BLS PROGRAM - R.I.P.???
By Frank Kelly, Secretary
|The BLS Pilot Program, two long years in existence, ended January
31, 2001. Most at the Presidio (the other fire department headquarters)
would lead you to believe the closure is in anticipation of a
lawsuit filed by a private company. However, no private company
has initiated a lawsuit. The Bronsan Act allows private firms
to bid openly for the rights to BLS Tier Programs. No bids have
been forthcoming. The BLS tier has not been challenged. The EMS
Section of the Fire Department is willing to gamble. It is their
desire to keep open the BLS units until there is a legal challenge.
But enough is enough. The Emergency Medical Service Agency of
San Francisco (EMSA), after reviewing the program, is less than
satisfied. Patient care is at risk, lawsuits may increase from
private citizens not from private companies. The program should
The closure raises a host of questions as to why the BLS Tier got its start in the first place. Soon after the merger there were radical spikes in the number of EMS calls. The Presidio gods conclusion was that of a remarkably high flu season. The volume of calls would taper off when the flu season ended. Ambulance and engine companies would soon get a break moving into spring. But the call volume continued to increase. Questions from Locals 798 and 790 about the new Computer Based Dispatch (CBD) system at Radio were rebuffed. There are kinks to be worked out; after all its a new system. The call volume will level off by summer. However the demand continued to increase. Downtown engine companies were dispatched 30-35 times then 40 times per day. Diversion status for ambulances were created. After their 15th dispatch they were given a four-hour rest period regardless of the time of day. The nearest ambulance was not always dispatched. Patient care diminished. The BLS Tier was created. However if one read the Phase I & Phase II documents produced by merger proponents the BLS Tier was a system pariah. It would never be of service to a community like San Francisco. The Administration defended the creation of the BLS Tier predicting it would relieve the stress and fatigue of ambulances and engine crews, especially in the downtown and Mission District corridors. Concerns by Local 798 and Local 790 regarding patient care were dismissed. Local 798 raised the issue when conscripting new firefighters, fresh off probation with limited skills, to work together on BLS ambulances. Holding them accountable was not a good idea. Once again our concerns were dismissed. The Department defended their position by pointing to the job application form. Fire fighter duties included medical services to the community. Medical Services - ambiguity as always. The job application form, the Department Rules and Regulations, the Civil Service Rules. Ambiguity - Ambiguity - Ambiguity.
Medical Services - I cant wait to see the General Order regarding brain surgery performed in the field. Module I & II mandatory, Module III & IV voluntary. But enough of this. Where am I headed you ask? Well, right back to the beginning. Are there enough ambulances to handle the call volume? Will the new class of lateral transfers be adequate to replace the loss of the BLS Tier? Will there be enough H-3 promotions to allow H-3 firefighter/paramedics to begin and complete their probation time on engine and truck companies? Will certain engine companies revert back to the good old days of 35 plus runs per day and will diversion status for medic units be re-implemented. Will the administration and the EMSA finally review the CBD system? A system that desperately needs to be overhauled? Should the EMSA and the Administration suggest to someone at City Hall the need for nurses at homeless shelters? To make available more MAP units at shelters ready to shuttle the homeless and indigent to general hospital or other care facilities when needed? Or will the administration fold to the demands of the Presidio gods who hail their not so new revelation as the savior to their program.
Will the EMS Division have their way again and implement the split tier program also known as the 1+1 system. One EMT and one paramedic ambulance. This new configuration of ALS engine companies and understaffed ambulances in theory are dispatched and arrive on the scene at the same time. If by necessity two paramedics were needed to transport a patient. Two problems could arise. One, the ambulance would now be overstaffed with two paramedics and one EMT leaving the engine in service and understaffed. Two, the engine would respond with the ambulance to the hospital resulting in engine companies out of service for longer periods of time. Every fire fighter understands it is their job to drive the ambulance in an emergency; such as shootings, stabbings, victims critically injured in auto accidents, and many other emergency situations. However with the implementation of Split Tier Programs engine companies will respond more frequently with the ambulance to hospitals on routine Code III EMS calls. Questions involving suppression remain unanswered. The daily routine of engine companies takes them to a myriad of other functions. Does fire ring a bell Chief? Full boxes would take two or three ALS engines out of service for periods of 15 to 20 minutes. First alarm fires for an hour to two hours, and greater alarms could conceivably hold eight or ten ALS engines out of service for several hours. The Presidio, who regards fire as our part time job, doesnt have any answers to these scenarios. But one conclusion is clear. Understaffed ambulances responding to Code III calls while ALS engines are out of service at working fires would have an unforeseen enemy on board, diminished patient care. To quote a former LA City attorney, whom in defense of the two-paramedic system said, This is the only time when 1+1 does not equal two. The LA Fire Department has relinquished its pursuit of the 1+1 system. To those H-3s in the field who support the Presidios plan ask yourself a few questions; Is it your purpose and do you support diminished patient care? Do you support the reduction of promotional positions within the SFFD? Do you support the alienation of fellow brother and sisters by forcing them onto the ambulance? I believe your answer to these questions would be an emphatic no. I understand your frustration. Promises that were made to all of you. H-1s, H-2s, and laterals have not been fulfilled. The Presidio gods are trying to dig themselves out of a hole that they created. Every step they take only exasperates the problem.
This mergers roots can be traced back a decade to the Paramedic Association of San Francisco. Many of its members hold rescue captains and chief positions at the Presidio. Ideas spawned there have been fruitless. The Band-Aid approach has been noteworthy for delays in the program and diminished quality of patient care. CBD has confounded the experts. The BLS program was not the panacea. Hiring H-3 laterals did not solve the problem. Hiring more H-3 laterals did not solve the problem. Hiring paramedics off a separate list will only dig a deeper hole. What happened to the promise of less than 10 runs per day for every ambulance in the City? Another dream deferred. The split system will only create more problems. Morale will suffer. Most important, patient care will suffer. It is not the purpose nor is it the will of this union to run the fire department. However, our membership has questions that remain unanswered. They will remain unanswered until someone at 698 Second Street tells the Presidio administration that they dont run the fire department either. Or do they?