Draft Summary
Advanced Life Support
Feasibility Study
City Council Presentation
May 27, 2025
Fire Chief Aaron Osorio 1
Synergistic Policies-Health in All Policies
Established and Approved by City Council in 2014
• Framework to guide and incorporate health-centered public policy development • Improve conditions that support health outcomes through prevention Intervention Area 6: Quality & Accessible Health & Home Services • Many need to receive quality and affordable health care & related services Key Finding From HiAP Report:
2 Synergistic Policies-City Council Goals & Priorities
Approved by City Council late Fall of 2023
• Established City-wide goals with measurable outcomes
• Outlines key initiatives and strategic objectives that guide the City's growth and improve the quality of life for all residents.
Strategic Goal Area 4 – Improve Public Safety
• 4.3 - Add and Improve Emergency Response and Preparedness Strategic Goal Area 5 – Strengthen the City’s Internal Infrastructure and Processes • 5.1 – Ensure that there is the right staffing level and experience to meet service goals of each City Department
3 Introduction
• Complex topic, may require additional presentations
• City of Richmond history on Advanced Life Support
Services
• History of study request & Matrix Consulting Group
• Con Fire funded study
• Objective of the feasibility study
• Align with countywide EMS system
4 Recommended Action
• RECEIVE the draft written report regarding Advanced Life Support (ALS) First Responder Feasibility Study and
DIRECT staff to pursue next steps for implementing the
recommended service models
• Does the City want to move forward with a program? If so, which service model is desired?
5 Definitions
• Basic Life Support(BLS): Emergency Medical Technicians • Advanced Life Support(ALS): Paramedics
• EMS: Emergency Medical Service
• Contra Costa County EMS Agency (CCCEMSA): Division
of CCC Health that regulates EMS services across county 6 BLS Scope of Practice
• CPR, semi-auto defibrillation, basic airway
management, medical assessments, blood sugar
testing, basic trauma treatments, basic medical
treatments,
• Oxygen, Narcan, Oral Glucose, Epinephrine, Oral
Aspirin
7 ALS Scope of Practice
• All BLS scope, EKG monitoring, cardiac pacing,
manual defibrillation, advanced airway management, IV
treatment, advanced trauma treatments, advanced
medical treatments, pain management
• Can administer 20 additional medications via IV, IM & oral
8 Current Regional Fire EMS System
9 Current EMS Services in Richmond
• Richmond Fire currently provides Basic Life Support
services (Emergency Medical Technician)
• Richmond Fire is only BLS fire agency in Contra Costa County
• Advanced Life Support (Paramedic) services and
transport provided by Con Fire/AMR Alliance
10 ALS – Why It Matters
• ALS scope provides more treatment options for patients • Improved outcomes: cardiac, trauma, stroke
• 3 primary categories of care
• Faster critical care = higher survival rate
• Experiencing ALS transport delays
• Consistency with regional partners
• ALS service improves equity in emergency response
11 ALS – Why It Matters
12 Squad Delivery Model
• QRV-Quick Response
Vehicle Model in Matrix
Study
• More commonly referred
to as a “Squad”
• Staffed with 2 Single-Role
Paramedics
• Need to hire 18-20
Paramedics
13 Engine Delivery Model
• Engine-Based ALS
Staffing
• Staffed by 3 fire
personnel with
minimum of 1
Firefighter Paramedic
• Need to hire 30
paramedics
14 Hybrid Delivery Model
• Combination of both
• 3 squads initially
• Phase in Firefighter/
Paramedics
• Upstaff ALS Engines
as staff is trained
15 2020-2023 EMS Call Volume
• Stations with highest EMS volume: 67, 68, 64, 62
• Best locations to implement Squads or initial ALS
Engines
16 2024 Call Volume
• 15,150 total incidents in 2024
• 4.75% increase over 2023
• 3-4% increase in total calls annually, post pandemic
• 8,870 total EMS incidents in 2024
• Predict this trend will continue due to projected increases to population in city
• Increased Housing > Population Rises > Increased Demand on 911 System
17 Staffing Requirements
• 10 RFD personnel currently licensed as paramedics
• Engine-Based ALS Model:
• Need 30 Firefighter/Paramedics (30 Firefighter EMTs)
• 5–6 month academy or laterals
• Squad Model:
• 18-24 Single-Role Paramedics
• 1-2 month EMS academy
18 Personnel Actions
• Create new job specifications for following positions:
• Single-Role Paramedic
• Firefighter/Paramedic
• EMS Supervisor
• EMS Analyst
• Update all current job specifications within Operations Division • Determine pay & benefits of new positions
• Determine pay incentive for current employees
19 Labor Considerations
• Meet & Confer with all impacted bargaining units
• IAFF Local 188, RFMA, SEIU, Executive
Management
• Unit determinations for:
• Single-Role Paramedics
• EMS Supervisor
• EMS Analyst
• Duties and working conditions
• Work with LCW & HR to update MOUs for impacted
barging units
20 Local Hire & Diversity Considerations
• Protect efforts to maintain and improve diversity in the Richmond Fire Department
• Continue to provide employment opportunities for residents from Richmond and West County
• Firefighter/Paramedic candidate pool is historically less diverse • Single-Role Paramedic program can lessen impact to candidate pool • Opportunities to candidates not interested in firefighter career 21 Training Requirements
• California Emergency Medical Services Authority
• Title 22 of California Code of Regulations, Chapter 4 • 454 hours of didactic instruction
• 160 hours of hospital clinical training
• 480 hours of field internship
• 40 ALS patient contacts
• Successfully pass National Registry Examination
22 Training Program
• Dual Path Program:
1. Retraining fire personnel already licensed as paramedics
2. Training existing firefighters interested in participating • Con Fire/Contra Costa College model on firefighter shift sched ule • 2 days/week, 16 months, 1,290+ hours
• Prerequisites
• Current tuition $7,500 / student
• Community College vs. Private School
• 48 hours continuing education / 2 years
23 EMS System Oversight
• California Emergency Medical Services Authority, CCC Emergency Medical Services Agency, City of Richmond Fire Department • State agency
• CCC Health-EMS Division
• EMS Director & Medical Director
• Richmond Fire EMS Director
• EMS Supervisor
• Each plays a unique role in Richmond Fire EMS Program 24 State & County Oversight
• CA Emergency Medical Services Authority
• Establish Health & Safety Code
• CCC Health-EMS Division
• Enforces CA Health & Safety Code
• Establishes county EMS policies and field treatment procedures • Authorizes level of care Richmond Fire is allowed to practice • Dictates scope of practice for all providers
• Investigates and administers discipline
25 Richmond Fire Oversight
• Richmond Fire EMS Director
• Mandated by CCC EMSA
• Mandated Continuous Quality Improvement Program
• DEA accountability program(narcotics monitoring)
• Continuing education
• Equipment & supply purchasing
• Liaison to CCC EMSA
• EMS Supervisor can be same as Director
• Civilian vs. Sworn
26 Draft ALS Fiscal Impact - Matrix
27 Draft Financial Projections
28 Funding Strategies
• Measure H
Revenue:
$229,462/year
• Annual
shortfall:
~$394,000
29 Funding Strategies
•E M S T a x
• Bill non-residents full amount
• First Responder Fee
• Charge for EMS responses
• Insurance Billing
• Only amount insurance will cover, waive remainder
• Medicare and Medi-Cal
• Typically do not reimburse non-transport
• 3rd-party billing contactor recommended
30 Implementation
• Consultant recommendation of a 67-month phased plan
• Not well suited to City’s annual budget cycle
• Plan based on fiscal year is more appropriate
• Propose a five-year implementation plan
• FY 25/26 through FY 29/30
• Must remain flexible with timeline
31 FY 25/26
•N e w
Agreement
with
CCCEMSA
•M e e t &
Confer
• Job Specs
•I n i t i a t e
Recruitment
of EMS
Director &
EMS Analyst
•S p e c &
Order
Apparatus
FY 26/27
•On-Board
EMS Director
& EMS
Analyst
•Pur chase
Equipment &
Supplies
•R ecruitmen t
of Single-Role
Paramedics
•Pr ogr am
Development
FY 27/28
•Accreditation
•Operational
Role Out of
Squads
•Initia t e
Paramedic
School for
Existing
Employee
Training
FY 28/29
•Pur chase
Equipment &
Supplies for
ALS Engines
•Complet e
Paramedic
School for
Existing
Employees
•National
Registry
•Accreditation
FY 29/30
•O p e r a t i o n a l
Role Out for
ALS Engines
Draft Implementation Timeline
32 UNANTICIPATED
DELAYS WOULD
PUSH FINAL
ROLL OUT TO
FY 30/31
Proposed Next Steps
• Receive policy direction
• Determine which service model to implement
• Negotiate new agreement with CCCEMSA
• Start labor discussions
• Complete job specifications with HR & Personnel Board • Provide the City Council an implementation update later in Summer 2025
33