*-'.

ife$Yi,

F-r.
v*P s{?+

:G _',-i'
-::f
1 *"*
lll;--:--}:

.t - a :

.i

-,

BUSIilESS 5.5

Octcber 22,2414

-::t--

Los AngQJes Coun$

Board of $spetvisors
':i

Gloria Molina
,rrs!$s5l

MichaeiA. Duree, Fire Chief

Ci$ of Long tseach Fire Department
3205 Lakewood Boulevard
Long Beach, CA 90808

ldarf, Ridley-Thomas
Scco$ DisYil

Zev Yarosiavsky

Dear Chief Duree:

Thid Disticl

Dcr Knabe
fcJ'ih }s:-r

Mhhael D. Antorovicft
Fdth D,b:-c:

Cethy Ct*destet

Cielrl
ffilliam lbenig,

MD

Mdar.lirr,bi

1S10$

Plo,reerBM. Suite 200

This letter is to request a written plan for improvement to the Rapid Medic
Deployment pilot project The Emergency MedicalServices (EMS) Agency
has been rnonitoring the Rapid Medic Deployment pilot proiect for compliance
with Reftrence F.,lo. 407, Advancd l-ife Support Unit Alternate Staffing Pilot
Progran': Requirements {attached), $pecifically, Reference No. 407, 1., K.
state$:

Provider Agency shall ensure that the MS incidents

responded to by Ane-Plus-Ane sfafied ALS unifs anive at the
scr?e of the incident within 3 minufes of each other 95% af
the time. Tfiere shall he a mechanism in place ta track and
report within 24 hours each EMS response and the AIS unffs
that responded to the incident; bath individualFMS r?cidenfs
and in aggregat'e fonnat.

Sanh Fe Spriqgs.0A 9ffi70

ret: {562} 347-15C0

(562) 941{83s

rar:

Ta ensure timely.
compassionate. and quali$
ernergency and disester
rnedica! sr;wices

The EMS Agency analyzed data from both the City of Long Eeach Fire
Departuirent tLBfD) ComputerAided Dispatch (CAD) system and patieni care
report fonns and found the RMD program to be out of compliance. On
September 8,2014 the EMS Agency staff met with you and your senior
rnanagement to discuss the two paramedics on scene times and further
review ynur data reports.
Your staff requested additionaltime to review the CAD data and resubmit a
repod, On $epternber 9, 2414, it was clear that the second pararnedic is not
aniving on tire scene of the "Charlie" calls within three minutes, 95% of the
time (attached). An emailwas sent to your staff, copied to you, requestiag a
written plan for improvement as soon as possible and irnplementation of the
plan no later than October 1,2414.
To date the EMS Agency has not received a plan for improvement and has
not been made aware of any changes to the RMD program to ensure timely
arrival of two pararnedics to the scene of all "Charlie" calls.
Flease subnrit your department's written plan for imprgvement ensuring
delivery to the EMS Agency by November 3, 2A14. The plan needs to include
an inrplernentation date no later than Ngvember 15, 2014.

1r

3'
f

Mic*aef,A. Duree" F'irc Chief

22.2014
October
I
Pe$e 2

\-*
.\
ff LBFD ie:not:able t6, prbyide tlte plsfi ,andtor dern@tr.at* signi*car$ irn$qffiaff ta
tlre *!ro gx4rqm*dic an'scen* fir$e,ttre .EndS Agency tadlt sider.ternination of the
pilstpr jgqas eenred iri Reterance No aSf.
Tha*rk you for. yeur gita:ftion

*o,

*ri$

tfi&r

Very truly yours,

tlf:

l;..
t

,ll

..,i,1

4.
/ .'*..,:li:'i

,,i;.*' i. .,

Catrv Chidester
Diredor
AtraehrflBnt

e:

EM"$ Gornm&sisn

DSMB
,frfredical Director, LBFD

Frnch *{y &lanagqr

'il4edie#,ilirectsr EM$ Agency
;t-o*'rg

"!i*

["+r &35*le: {or, *t1

F-rr*.gr:nry ;r/kdir:il te& ;f, :::i AG;r,t r?

h-HFtlc'f

irnc

F:isst Unifr

llrriusg dl* $*c*'is {;* linre $ecwnd Unit *rrirr*d #tt"Se'**'r*

'.:::
Jr,li'

3fl

.ru|'.1

11 I01,{

$urIHri$l tr:

&{iH lird Snit Ari"iv*d iri S rflin.iitls:rr }s:15

i9"/,, -;'nfi unlt fi{rl{rsd bfl:vl+er .E - .ll li}l}],itps
lfr, - ffnd lJrit '\rnrynq"l k*tnr**n m*eter its:: tn rnirs.:t*r

,o*t

-',.''' -:,.'

*'

,*3

*'*

i\'t

;*'t'

*'t
"",,

-' tt *

irr

;r
;.:1

t'

-*-'ot *r.

ll'i nr tlr
:rrf anr{l

;ri f tli'f hl'

;Jil:,hFrJ, l:J-J

clTY oF LONG BEACH

Business 5.6

FIRE DEPARTMENT
Long Beach CA 90808--r733

3205 Lakewood Boulevard

Telephone (562) 570-2500

FAX {562) 570.2508

MICHAEL A. DUREE
FIRE C}IIEF.

October 28,2014

Cathy Chidester
Director of EMS
Los Angeles County EMS Agency
10100 Pioneer Blvd., Suite 200
Santa Fe Springs, CA 90670
Ms. Chidester,

The Long Beach Fire Department prides itself in achieving excellence in protecting the
public we serve- We have always strived for new ways to improve our service to the
community. The Rapid Medic Deployment (RMD) model is one of many ways we have
raised the bar in providing excellent care to the citizens and visitors to Long Beach.
The RMD plan has been in operation since July 10, 2014 and we have already seen
improvements in many areas of service delivery. When we compare post RMD data to the
previous year, we have been able to deliver the first ALS capable resource on scene 50
seconds faster since the inception of the program. We have done this by increasing our
number of Paramedic Assessment Units (PAUs) from g to 17. This has allowed us to
dispatch a paramedic to almost every medical emergency in the city. Prior to RMD with
only 9 PAU's, 66.5% of our responses didn't receive ALS level care until the Paramedic
Unit anived. The original engine company could start assessing at a BLS level, but no ALS
level care could be provided untilthe paramedics arrived.
Within reference 407 there was a requirement included that stated the time frame between
the first arriving medic and the second should be within 3 minutes or less 95o/c of the time.
This has never been a requirement for any agency in the past- We also do not believe any
agency within Los Angeles County could meet such a requirement. ln the past if the first
unit on scene was a PAU there was never any concern as to how long the PAU medic was
operating prior to paramedic unit arriving. The chief concern was how long it took to get an
ALS level care on scene. PAUs have been operating in Los Angeles County for many years
without any concerns or issues in their operation. Prior to RMD, when we did have a PAU
arrive in lieu of a BLS engine first, we had the second unit an?e within 3 minutes or less
79% at the time when we reviewed 2013 data. Since the inception of the RMD program
that percentage has essentially remained uftchanged. The second medic anives

Adminislration

Firc Prevention

{562} 570.2510

(562)

FAx {S?} flC2506

t0-2560

FAX {562}tl0-2566

i*.

Operatiom

$6a r0.?5&t
FAX (562) $10-?561

Support Seoices
{564 5t0-2s01
FAX (564 tr0-25s6

Cathy Chidester, Director of EMS

October 28,2014
Page

'

within3 minutes 79% of the time. lf we look at the variance between the first arriving
Paramedic and the second resource we show the following data:
:

3:20
3:14

1t1t2Q13..12t31ft413
1n12aM..71112014
7nat2014..10t1012014

We believe

2:21

a more accurate way to asse$$ the RMD program is to evaluate its

effectiveness by comparing how quickly we delivered two paramedics prior to RMD and
comparing it to Post RMD. lf we look at the same data set for 2013 and 2014 (see chart
below) we show an improvement of 1:04 seconds on average.

The data is as follows:

5:54

8:38
8:25
8:15
8:26

5:14
4:58
4:57
5:03

7:15
7.23
7:28
7:22

5:55
5:48

Julv 10-30
August
September

6:O1

AvE Time

2AM
Julv 10-30
Auqust
Sentember
Avcr Time
P,LAN'FOR IMPROVEMENT

As a plan for improvement we have already made some changes to our system to deliver
the second paramedic to the scene quicker. They are as follows:
o

'

We have added two peak load BLS units to the system. This reduces the overall call
volume per rescue and keeps the RMD rescues available a higher percentage of the
time for ALS responses. By transporrting a higher perceiltage of ALS calls, it also
reduces their wait times at the htispital.

,i'
Cathy Chidester, Director of EMS
October 28,2014

'' Page2

,.
g

"-

We will also be adding a third peak load BLS unit to further help in this regard.
We are more closely monitoring our dispatch data. We just started a more proactive
approach in tracking our rssponse times-by instituting a prCIgram called "Firestaf'.
Firestat allows us to track key performance'indicators such as dispatch and response
times to the Battalion Chiefs and Company Commanders using real time data
directly. This will allow us to improve dispatch times by increasing accuracy and
accountability, With the additional BLS units and Firestat reporting, we expect to see
a better performance profile in the future.

Sincerely,

tl.fr-

MichaelA. DuRee
Fire Chief

cc: .

EMS Commission
DSMB
Medical Director, LBFD
Long Beach City Manager
Medical Director, EMS Agency

,l'

Cathy Chidester, Director of EMS

October 28,2014
Page

i.

:r
\$

"' \

We will also be adding a third peak load BLS unit to further help in this regard.
We are more closely monitoring our dispatch data. We just started a more proactive
approach in tracking our re$ponse times-by instituting a program called "Firestaf'.
Firestat allows us to track key performance'indicators such as dispatch and response
times to the Battalion Chiefs and Company Commanders using real time data
directly. This will allow us to improve dispatch times by increasing accuracy and
accountability. With the additional BLS units and Firestat reporting, we expect to see
a better performance profile in the future.

Sincerely,

d-fu-

MichaelA. DuRee
Fire Chief

cc: .. EMS Comrnission

DSMB
MedicalDirector, LBFD
Long Beach City Manager
Medical Director, EMS Agency