CITY COUNCIL AGENDA Members Nikuyah Walker, Mayor September 20, 2021 Sena Magill, Vice Mayor Heather D. Hill Michael K. Payne J. Lloyd Snook, III Kyna Thomas, Clerk 4:00 PM WORK SESSION Register at www.charlottesville.gov/zoom. Virtual/electronic meeting in accordance with a local ordinance amended and re-enacted April 19, 2021, to ensure continuity of government and prevent the spread of disease during a declared State of Emergency. Individuals with disabilities who require assistance or special arrangements to participate in the public meeting may call (434) 970-3182 or submit a request via email to ada@charlottesville.gov. The City of Charlottesville requests that you provide a 48 hour notice so that proper arrangements may be made. CALL TO ORDER ROLL CALL REPORTS 1. Report: Charlottesville Fire Department Update PUBLIC COMMENT Page 1 of 72 Charlottesville Fire Department City Council Update September 20, 2021 Dr. Hezedean A. Smith, Fire Chief Dr. George Lindbeck, Medical Director Mike Rogers, Deputy Chief FAMILY INTEGRITY RESPECT EXCELLENCE Page 2 of 72 • Military Veteran • Certified Public Manager • Doctorate in Management (Organizational Leadership) • Emergency Services & Public Safety (33 years) • Retired from Orlando Fire Department (24 ½ years) • Adjunct Professor, Embry-Riddle Aeronautical University • Adjunct Professor, Columbia Southern University • Fire Chief Charlottesville Fire Department - 12/1/2020 FAMILY INTEGRITY RESPECT EXCELLENCE Page 3 of 72 CHARLOTTESVILLE ORLANDO • 10 sq. miles, 7,000 calls/year • 113 sq. miles, 70,000 calls/year • 3 fire stations, 2 ambulances • 17 fire stations, 17 ambulances • 4 fire engines, 2 tower trucks • 18 engines, 8 tower trucks • 108 members • 500+ members • Peer Support Group • Peer Support Group • Arson Bomb Team/CRR • Fire Prevention (CRR) • Deputy Chiefs, District Chiefs • Deputy Chiefs, Battalion • Lieutenants, Engineers Chiefs • Firefighters • Captains, Firefighters FAMILY INTEGRITY RESPECT EXCELLENCE Page 4 of 72 The mission of the Charlottesville Fire Department is to improve the quality of life in our community by consistently striving to provide superior fire and emergency services focused on prevention, preparedness, response, and recovery. Core Values Family Integrity Respect Excellence FAMILY INTEGRITY RESPECT EXCELLENCE Page 5 of 72 *VISION *ALIGNMENT EXECUTION FAMILY INTEGRITY RESPECT EXCELLENCE Page 6 of 72 Vision: To enhance the department’s culture and service delivery through Transparency, Innovation, Trust, and Integrity. Values Mission Driven Safety Collaboration Responsiveness Equity Inclusion Timeliness A Just Culture FAMILY INTEGRITY RESPECT EXCELLENCE Page 7 of 72 1. Workforce 2. Health & Safety NEW 3. Communication 4. Training 5. Services 6. Support View the CFD Strategic Plan FAMILY INTEGRITY RESPECT EXCELLENCE Page 8 of 72 COMING SOON • The Medical Priority Dispatch System (MPDS) is an emergency medical dispatch (EMD) system that is widely used to prioritize 9-1-1 calls and optimize resource allocation. MPDS is a computer-based EMD system that uses callers' responses to scripted questions to categorize cases into groups and subgroups, based on complaint and perceived acuity (Sporer & Wilson, 2012) • Higher rates of Advanced Life Support (ALS) interventions in higher-acuity categories (e.g., Alpha, Bravo, Charlie) were seen in several EMD categories, including unconscious/fainting, breathing problems, and abdominal pain; but this was not observed in many other categories, including seizure, sick person, traumatic injury, and hemorrhage/lacerations (Sporer & Wilson, 2012) Sporer KA, Wilson KG. How well do emergency medical dispatch codes predict prehospital medication administration in a diverse urban community? J Emerg Med. 2013 Feb;44(2):413-422.e3. doi: 10.1016/j.jemermed.2012.02.086. Epub 2012 Oct 22. PMID: 23089206. FAMILY INTEGRITY RESPECT EXCELLENCE Page 9 of 72 The Charlottesville Fire Department must be prepared to embrace the forces impacting the 21st Century Fire and Emergency Services FAMILY INTEGRITY RESPECT EXCELLENCE Page 10 of 72 View the EMS 2050 Agenda FAMILY INTEGRITY RESPECT EXCELLENCE Page 11 of 72 Realignment Realignment New (volunteer) Realignment Temp New Page 12 of 72 100-day Plan FAMILY INTEGRITY RESPECT EXCELLENCE Page 13 of 72 9-MONTHS OF PROGRESS • 22 new recruits – largest class in • NAEMT Training Center history • Implicit Bias, Diversity, Equity, and • Professional Standards Division Inclusion Training • Employee recognition • Solidified Peer Support Program • Emergency Preparedness Bureau • “Just Culture” philosophy • “Just Culture” philosophy • Internship program with Virginia • Fire Department Chaplain State University Program • Scholarship program (Columbia • Secured $26,000 grant (Firehouse) Southern University) • ASHER training with CPD • Framework for Drone and Water Rescue programs View CFD's FY21 Annual Report FAMILY INTEGRITY RESPECT EXCELLENCE Page 14 of 72 Ridge Street Station(1959) 62 years old Bypass Station (1961) 60 years old FAMILY INTEGRITY RESPECT EXCELLENCE Page 15 of 72 Ethnicity (before Ch. Smith) Count Percentage Black or African American 10 12% Hispanic 1 1% White/Not Hispanic origin 74 87% Equity Ethnicity (Since Ch. Smith) Black or African American Hispanic Count 17 1 Percentage 16% 1% White/Not Hispanic origin 90 83% Gender 15 new firefighter positions (SAFER Grant) (before Chief Smith) Count Percentage 7 new firefighters (attrition) Female 3 4% Male 82 96% Inclusion Gender (Since Ch. Smith) Count Percentage Female 10 9% Male 98 91% FAMILY INTEGRITY RESPECT EXCELLENCE Page 16 of 72 Diversity Page 17 of 72 CULTURAL CHANGE FAMILY INTEGRITY RESPECT EXCELLENCE Page 18 of 72 DATA & DASHBOARDS • Neighborhood Risk Reduction • Call Volume Analysis • Response time analysis • Personnel Workload • Resource Use Factor • Incident Heat Mapping • Unit Hour Utilization • Patient Disposition Analysis • Overtime Dashboard • Turn Out Time Tracking • Drive-time analysis FAMILY INTEGRITY RESPECT EXCELLENCE Page 19 of 72 View Charlottesville Neighborhood Risk Dashboard FAMILY INTEGRITY RESPECT EXCELLENCE Page 20 of 72 EVALUATION OF SERVICES (2007) FAMILY INTEGRITY RESPECT EXCELLENCE Page 21 of 72 EVALUATION OF SERVICES (2007) ? Full Minutes EMS Committee Report (2007) FAMILY INTEGRITY RESPECT EXCELLENCE Page 22 of 72 EFFICIENCY STUDY (2017) FAMILY INTEGRITY RESPECT EXCELLENCE Page 23 of 72 EVALUATION OF SERVICES (2021) FAMILY INTEGRITY RESPECT EXCELLENCE Page 24 of 72 EVALUATION OF SERVICES (2021) FAMILY INTEGRITY RESPECT EXCELLENCE Page 25 of 72 ALS RESPONSE PERFOMANCE CARS CFD FAMILY INTEGRITY RESPECT EXCELLENCE Page 26 of 72 BLS RESPONSE PERFOMANCE CARS CFD Page 27 of 72 4 MINUTES VS. 8 MINUTES Drive-time analysis Page 28 of 72 DEFINITIONS • 90th percentile response times were calculated for five different response time elements within Tableau: • Call Handling Time: time from an ECC dispatcher answering a 911 call to a unit being notified • Turnout Time: time from a unit receiving notification of the incident to the unit’s wheels beginning to move Travel Time: time from a unit beginning to move toward the incident to a unit’s arrival on scene FAMILY INTEGRITY RESPECT EXCELLENCE Page 29 of 72 DEFINITIONS • 90th percentile response times were calculated for five different response time elements within Tableau: • Total Response Time: Aggregation of the previous three response time elements that measure the time from ECC to the arrival of the first unit on scene. • Unit Best Performance Time: Aggregation of turnout and travel time, as these two elements are within the control of a crew staffing a unit (travel time to a lesser extent to safely travel to a scene). FAMILY INTEGRITY RESPECT EXCELLENCE Page 30 of 72 DEFINITIONS • Emergency Medical Technician (EMT-Basic): The Emergency Medical Technician is to provide basic emergency medical care and transportation. This individual possesses the basic knowledge and skills necessary to provide patient care and transportation. • Advanced - Emergency Medical Technician (A-EMT): primary focus of the Advanced Emergency Medical Technician is to provide basic and limited advanced emergency medical care and transportation for critical and emergent patients. FAMILY INTEGRITY RESPECT EXCELLENCE Page 31 of 72 DEFINITIONS • Emergency Medical Technician-Paramedic (EMT-P): A Paramedic is an allied health professional whose primary focus is to provide advanced emergency medical care for critical and emergent patients. • *Emergency Medical Technician-Intermediate (EMT-I): Recognized in Virginia based on approved scope of practice by a medical director FAMILY INTEGRITY RESPECT EXCELLENCE Page 32 of 72 DEFINITIONS • ECC determines the type of response (ambulance/trauma/medic level) needed for a 911 caller based on call processing parameters and medical response plans approved by the local medical director responsible for an EMS system. The call triage process is currently being upgraded. • Advanced Life Support: Involves the administration of medications and basic or advanced medical/trauma procedures by paramedics and typically only done by physicians in an in-hospital setting. • Basic Life Support: Basic medical care provided by EMTs in an ambulance or other setting. FAMILY INTEGRITY RESPECT EXCELLENCE Page 33 of 72 DATA REVIEW ALS vs. BLS FAMILY INTEGRITY RESPECT EXCELLENCE Page 34 of 72 CONTINUOUS QUALITY IMPROVEMENT Page 35 of 72 PROXIMITY DISPATCH • CFD now sends the closest ”appropriate" ambulance to ALS & BLS level calls • Prior to change - ambulances were often sent to scenes with long response times and very frequently passed a fire station with an ”appropriate" life support available in the station. • Improvement was necessary for providing a timelier response with the highest level of out-of-hospital medical care to neighborhoods such as 10th & Page, Fifeville, Fry's Springs, Ridge Street, Woolen Mills, and others. • 10th & Page neighborhood is #1 for Cardiac Arrests, #3 for Diabetic, Cardiac Emergencies, and Falls • The EMS system must ensure timely responses to all neighborhoods. FAMILY INTEGRITY RESPECT EXCELLENCE Page 36 of 72 CLOSEST AMBULANCE • Cardiac Arrest Response - Example FAMILY INTEGRITY RESPECT EXCELLENCE Page 37 of 72 CLOSEST AMBULANCE • BLS Response Plan - City • BLS Response - County FAMILY INTEGRITY RESPECT EXCELLENCE Page 38 of 72 IMPLICATIONS • Statement - "83% of all patients …. only required Basic Life Support (BLS) level care”. • 100% of patients transported require BLS level care; • BLS staffed ambulances only provide “basic” care (unit capability) • Limited opportunity to receive higher-level care (BLS units do not have medics on board). • If an advanced level care or assessment is needed on BLS call, then what? • In reviewing a sample (small) of "BLS" calls with abdominal pain transported by EMS, approximately 18% were admitted; thus, suggests they were patients who could have benefitted from advanced life support measures (IVs, EKGs, etc. prior to arrival in ED). FAMILY INTEGRITY RESPECT EXCELLENCE Page 39 of 72 OUTCOMES • Impact • Hospital data exchange (HDE) no automated - needed • Response has improved service delivery in areas such as • Travel Time • Total Response Times • Unit Best Performance • Turnout. • Barracks Road, Greenbrier, JPA, Johnson Village, Lewis Mountain, Locust Grove, Rose Hill, Starr Hill, UVA, and Venable have seen a • 17% improvement in Travel Time • 10% improvement in Total Response Times • 11% improvement in Unit Best Performance FAMILY INTEGRITY RESPECT EXCELLENCE Page 40 of 72 MULTIPLE UNIT RESPONSES • CFD rarely multiple units of the same “type” to medical scenes • Findings - more efficient use of resources • [past-practice] non-CFD unit arrives and requests a medic or a suppression unit • Validity - Based on EMS data only and queries any "response incident number" (as it's called in the EMS dataset) with more than one unit with a confirmed arrival time on scene • Filtered to city and UVA zones only to remove county responses. FAMILY INTEGRITY RESPECT EXCELLENCE Page 41 of 72 IMPLICATIONS • # of EMS runs in the city+UVA that result in a call for fire engines/trucks on BLS calls • Improved efficiency in reducing the use fire engines/trucks to BLS calls FAMILY INTEGRITY RESPECT EXCELLENCE Page 42 of 72 PRE/POST- PROXIMITY ANALYSIS FAMILY INTEGRITY RESPECT EXCELLENCE Page 43 of 72 DATA SOURCES • The FRITS_Final_Apparatus table is an authoritative, apparatus-level table built by ACFR • ImageTrend – RMS used to collect data for CFD, CARS, and ACFR • A custom query built in ImageTrend’s report writer module to bring additional relevant data into the analysis • Dataset imported into ArcGIS Pro, clipped to city boundaries to exclude any responses to Albemarle County, and a spatial join on city neighborhoods and UVA polygons was performed to enable neighborhood-level analysis of response performance changes after proximity dispatching was implemented. FAMILY INTEGRITY RESPECT EXCELLENCE Page 44 of 72 VALIDITY PROCESS Filters applied to extract/control for outliers and limit the date range to the defined study period: • Incident Dates between July 3, 2021, and August 13, 2021 • Call Handling Time (Incident Dispatch Notified to Unit Notified by Dispatch in Minutes) <= 5 minutes FAMILY INTEGRITY RESPECT EXCELLENCE Page 45 of 72 VALIDITY PROCESS • Turnout Time (Incident Unit Notified by Dispatch to Unit Enroute in Minutes) <=5 minutes • Travel Time (Incident Unit Enroute to Unit Arrived on Scene in Minutes) <=25 minutes • Total Response Time (sum of the previous three response time elements) <=30 minutes FAMILY INTEGRITY RESPECT EXCELLENCE Page 46 of 72 METHODOLOGY • CARS and CFD call volumes vary by day of week with CARS historically running more incidents on weekend days. • Based on this historical pattern, an equal number of weekdays and weekend days were used in the comparative analysis prior to priority dispatch implementation on 7/24/21 and after that date. • The pre-proximity dispatch date range - Saturday 7/3/21- Friday 7/23/21 • The post-proximity dispatch date range - Saturday 7/24/21- Monday 8/13/21 • 21 days are included in both analyses 15 weekdays and 6 weekend days FAMILY INTEGRITY RESPECT EXCELLENCE Page 47 of 72 NEIGHBORHOOD ANALYSIS • For neighborhood analyses, only neighborhoods with ten or more EMS incidents in the two study periods compared (before and after proximity dispatch implementation) were examined. • The threshold of ten incidents in each period was used to select neighborhoods for analysis as 90th percentile calculations are only considered statistically significant when there are ten or more unique numbers to analyze. FAMILY INTEGRITY RESPECT EXCELLENCE Page 48 of 72 NEIGHBORHOOD ANALYSIS • Only neighborhoods with 10 or more EMS • 10th & Page incidents in the two study periods compared (before and after proximity dispatch • Belmont implementation) were examined. • Fifeville • Fry’s Spring • A threshold of 10 incidents in each period was used to select neighborhoods for analysis • Martha Jefferson • 90th percentile calculations are only • North Downtown considered statistically significant when there • Ridge Street are 10 or more unique numbers to analyze. • The Meadows • Woolen Mills FAMILY INTEGRITY RESPECT EXCELLENCE Page 49 of 72 Call Handling Change: -47% Turnout Change: -10% Travel Time Change: -10% Total Response Time Change: -17% Unit Best Performance Change: +2% FAMILY INTEGRITY RESPECT EXCELLENCE Page 50 of 72 Call Handling Change: -18% Turnout Change: -13% Travel Time Change: -36% Total Response Time Change: -17% Unit Best Performance Change: -29% FAMILY INTEGRITY RESPECT EXCELLENCE Page 51 of 72 OVERALL • EMS incidents 338 • 90th Percentile • *Travel Time improved Call Handling Change: -3% by 6% • Total Response Time Turnout Change: -1% improved by 4% Travel Time Change: -6% Total Response Time Change: -4% Unit Best Performance Change: -4% FAMILY INTEGRITY RESPECT EXCELLENCE Page 52 of 72 Call Handling Change: -26% Turnout Change: -14% Travel Time Change: -55% Total Response Time Change: -40% Unit Best Performance Change: -51% FAMILY INTEGRITY RESPECT EXCELLENCE Page 53 of 72 Call Handling Change: -2% Turnout Change: +22% Travel Time Change: +2% Total Response Time Change: +4% Unit Best Performance Change: +5% Page 54 of 72 Call Handling Change: -31% Turnout Change: -16% Travel Time Change: -16% Total Response Time Change: -27% Unit Best Performance Change: -16% FAMILY INTEGRITY RESPECT EXCELLENCE Page 55 of 72 Call Handling Change: -3% Turnout Change: +20% Travel Time Change: -17% Total Response Time Change: -10% Unit Best Performance Change: -11% FAMILY INTEGRITY RESPECT EXCELLENCE Page 56 of 72 CARDIAC ARREST FAMILY INTEGRITY RESPECT EXCELLENCE Page 57 of 72 STANDARD OF RESPONSE COMPLIANCE FAMILY INTEGRITY RESPECT EXCELLENCE Page 58 of 72 • 71% of the time in FY21 the first arriving CARS unit on an ambulance-level EMS call met the performance benchmark for turnout and travel time. • 87% of the time in FY21 first arriving CARS met the performance benchmark for travel time. FAMILY INTEGRITY RESPECT EXCELLENCE Page 59 of 72 • 10% of the time in FY21 the first arriving CARS unit on a medic/trauma-level EMS call met the performance benchmark for turnout and travel time. • 22% of the time in FY21 first arriving CARS met the performance benchmark for travel time. FAMILY INTEGRITY RESPECT EXCELLENCE Page 60 of 72 • 96% of the time in FY21 the first arriving CFD unit on an ambulance-level EMS call met the performance benchmark for turnout and travel time. • 98% of the time in FY21 first arriving CFD met the performance benchmark for travel time. FAMILY INTEGRITY RESPECT EXCELLENCE Page 61 of 72 • 58% of the time in FY21 the first arriving CFD unit on a medic/trauma-level EMS call met the performance benchmark for turnout and travel time. • 75% of the time in FY21 first arriving CFD met the performance benchmark for travel time. FAMILY INTEGRITY RESPECT EXCELLENCE Page 62 of 72 OTHER COMMUNITY NEEDS FAMILY INTEGRITY RESPECT EXCELLENCE Page 63 of 72 THE FUTURE The fire and emergency services are in an enviable position in communities, as they are well positioned to be the hub of service provision for many supporting services already found within their community, and that align with organization’s core mission. There are significant opportunities to create partnerships with allied health care, mental and behavioral health providers, and various social service agencies to leverage the talents of each agency with a focus on improving service to the community. Too often agencies respond multiple times to the same individual who calls 911 as their only known access for assistance, when the need is truly not an emergency, but could be met by UVA researchers reveal shortage in at-home medical care another service provider in the community. https://www.cpse.org/wp-content/uploads/2020/07/21st-Century-Fire-and- Emergency-Services-White-Paper-Final-07.15.20.pdf Page 64 of 72 Mental Health Sister Cities Cultural Collaboration Task Force Ghana Change Policies Diversity Inclusion Equity FAMILY INTEGRITY RESPECT EXCELLENCE Page 65 of 72 FAMILY INTEGRITY RESPECT EXCELLENCE Page 66 of 72 THE FUTURE UVA researchers reveal shortage in at-home medical care Page 67 of 72 Collaboration FAMILY INTEGRITY RESPECT EXCELLENCE Page 68 of 72 UVA researchers reveal shortage in at-home medical care THE FUTURE? • Opportunities to create partnerships with allied health care, mental and behavioral [mental] health providers, and various social service agencies • Partner with related service providers to create a local response network that can provide a host of services not only focused on emergency response but under the umbrella of a multifaceted volunteer organization Page 69 of 72 WHAT’S NEXT? • Bypass Fire Station • Pulse Point – Heart Safe Charlottesville • ProQA Emergency Medical Dispatch Protocols • Continued mutual-aid and other resources to support EMS • Community Mental Health Initiatives – CFD/CARS/CPD • Frequent 911 Users • Prevention of hospital re-admission • MIH – volunteers at CARS with advanced medical background FAMILY INTEGRITY RESPECT EXCELLENCE Page 70 of 72 “NFPA 1710 is a national standard for fire departments, and as an accredited ISO 1 all-hazards department, we are committed to improving the EMS/FIRE system through a collaborative approach with all stakeholders.” “Our focus is on maintaining our accreditation status and ensuring our all-hazards preparedness meet the needs of our community. We must transition to becoming a 21st century community with fire and prehospital medical service delivery consistent with Dr. Hezedean A. Smith, Fire Chief the needs of our residents and visitors.” Email: smithhez@charlottesville.gov Phone: 434- View our Annual Report FAMILY INTEGRITY RESPECT EXCELLENCE Page 71 of 72 COMMENTS FAMILY INTEGRITY RESPECT EXCELLENCE Page 72 of 72