emergency operations capabilities. Replacing the current uniformed members of the Fire Department with civilians would endow the Fire Department with the equivalent of two Fire Academy classes of 24 recruits each, reduce the need for overtime associated with the Department"s minimum daily staffing requirements for fire suppression, and allow for more economical, efficient, and effective communications operations at the Combined Emergency Communications Center.

Currently, the tour of duty for firefighters assigned to the CECC is approximately one year, which according to some managers approximates the amount of time required for the average person to become well qualified in Fire/EMS Dispatch duties. Thus, unlike civilians who continue to perform CECC duties for an indefinite period, uniformed members most often are reassigned to the field just when they are becoming proficient in Fire/EMS Dispatch duties.

Conclusions

Responsibility for answering calls for fire, rescue, and emergency medical assistance, and dispatching units to reported incidents, was transferred from the Fire Department to the Emergency Communications Department (ECD) in April 2000. However, uniformed Fire Department personnel, most of whom consider Communications Center duty as being highly undesirable, continue to staff the positions necessary to perform dispatch functions.

The system used by Fire/EMS Dispatch since the spring of 1998 to triage emergency medical calls for assistance is a manual system known as Criteria Based Dispatch (CBD). Use of CBD has been problematic almost from its inception: Evaluations by the Health Department"s Emergency Medical Services Section have resulted in multiple unsatisfactory ratings, primarily because Fire/EMS Call Evaluators very often do not follow CBD protocols. The EMS Administrator has informed the Budget Analyst that recent repeated failures of Call Evaluators to follow CBD protocols may have contributed to "untoward" medical outcomes. The EMS Administrator has stated that the EMS Administration is determining what specific actions will remedy the current situation.

The ECD intends to replace the uniformed Fire Department personnel with civilian Call Takers/ Dispatchers by September 30, 2003, provided that adequate funding to replace Fire Department personnel is authorized for this purpose and sufficient new staff is available. That action would require an initial outlay of approximately $2.3 million, but would result in salary savings of approximately $2 million annually in ensuing years. Additional potential annual savings of up to approximately $943,280 could be realized by training all call takers to triage and process fire/medical service calls, in addition to calls for police assistance.

Recommendations

The Mayor and the Board of Supervisors should:

1.12.1 Allocate funding required to replace uniformed members of the Fire Department with civilians to staff Fire/EMS Dispatch in a manner that facilitates the schedule proposed by the ECD.

The Emergency Communications Department should:

1.12.2 Recruit and train sufficient civilian trainees to staff the Fire/EMS Dispatch function in accordance with the planned schedule.

1.12.3 If feasible, train all Call Evaluators to process Fire/EMS calls for assistance.

1.12.4 Procure the Clawson medical dispatch system and place it into operation as soon as possible.

1.12.5 In conjunction with the Fire Department, ensure that CBD protocols are adhered to.

1.12.6 In conjunction with the Fire Department, develop a signed Interdepartmental Agreement concerning Fire/EMS Dispatch operations.

The Fire Department should:

1.12.7 In conjunction with the ECD, ensure that CBD protocols are adhered to.

1.12.8 Develop a Fire/EMS Dispatch operating procedure that covers such topics as departmental rules and regulations, personnel management, dispatch policies, and operational procedures.

1.12.9 In conjunction with the ECD, develop a signed Interdepartmental Agreement concerning Fire/EMS Dispatch operations.

Costs and Benefits

The cost of replacing uniformed members of the Fire Department with civilian Call Evaluators/Dispatchers would require an initial outlay of approximately $2.3 million.

However, when fully implemented, approximately 48 Firefighters and 4 Paramedic Captains would be released for primary duties in their professions and annual savings of approximately $2 million would be realized because of the compensation differences between uniformed members and civilians. In addition, the Fire Department would save an undetermined amount on overtime, due to the increased availability of Firefighters and Paramedic Captains. Finally, by training all PSAP Call Evaluators to process Fire/EMS call for assistance, the ECD could save up to $943,280 in salaries and mandatory fringe benefits.