|By Tom O'Connor, Treasurer|
| Well, the Presidio machine marches on
despite budget cuts city-wide, despite all Department members just voting themselves a pay cut, despite all of the complete and unqualified failures of the merger so far. The latest development is the implementation of the new, new, new Rapid Paramedic Response System (RPRS) plan
12 ALS engines immediately, with a total of 18 by July 1st. And while increased ALS engines are a dramatic improvement in the services we offer to the community, the manner in which this new plan is being implemented negates all of the benefits
and only spells troubles for the future of the San Francisco Fire Department.
The last pilot program the Department went through was not without its problems namely the one and one ambulance. Everyone wants to blame the ALS trucks for the failure of the pilot program, but if the trucks werent chasing understaffed ambulances all around the City, then the trucks would never
|have left their first alarm areas. Now with an increase in the number of ALS engines, and an increase in the number of one and one ambulances, the same scenario will be happening
only this time engines will be crisscrossing the city trying to chase down an ambulance being driven by a probie firefighter.
Of course, the Presidio will mobilize their army of statisticians (who should really be staffing ambulances to help their overworked brothers and sisters) and these desk jockeys will come out with all sorts of facts and figures that look wonderful but mean nothing. Facts and figures like the time it takes a paramedic to get to the scene of course with more medics on more engines they will get there quicker, but will they do anything different than the firefighters before the ambulance arrives? And once the ambulance gets on the scene, will there be a longer transfer process from one medic to another, thereby even further delaying the patients transport to the hospital. This is San Francisco folks, only 49 square miles, if you swing a dead cat over your head youre likely to hit at least two hospitals. All we should be doing is stabilizing and rapidly transporting victims. If we were out in Vacaville or Lake Tahoe, then more advanced treatments would be necessary because of the long transport times.
What other facts and figures will the Presidios Statistical Attack Department (S.A.D.) roll out? How about the ol TFCI? Whats that you ask? Why its the Time to First Critical Intervention, of course. The TFCI is supposed to measure if ALS care is actually being delivered earlier than it was before the RPRS. What could be wrong with this statistic? Well, nothing really if you ignore the fact that a recent study conducted for the Department reported that the Department lacks the reporting capabilities to completely and accurately determine changes in TFCI.
The study also went on to say that the Department needs to measure the frequency of delivery of ALS care. Specifically, the report said, the Department may wish to determine the degree to which a RPRS system makes available a high standard of patient care that is justified by sufficient need for that care. Put more simply, how often does the ALS paramedic make a difference by performing a skill that an EMT could not have done?
The study, conducted by Amiee Albertson of the UC Berkeley School of Public Policy, goes on to conclude that the Department should also measure on-scene times for the RPRS ambulances. The study determined that some paramedics report that the ambulance paramedic who arrives after the ALS engine or truck may perform his/her own evaluation. This may be due to lack of familiarity with paramedics recently hired by the Department, or to the perception by one medic that another is incompetent.
The report also noted that measurements of the impact on fire response times were not measured. Albertson concludes, the Department should monitor what impact RPRS in fact has on non-CBD response times, and particularly for working fires. Now the report also went on to state that 25 ALS engines and 19 one and one ambulances were needed to make the whole RPRS work properly, but like the Presidio, Im going to ignore numbers that dont fit in with my operational models.
More critically though, the study did not measure the effect of the one and one ambulance on our system. The one and one ambulance is the root of all the problems with the RPRS, forcing rigs to meet up with an understaffed piece of equipment. That is why the pilot program and the ALS trucks failed, and that is why a complete roll out of the RPRS will also fail. Sorry, the program wont fail it will only require more resources and more paramedics.
In fact, if you listen to the Presidio, nothing that has happened for the past five years can be pinned on their mismanagement. According to the Presidio, problems have only resulted from an underfunded and understaffed system.
Most alarming for the future though, are the recent results of the suppression training for medics in the pilot program only one medic passed the pump test. Only one. The Presidios response to this it must be the officers fault. Now, I am not going to blame the medics either, but what this reflects is a systemic breakdown in our training process. The whole system needs to be evaluated and revamped, now.
Instead of marching blindly forward with the new, new, new RPRS that includes no truck training whatsoever, we need to slow down and properly train our medics on how to be firefighters. And that includes truck time and truck training. Maybe the Department should only have 12 ALS engines and six BLS trucks for medics to train on. If only one of your trainees passes probation, why would you then further shorten your training program?
At a recent meeting with H-3s, Chief Trevino sought to quell the unrest amongst our paramedics and explain to them his plans for the immediate future of the Department, including the new, new, new RPRS. When the Chief explained that there would be no truck training for just this one group of medics (nearly 150, or 65%) the crowd groaned in disapproval. From now on though, all new medics hired will serve out the new probationary year of 4 months engine, 4 months truck, and 4 months ambulance. Those medics currently in the program will only get 6 months engine time with efforts made to get drills on the truck and increased truck training on Treasure Island. With nearly all of our current medics failing the engine portion of their training, why would we shorten the probation time even further for this group? After 6 months on the engine, will they be considered fully cross-trained? Will they be eligible to take a promotional exam having never worked on a truck?
The implementation of an ALS engine program is a wise and noble concept that will benefit the citizens of San Francisco, but if training is ignored for fire suppression, what price will fire fighters and San Franciscans pay?
If we never finish cross training our medics, and we have 25 ALS engines in July, what will happen when we start our massive hiring to compensate for all of our impending retirees? Where will we put all the probies? Will we now allow two probies on an engine? Will fire suppression be comprised of an officer and two novices on the hose line? Is this what San Francisco bargained for when the merger between DPH and the SFFD was put before the Board of Supervisors?
At the H-3 meeting with Chief Trevino, one paramedic summed up his frustration with his abbreviated training by continually asking why he couldnt continue to learn his new trade, firefighting? Why cant the Department finish training medics so that we can be good firefighters and prove ourselves to all of our coworkers, he asked. He never received a good answer the only answer he got was that we cant fix the past, we can only fix the future. Well, if we dont fix the past and all of the mistakes made in this merger, the mistakes will only compound themselves in the future.
The SFFD does not need yet another band-aid solution for the implementation of ALS engines. The SFFD does not need a quick fix cover-up of past mistakes to make us look like an ALS Department on paper. What the Department needs, and needs now, is an absolute timeline for the complete training of all of our current and future medics, and a gradual rollout of the RPRS. What the Department needs is to start the SFFD/DPH merger all over again, and do right this time. Without building a strong foundation now, we are only doomed to fail again and fail again very soon.