RESPONSE TO GRAND JURY FINDINGS AND RECOMMENDATIONS - FIRE CHIEF Huntington Beach Fire Chief Response
Finding #1:
Despite fire departments throughout Orange County having evolved into emergency medical departments, most have not updated their emergency response protocols accordingly, but have simply absorbed emergency medical responses into their existing fire response models.
Fire Chief’s Response: Disagree
Since the initial implementation of EMS in the early 1970’s the Huntington Beach Fire Department has updated emergency response protocols to adapt to the evolving EMS needs of our community and advances in technology in order to always provide the highest quality emergency medical services within the boundaries of policy and budgetary decisions of the City Council. Current customer satisfaction surveys sent to patients who are treated and transported by the Huntington Beach Fire Department show that 98.7 % of patients feel that the quality of medical care met or exceeded expectations.
Finding #3:
ALS staffed ambulances or smaller squad vehicles are often the most appropriate response to medical calls and do not compromise the quality of medical care.
Fire Chief’s Response: Disagree
The Huntington Beach Fire Department uses ALS equipped emergency transport units (ambulances) for transporting patients. These units are equipped with the required ALS equipment and supplies but staffed with non-firefighter BLS personnel. This model keeps costs down and maintains the availability of ALS resources while BLS patients are being transported. It is also considered an industry best practice.
Not all patients transported within the City of Huntington Beach require paramedic escort and the current deployment model maintains ALS unit availability even when there are numerous ETs transporting BLS patients or waiting at the hospital for an available bed.
Supported by our CAD data, a paramedic engine company can run a medical aid and be available again for the next call often within 20 minutes while the emergency transport will usually be committed to that call for over an hour. Committing the ALS resource to a BLS transport would triple the time the ALS resource is unavailable for another call.
RESPONSE TO GRAND JURY FINDINGS AND RECOMMENDATIONS - FIRE CHIEF Huntington Beach Fire Chief Response
Finding #4:
There has been a breakdown of communication and trust between OCEMS and Orange County Fire Chiefs.
Fire Chief’s Response: Agree
The Huntington Beach Fire Department has enjoyed a collaborative and professional relationship with OCEMS for many years. The HBFD has worked in conjunction with OCEMS on many different EMS projects which has brought new treatments and protocols to Orange County. These collaborations have ultimately enhanced emergency medical services and helped save lives.
In 2009, the HBFD collaborated with OCEMS to allow a new cardiac procedure called “transcutaneous pacing” which allowed firefighter/paramedics to treat patients with dangerously low heart rates with electrical therapy to keep the patient alive during transport to an emergency room.
In 2014, the HBFD again collaborated with OCEMS to design the first 12 lead transmission program. This allowed HBFD firefighter/paramedics to electronically transmit 12 lead EKGs of suspected heart attack patients directly to base hospital physicians and receiving cardiologists. This significantly reduced the treatment time of serious heart attack patients and has saved countless lives in Orange County. This partnership extended not only with OCEMS, but our local cardiac receiving centers as well. The HBFD has been recognized by the American Heart Association numerous times for this endeavor.
In 2018, the HBFD proposed a “Pit Crew CPR” trial to Dr. Schultz and the OCEMS clinical staff that was very successful in increasing cardiac arrest survival rates and has since become the County-wide protocol for managing cardiac arrests. Dr. Sam Stratton was the OCEMS medical director prior to Dr. Carl Schultz and he has served in a volunteer capacity as a medical advisor to the Huntington Beach Fire Department since 2020 and has been an asset to our organization.
Broadly speaking, there has been some difficulty between fire agencies and OCEMS primarily due to policy or protocol changes made by OCEMS that lacked desired coordination and/or communication. In some cases, one or more changes were made when OCEMS chose not to engage the EMS advisory subcommittee and in numerous cases, changes were made that did not follow OCEMS Policy 310.80, which delineates when updates will be posted and take effect.
RESPONSE TO GRAND JURY FINDINGS AND RECOMMENDATIONS - FIRE CHIEF Huntington Beach Fire Chief Response
Finding #5:
Over-deployment of firefighters for medical calls contributes to the current climate of forced hiring and firefighter fatigue.
Fire Chief’s Response: Disagree
The Huntington Beach Fire Department has been continually adapting our staffing policies in order to collaboratively work with the labor groups to ensure proper service delivery while preserving job satisfaction and limiting firefighter fatigue. With transport units staffed by non- firefighters, there is no perceived over-deployment of firefighters for medical calls in the City of Huntington Beach.
Current staffing challenges are not necessarily a result of over-deployment of Firefighters on medical aid calls. A recent independent third–party standards of cover (SOC) report by Citygate Associates indicates that our unit hour utilization is appropriate to avoid firefighter fatigue.
Finding #9:
OCEMS has the authority and responsibility to inspect all for-profit ambulances operating in Orange County; however, publicly-owned ambulances are not automatically subject to OCEMS oversight.
Fire Chief’s Response: Agree
This is true. OCEMS does not have authority to require inspection of publicly-owned ambulances. The Huntington Beach Fire Department cooperated with OCEMS and participated in annual ambulance inspections from 1993 through approximately 2007. In the final few inspections, HBFD staff was advised by Patrick Powers, then BLS Coordinator at OCEMS, the inspections were not required and were not of much use since our ambulances were outfitted far beyond the requirements of OCEMS. We responded to Mr. Powers’ offer and discontinued the inspections and have continued to stock and maintain our emergency transport units in excess of OCEMS requirements. OCEMS has not requested to re-institute ambulance inspections since that time.
RESPONSE TO GRAND JURY FINDINGS AND RECOMMENDATIONS - FIRE CHIEF Huntington Beach Fire Chief Response
Recommendation #1:
As recommended in the 2012 and 2014 OCFA Standards of Coverage and Deployment Plans, as well as other studies, the Grand Jury recommends that, by 2024, all Orange County fire agencies utilize criteria-based dispatch protocols and send a single unit response to those incidents triaged as non-life-threatening (BLS). Fl, F2, F5
Fire Chief’s Response: Recommendation will not be implemented This recommendation will not be implemented because it is not warranted. The Huntington Beach Fire Department has a recent independent third-party Standards of Cover (SOC) report by Citygate Associates that indicates our current deployment model is excellent and a standard for the fire service. The City of Huntington Beach has full authority to determine the level of service to provide its community. The Huntington Beach Fire Department will continue to work under the direction of the City Council to determine the most effective, cost efficient and appropriate way to deliver EMS in our jurisdiction.
Recommendation #4:
While OCEMS should recognize how certain policy changes may pose operational challenges to emergency responders in the field, fire leadership should recognize and respect the independent oversight authority and expertise of OCEMS. F4
Fire Chief’s Response: Recommendation has been implemented This recommendation is already a standard practice. The Huntington Beach Fire Department acknowledges and appreciates the expertise and fully recognizes the medical oversight of OCEMS in accordance with the laws of the State of California and the duly established regulations of the California Emergency Medical Services Authority. We will continue to operate under the medical direction of OCEMS and will continue to respect and collaborate with this agency as a regulatory partner in EMS.
Recommendation #5:
Departments with publicly owned ambulances should allow OCEMS to inspect their ambulances for compliance with State EMS guidelines and adopt OCEMS recommendations. F9
Fire Chief’s Response: Recommendation will not be implemented This recommendation will not be implemented because it is not warranted. The Huntington Beach Fire Department has never disallowed OCEMS to inspect our ambulances, but we did come to a mutual determination that these inspections were unnecessary because the existing internal policies and standards of the HBFD far exceeded the OCEMS criteria in the inspection process. Should OCEMS change their prior position and express a desire to inspect our ambulances, we would give the request full consideration and work with them to determine if reinstating the process would be helpful and fiscally responsible.