HomeMy WebLinkAboutConsider for Approval the City's Responses to Grand Jury Rep (5) 2000 Main Street,
Huntington Beach, CA
92648
City of Huntington Beach
Y
File #: 22-715 MEETING DATE: 9/6/2022
REQUEST FOR CITY COUNCIL ACTION
SUBMITTED TO: Honorable Mayor and City Council Members
SUBMITTED BY: Al Zelinka, City Manager
VIA: Scott M. Haberle, Fire Chief
PREPARED BY: Kevin Justen, Senior Administrative Analyst
Subiect:
Consider for approval the City's responses to Grand Jury Report "Where's the Fire? Stop
Sending Fire Trucks to Medical Calls"
Statement of Issue:
The City Council is requested to approve the attached responses by the City Council and the Fire
Chief to the 2021-2022 Orange County Grand Jury report "Where's the Fire? Stop Sending Fire
Trucks to Medical Calls" and authorize the Mayor to sign the attached transmittal letter to The
Honorable Erick L. Larsh, Presiding Judge of the Orange County Superior Court. The Grand Jury
report cites Penal Code requirements that the City Council and Fire Chief provide responses to the
report's findings and recommendations.
Financial Impact:
Not applicable.
Recommended Action:
Approve the City Council and Fire Chief responses to the findings and recommendations in the
Grand Jury report "Where's the Fire? Stop Sending Fire Trucks to Medical Calls" and authorize
the Mayor to sign the attached transmittal letter to The Honorable Erick L. Larsh, Presiding Judge
of the Superior Court of Orange County.
Alternative Action(s):
Do not approve the responses to the Grand Jury report, and direct staff accordingly.
Analysis:
In 2021-2022, the Orange County Grand Jury prepared the report "Where's the Fire? Stop Sending
Fire Trucks to Medical Calls" (Attachment 1). This report evaluates the emergency medical services
(EMS) response model in Orange County and offers various findings and recommendations
regarding EMS practices of all Orange County fire departments. In their evaluation, the Grand Jury
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determined that many fire departments may have absorbed emergency medical responses into their
fire response models; however, those models have not evolved over the years and may require
updates to ensure that fire departments deploy the appropriate emergency response for each
medical crisis.
The Huntington Beach Fire Department (HBFD) has provided these services since the early 1970's
and continues to update its EMS protocols to address the needs of our community. This includes
updating procedures and implementing advances in technology to provide a high service level to
residents. This is reflected in responses to customer satisfaction surveys sent to patients who are
treated and transported by HBFD, which show that 98.7% of patients feel that the quality of EMS
services met or exceed their expectations. The model used by HBFD is considered an industry best
practice, and members continue to strive for excellence in EMS service delivery.
As required by California Penal Code Section 933.05, the governing bodies of the public agencies,
which the Grand Jury has reviewed, are required to comment on any applicable findings and
recommendations in the report. The Huntington Beach Fire Department was provided with five
findings and three recommendations, and responses must be sent to Erick Larsh, the Presiding
Judge of the Superior Court. City staff has prepared a letter to the Presiding Judge with a response
to each of the eight items (Attachment 2).
In compliance with Penal Code requirements, HBFD's responses to findings must include either an
agreement or disagreement and an explanation. Responses to recommendations must include
commentary and one of the following required actions:
1. The recommendation has been implemented, with a summary regarding the implemented
action.
2. The recommendation has not been implemented, but will be implemented in the future,
with a timeframe for implementation.
3. The recommendation requires further analysis, with an explanation of the scope and
parameters of that analysis and timeframe.
4. The recommendation will not be implemented because it is not warranted or is not
reasonable, with an explanation.
In addition, the report requires the Fire Chief to provide commentary and a response for each finding
and recommendation (Attachment 3). Lastly, a proposed transmittal letter from the Mayor is available
under Attachment 4.
The responses must be must be approved by the City Council and submitted by September 30,
2022.
Environmental Status:
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None.
Strategic Plan Goal:
Financial Sustainability, Public Safety or Other
Attachment(s):
1. Grand Jury Report "Where's the Fire? Stop Sending Fire Trucks to Medical Calls"
2. City Council Response to the 2021-22 Grand Jury Report
3. Fire Chief Response to the 2021-22 Grand Jury Report
4. Transmittal Letter from Mayor Delgleize to the Honorable Eric L. Larsh
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Table of Contents
SUMMARY...................................................................................................................................2
BACKGROUND...........................................................................................................................2
The Evolution of Fire Departments Providing Medical Services............................................ 2
A Myriad of Acronyms: EMS, ALS, BLS, PAU........................................................................ 3
REASON FOR THE STUDY......................................................................................................4
METHODOF STUDY.................................................................................................................5
INVESTIGATION AND ANALYSIS.........................................................................................5
The Vast Majority of 911 Emergency Calls Routed to Fire Stations Are Medical in Nature. S
Orange County Fire Departments and Personnel................................................................... 6
Different Areas, Different Needs............................................................................................. 6
Anatomy of a Medical Call: Dispatch to Response................................................................. 7
FirefighterFatigue.................................................................................................................. 7
The Different Approaches to EMS Response in Orange County............................................. 8
Independent City Fire Departments........................................................................................ 8
San Bernardino County Fire Protection District.................................................................... 9
Placentia Model for EMS—A New Approach....................................................................... 10
Orange County Fire Authority.............................................................................................. 11
Friction Between OCEMS and OCFA................................................................................... 13
COMMENDATIONS................................................................................................................. 14
FINDINGS................................................................................................................................... 14
RECOMMENDATIONS............................................................................................................ 15
RESPONSES............................................................................................................................... 16
ResponsesRequired................................................................................................................ 17
REFERENCES............................................................................................................................ 19
GLOSSARY.................................................................................................................................21
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269
TYPES OF FIRE TRUCKS
& FIRE ENGINES
Has a water pump and
Fire %, hoses.Typical tank capacity is
500-750 gallons with pump
Engines k flow of 1500 GPM
Carries fire fighters and tools,
Fire + x: like ladders, extinguishers,
Trucks ❑ floodlights, and rescue tools.
Designed to traverse rough
Wildland terrain and transport more
Engines ..-.. water relative to their size.
Carries as much water as
possible to the scene for
Water �., another firefighting apparatus.
Tenders - � *� Has weak pump and less
hoses than fire engine.
Aerial Has an attached telescopic
Trucks ladder to reach upper stories
i of buildings.
Has an aerial ladder,water
+*� tank(at least 300 gallons),and
Quints at least 40 cubic feet for
-- W`�-- equipment storage.
Has an aerial ladder that is
Tiller .� __ _ mounted to the rear of a
/"
Trucks semi-trailer truck.
Heavy �77 Designed to carry a lot of
Rescue s equipment for traffic collisions,
.*# — building collapses,and other
Trucks disasters.
' Similar to an ambulance and
Paramedic comes with advanced life
Unit -� support(ALS)equipment.
Fire Often driven by a fire chief_
Command Equipped with lightbars, sirens,
Vehicles radios, and other equipment.
WHERE'S THE FIRE?
Stop Sending Fire Trucks to Medical Calls
SUMMARY
In Orange County, nearly 80 percent of all 911 calls to fire departments are for medical services.
Efficient and effective responses to 911 calls are of utmost importance to every community. Even
though 911 calls are categorized by severity, responses by most Orange County fire departments do not
change accordingly. Current protocol requires sending multiple vehicles to the scene which involves not
only additional personnel but also expensive fire equipment. This is the case even when an ambulance or
rescue squad vehicle could provide all the necessary medical supplies and personnel. Sending a 36,000
to 60,000-pound fire engine or aerial ladder truck down residential streets for strictly medical calls is not
only dangerous and costly, but it also results in unnecessary wear and tear on our streets.
Our Orange County firefighters perform an exemplary job under extremely stressful circumstances.
They often work compulsory overtime hours. After considering the demands placed on our firefighters
and the importance of optimizing efficiency while maintaining a high level of care and response time,
the Orange County Grand Jury recommends the following: Fire departments implement a universal
tiered response system to dispatch ambulances or rescue squad units to most medical calls rather than
deploying larger fire equipment as the standard response.
While the Orange County Grand Jury sees distinct advantages to separating EMS from Fire
response, we are not currently recommending privatization of medical services. We applaud the
level of care provided by all paramedics, including firefighter paramedics. The Orange County
Grand Jury does recommend, however,that the emergency medical services response model
should change.
This investigation also revealed a breakdown in communication and trust between Orange
County Emergency Medical Service (OCEMS) and OC Fire Chiefs, which includes Fire Chiefs
of the Orange County Fire Authority (OCFA)and various city fire departments. Although their
mandated responsibilities are clear,there is a mutual reluctance to acknowledge their respective
spheres of authority, in particular the critical role of OCEMS as an independent regulatory body.
BACKGROUND
The Evolution of Fire Departments Providing Medical Services
Over 100 years ago, organized firefighting in America was established primarily to guard against
loss of property. Prior to the 1970s, emergency medical calls were transferred to either private
ambulance companies or hospital ambulance companies. By the 1970s, the number of calls for
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fire service declined due to the development and enforcement of stringent building codes and fire
prevention systems. As a result, the role of local fire department has changed substantially.
In conjunction with the development of the 911 emergency call system, fire departments
broadened their service models and capabilities, creating an all-hazards approach to emergency
services delivery. The strategic location of firehouses throughout their service area made them a
logical choice to respond to time critical calls. Fire departments now respond to any number of
emergencies, including but not limited to traffic collisions, hazardous spills, cat rescues, and
natural disasters as well as fires. However, 80 percent of all calls are for medical assistance.
An Explanation of Acronyms
This report looks at the ways in which fire departments respond to and provide emergency
medical services (EMS). There are two levels of support systems in any kind of medical
emergency: Basic Life Support and Advanced Life Support.
Basic Life Support (BLS) generally refers to the type of care that first-responders, healthcare
providers, and public safety professionals provide to anyone who is experiencing a non-life-
threatening medical event. BLS treatment is noninvasive and is usually performed by an
Emergency Medical Technician (EMT).'
Advanced Life Support (ALS) is a response to critical care patients who may require invasive
procedures such as injections, intubation, or the administration of medication. Due to the more
severe nature of the patient's condition, ALS calls require a response from a crew that includes
ALS-certified responders, specifically paramedics. All paramedics, including firefighter
paramedics, are required to undergo a higher level of training than EMTs. Paramedics are trained
to administer drugs, intubate patients, and insert IVs. EMTs are not certified to perform these
procedures.
California's EMS Act authorizes each county to develop an EMS program and to designate a
local Licensed Emergency Medical Services Agency (LEMSA) that oversees the delivery of
EMS within that geographic area. This level of governance allows for local control of emergency
medical services. In Orange County, the LEMSA is the Orange County Office of Emergency
Medical Services (OCEMS) which operates under the Orange County Health Care Agency.
OCEMS is responsible for the oversight of licensing all BLS and ALS responders, the
management and inspection of privately owned ambulances, and the creation of response
protocols including mass casualty incident response plans.
California Emergency Medical Services"Scope of Practice,"(November 2017).
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A Paramedic Assessment Unit(PAU) provides initial field paramedic assessment and
interventions utilizing a minimum of one qualified paramedic and an EMT. A PAU may escort,
monitor, and treat patients during transport to a hospital in accordance with that paramedic's
provider agency policy.2
REASON FOR THE STUDY
Previous studies within Orange County and elsewhere have come to the same conclusion: there
is an over-deployment of equipment and personnel for non-life-threatening emergency medical
calls. For example, in 2014,the OCFA commissioned Emergency Services Consulting
International to conduct a study on OCFA deployment. One of their recommendations is as
follows:
To improve the overall response performance of the OCFA delivery system the number
of units sent to most emergency medical incidents must be reduced. Criteria-based
dispatch (CBD)protocols could be implemented allowing a single unit response to most
emergency medical incidents.3
Furthermore, as part of the Anaheim Fire& Rescue 2015-2020 Strategic Plan, at page 25, it was
recommended that a Community Care Response Unit be established as "an alternative and
innovative response model that will deploy a single vehicle utilizing a nurse practitioner and
paramedic to respond to non-urgent call requests in place of a standard paramedic engine/truck
and ambulance unit response."
Grand Juries in Orange County (2011-12) and Santa Clara County (2010-11)both delivered the
same message in their reports: re-evaluate your response model to enable an appropriate EMS
response,thereby reducing costs and equipment wear and tear.
Despite all these recommendations,the response deployment for medical calls remains
substantially unchanged. This Grand Jury will revisit concerns about the expensive deployment
of fire equipment and personnel for routine medical calls.
z OCEMS Agency Policy#330.70
s Emergency Services Consulting International,OCFA Standards of Coverage and Deployment Plan, p. 147(2014).
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METHOD OF STUDY
To understand the structure, staffing, and response models for various fire departments within
California, as well as the relationship among the fire agencies and OCEMS,the Orange County
Grand Jury engaged in the following:
• Reviewed statutes, articles, ordinances, reports, OCFA Memorandum of Understanding
(MOU), and commissioned studies.
• Interviewed OCFA leadership, Fire Chiefs inside and outside of Orange County, City
Managers, personnel from OCEMS, private ambulance company executives, and
firefighter union leadership.
• Reviewed a large volume of material from various relevant websites.
• Reviewed OCFA Board of Directors and various City Council meeting minutes, agendas,
and staff reports related to fire and medical services.
• Toured OCFA Headquarters and Training facility.
• Reviewed multiple written communications, deployment protocols, annual reports, and
financial reports.
INVESTIGATION AND ANALYSIS
The Vast Majority of 911 Emergency Calls Routed to Fire Stations Are
Medical in Nature
OCEMS data, as well as most fire department representatives interviewed, agree that of all 911
calls routed to a fire department for response, at least 80 percent are for EMS; the lowest figure
provided was an estimated 75 percent. In areas with older demographics,the EMS percentage of
medical calls as opposed to other emergencies is even higher. At least one fire department
reported that nearly 90 percent of its calls are purely medical in nature. Furthermore, it has been
estimated that up to 80 percent of those EMS calls can be classified as BLS.4
In an OCFA-commissioned comprehensive study, it was reported in 2018 that OCFA responded
to 139,287 incidents of which 77.39 percent were EMS. Only 1.47 percent of the 911 calls routed
to OCFA stations were dispatched as fire calls.5 The remaining 21.14 percent were classified as
"other,"which included calls for persons in distress, smoke, odor problems, hazardous
conditions, electrical wiring arcing, false alarms, children or pets locked in cars, and calls that
4 Emergency Consulting Services International,OCFA Standards of Coverage and Deployment Plan, p. 146(2014);
interviews with OCEMS staff and several Fire Chiefs.
5 Citygate,Associates,Inc.,Standards of Coverage Service Level Assessment OCFA, p.53 (June 30,2020).
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were resolved prior to OCFA arrival. Consistent with this report, the OCFA Comprehensive
Annual Financial Report for fiscal year ending June 30, 2021, provided statistics showing that
out of the 152,289 emergency calls directed to OCFA, close to 75 percent were classified as
EMS, while only 1.7 percent were considered fire calls.
Orange County Fire Departments and Personnel
Orange County cities are either part of the Orange County Fire Authority or have their own
independent fire departments. Founded in 1995,the OCFA is a regional fire service agency that
currently serves 25 cities in Orange County and all its unincorporated areas. The OCFA protects
nearly two million residents with 77 fire stations located throughout Orange County. The nine
Orange County cities that are not OCFA members each have a separate fire department and
collectively protect approximately 1,187,000 residents. These independent cities include
Anaheim, Brea/Fullerton, Costa Mesa, Fountain Valley, Huntington Beach, Laguna Beach,
Newport Beach, Orange, and Placentia.
OCEMS has established a minimum requirement that one paramedic and one EMT respond to
EMS calls. It is left up to the individual fire departments to determine how to deploy personnel
and whether to exceed these minimum staff requirements. According to several OCEMS
employees and its written protocols, one paramedic and one EMT are sufficient to provide
appropriate care in response to an EMS call.
In its June 4, 2019 presentation "Consideration of Placentia Fire and Emergency Service,"the
City of Placentia reported that out of 43 fire departments surveyed in Los Angeles, Orange, and
Riverside Counties, 27 departments (67 percent) utilize a three-person engine crew. This was the
most common standard among the three counties. San Bernardino County and several Orange
County cities (including La Habra, Laguna Beach, and Huntington Beach) also allow three-
person engine companies. OCFA and several other independent fire departments within Orange
County staff their engines and trucks with four-person crews.
Different Areas, Different Needs
Based on local demographics, geographic features (for example: beaches vs. forest areas), and
other community differences, the needs of various individual communities are radically different.
Fire Station 22, located in Laguna Woods, serves a median resident age over 78 years old which
results in a very high number of medical responses. Fire Station 2, located in Los Alamitos,
operates within a very different demographic and a service territory that includes beaches, a large
military installation, as well as a large retirement community. And Station 18 in Trabuco Canyon
provides services to a wildland area as well as a `suburban' area with a much lower age
demographic than Fire Station 22. Different equipment and staff deployment models are
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warranted for each environment. The OCFA approach appears to be to add `engines and trucks'
to provide service, rather than taking a much more tailored approach. The trend within OCFA
has been to remove Paramedic Squad units and replace them with Engines and Trucks.
Anatomy of a Medical Call: Dispatch to Response.
The goal of any emergency responder is to arrive on site quickly with the appropriate equipment
and personnel needed to handle the emergency. The goal of a tiered dispatch system is to match
the emergency with the appropriate level of response in terms of urgency,personnel, and
equipment.
The most well-known of the tiered dispatch systems is the Clawson system of priority dispatch.
Emergency medical dispatchers use call screening to determine what level of response is
required by determining what Clawson refers to as the four commandments of medical dispatch:
1) chief complaint, 2)approximate age, 3) status of consciousness, and 4) status of breathing.
Several of the independent city departments are members of Metro Cities Fire Authority, also
known as Metro Net Fire Dispatch or Metro Net, a joint powers agency that provides
professional dispatch services for fire and emergency medical services. Metro Net uses a
modified version of the Clawson model software to triage medical calls. Once it has been
established that the call is for medical services,the dispatchers use a software package to walk
through triage questions.
OCFA uses a severity model based loosely on the Clawson system for assessing medical
emergency calls. Dispatch employees make a preliminary determination as to the nature and
severity of the medical emergency through a series of carefully designed questions and computer
applications. However, regardless of the preliminary assessment, a full ALS response is
dispatched. This means that an engine or truck staffed with four personnel, often in partial or full
firefighter turnout, is dispatched, at least two of whom are paramedic/firefighters. A transport
ambulance with two EMT trained attendants is also dispatched, regardless of the classification of
the medical emergency.
Firefighter Fatigue
Overworked and fatigued firefighters have been the topic of several articles and commentaries in
counties throughout the State, and Orange County is no exception. There are staff shortages due
to retirements. Firefighters have been forced to take extra shifts when voluntary coverage is not
available. This can occur when firefighters are out ill, injured, on workers' compensation, or
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absent for personal reasons. Absences have been exacerbated by the COVID pandemic and the
increased prevalence of wildfires.According to the OCFA, "The volume of vacant shifts is
substantially exceeding the overtime our firefighters wish to work."6 As publicly explained by
OCFA Fire Chief Brian Fennessy, "Workplace burnout is an occupational phenomenon marked
by exhaustion,negativity to one's job, and reduced professional efficacy."7
Compulsory overtime work, often referred to as "forced hiring,"is not new. While an increase in
wildfires as well as the various reasons described above contribute to the firefighter shortage,
routinely and unnecessarily sending out fire engines and trucks with the fire personnel required
to staff that equipment is also a contributing factor. Using ambulances and other similar
paramedic assessment units (PAUs) or paramedic squad units that are more efficient, nimble, and
less personnel-intensive would substantially reduce the demand on firefighters leading to a
reduction in work time and stress for on-duty firefighters. This is especially important when they
are working compulsory overtime.
The Different Approaches to EMS Response in Orange County
Independent City Fire Departments
Several long-established cities in Orange County have independent fire departments. Examples
include Anaheim Fire and Rescue, Huntington Beach Fire Department, Fullerton Fire Department,
and Laguna Beach Fire Department. Most of these departments utilize Metro Net(described above)
as their dispatcher. Even though medical priorities are evaluated by the Metro Net dispatcher, in most
cases an engine or truck with firefighter/paramedics is dispatched to the incident, along with an EMT
ambulance, regardless of the severity of the medical call. OCFA and Metro Net communicate when
necessary.
To avoid competition and to ensure quality of service, OCEMS is also responsible for contracting
qualified ambulance companies to service a particular geographic area,known as Exclusive
Operating Areas (EOA) for patient transport to hospitals. However, some cities can own and operate
ambulances that are not subject to the EOA ambulance agreements provided by OCEMS. Under
California law, only cities that had their own ambulance services prior to 1980 (including cities
served by OCFA) have the option of purchasing or contracting for their own ambulances. Those cities
may also contract with private ambulance companies independently of OCEMS.
6 OC Register,Saavedra,T.and Licas,E.,"OCFA Firefighters Burned Out By Overtime"(Oct.29,2021).
'ibid.
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Huntington Beach and Anaheim are two examples of this. Both cities deploy city-owned and operated
ambulances which are based in fire stations; however, not all fire stations have ambulances. Where
available, the ambulance rolls concurrently with the fire apparatus and typically arrives at the same
time. The consensus among those interviewed indicated that this is a far better scenario in terms of
overall response than relying on contracted private ambulances. There are also significant economic
and long-term staffing advantages associated with this model. One example is that having EMTs
working within the fire department serves as a pipeline for developing qualified firefighter
paramedics. A disadvantage, however, is that city-owned ambulances are not subject to required
inspection and approval by OCEMS, which the Orange County Grand Jury finds problematic.
Other benefits to cities able to operate their own ambulances are potential economic and service
advantages for residents. In those cases, fees for ambulance services are payable to the city either by
individuals or through medical insurance. Those fees typically offset the costs and, in some cases,
provide marginal revenue. That excess revenue can be then provided to the overall city Fire/EMS
department budgets to enhance services.
Most of the independent city fire agencies within Orange County offer a paramedic subscription
service for residents and local businesses. An annual fee (around $60 per household)provides "free"
paramedic services to subscribers. Otherwise,there is a per-call fee charged which is not typically
covered by health insurance companies. Huntington Beach, Fountain Valley, and Anaheim are
examples of cities with subscription paramedic services. The fees cover many of the fire department
costs for paramedic services within the jurisdiction.
San Bernardino County Fire Protection District
For comparison, San Bernardino County uses a staffing model like many other counties in the
state. Engines are staffed with a crew of three: a captain, an engineer, an ALS
paramedic/firefighter. The captain and engineer are BLS certified. Each engine is considered an
ALS response unit. In some areas, depending on budget, there may be an additional paramedic
squad unit staffed by an ALS certified paramedic/firefighter and a BLS certified firefighter.
These units can participate in rescue activities and carry appropriate rescue equipment. Contract
EMS ambulances are provided in parts of the service territory by a private provider while the
other areas are covered by the San Bernardino County Fire Protection District Ambulance
Operator Program which staffs ambulances with a single function paramedic as well as an EMT.
Dispatch is staffed by Emergency Medical Dispatch(EMD) certified personnel. Each medical
call is screened to determine its category and severity. Based on that screening, appropriate
response units are dispatched. Typically for a critical situation an engine and an ambulance will
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be dispatched Code 3 (lights and sirens). In situations that are deemed to be less critical,the
response can be a single unit or a transfer to a nurse's hotline. Their current MOU allows for
single paramedics on engines, squads, or aerial ladder trucks.
Placentia Model for EMS —A New Approach
Due to severe economic pressures, in 2019 the City of Placentia notified OCFA that they would be
withdrawing from OCFA and forming their own fire department. To save money and become more
efficient, Placentia separated the paramedic EMS response team from its Fire Department personnel
and contracted with a private ambulance company to deliver EMS paramedic services.
Placentia also decided to keep dispatching responsibilities within its Police Department which
receives all 911 calls. The police dispatcher determines whether the police, the Fire Department, a
private ambulance EMS unit, or some combination thereof(as in the case of a serious traffic accident)
should be dispatched to respond. Based on preliminary reports, the system is efficient and results in
faster EMS responses, especially for coronary and stroke cases.' This is attributed in large part to the
fact that"turnout time" for fire equipment and firefighter personnel (listed at over three minutes and
30 seconds for OCFA) is essentially eliminated with this model. Preliminary statistics show that not
only have City costs have gone down,the time taken to appear on site for an EMS call also has been
reduced by four minutes, from 9.5 to 5.5.9
Despite the positive results and cost savings, Placentia has withstood considerable criticism as well as
a lack of cooperation from OCFA and its union.10 The cost savings could be partially attributed to
several factors: its very small geographical area; fewer wildland fires to contend with; no fast-water
rescue requirements; and the City's firefighters do not earn the same salary or benefits that OCFA
firefighters enjoy. From a cost perspective,why should they be charged by OCFA for services they
do not require?Placentia should receive credit for attempting(and in many ways delivering) a new
and better approach to EMS.
8 City of Placentia Fire and Life Safety Department Inaugural Report FY 2020-21,pps.8-9.
9 Ibid.
10 See,e.g.,OCFA Board Meeting,May 26,2020,comments by Craig Green;Fullerton Observer, Council and Fire
Dept. Clash Over Agreement with Placentia(June 24,2020);California Policy Center,Ring,E.Firefighting in
Orange County, Part 3-Placentia's War for Independence(July 1,2020);OC Register,Robinson,A.,Placentia
Alleges Retaliation, `Unprofessional Behavior'After Vote to Quit OCFA (June 28,2019);Correspondence between
OCFA,OCEMS and Placentia Fire Dept.;Interviews.
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Orange County Fire Authority
As noted above, OCFA makes an initial determination as to the nature and severity of the
medical emergency. Regardless of the preliminary assessment, a full ALS response is
dispatched. This means that an engine or truck company, staffed with at least two
paramedic/firefighters,two EMT trained firefighters, and a transport ambulance with two EMT
trained attendants is sent to the scene. While this approach means less time is spent with the
caller before the dispatch for services occurs, it also results in a minimum of six people and two
vehicles being dispatched for all EMS calls, even for minor medical events. The OCFA MOU
with the firefighter's union specifies a minimum of two paramedic/firefighters on each ALS unit.
OCEMS agrees that a single PAU unit staffed with a paramedic and EMT provides the service
needed for most types of emergency medical calls if the requests for service are properly triaged
and dispatched based on medical priority.I I
In a 2014 OCFA-commissioned report,12 recommendations included the following:
Formally establish"criteria based"dispatch protocols to allow a single unit response to
those incidents triaged as non-life threatening. Staff the majority of fire engines with
three personnel, one of whom is a paramedic; in areas considered hard to cover, or those
lacking an effective response force coverage (for example areas covered by stations 40
and 53), staff fire engines with four persons,two being paramedics. Response to a life-
threatening incident would be two units.
For nonlife-threatening incidents, any response unit can be dispatched. If for example, a
squad and engine are both available and the same distance from the incident the squad
can be dispatched preserving the engine in the event of a fire incident.
Because over 75 percent of all fire dispatch calls are for medical emergencies, dispatching an ALS
response with a truck or engine to every emergency medical call does not make sense and results in a
consistent over-deployment of equipment and personnel.
Avoiding the dispatch of fire engines and trucks offers an additional advantage. If one (or both)
of the responding firefighter/paramedics must accompany the patient in the ambulance to the
hospital,then their engine typically follows the ambulance to the hospital. The fire engine and its
crew must wait until the hospital staff takes charge of the patient and releases the paramedic to
" OCEMS Policy#330.70
'Z Emergency Services Consulting, OCFA Standards of Coverage and Deployment Plan,pp. 146-47(2014).
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rejoin their unit. The time the engine or truck is out of service waiting for the firefighter
paramedic to be released is referred to as "wall time."COVID-19 has made wall time longer as
many emergency rooms have not been able to deal with the high volumes of patients, resulting in
much longer wait times and potential degradation of service.
Within OCFA's jurisdiction,there are at least two geographic areas with even higher medical
emergency call volumes. One such area is Laguna Woods which is served by OCFA Station 22.
Laguna Woods comprises 3.1 square miles and is home to approximately 16,000 residents with a
median age of over 78.Notwithstanding its size, Laguna Woods has the same number of calls as
the City of Tustin, which consists of a service territory of 11.1 square miles and a population of
approximately 80,000. The table below depicts the high volume of calls and the proportion of
medical calls between the two areas with the overall same number of calls.13
CITY POPULATION SIZE #EMS #FIRE #TOTAL
(Sq Miles) CALLS CALLS CALLS
Laguna
Woods 16,000 3.31 4,876 24 5,000
Tustin 80,000 11.14 4,062 95 —75,395
%EMS EMS %FIRE %EMS
CITY CALLS/TOTAL CALL/POP CALLS/POP CALLS/POP CALLS/SIZE
Laguna
Woods 97.52% 31.25% 30.48% 0.48% 2.07%
Tustin 75.29% 6.74% 5.08% 1 1.76% 1.39%
While averaging just two fire calls each month, Laguna Woods is equipped with two Type 1
Engines and one aerial truck. Given the size and weight of these large fire vehicles,there is
unnecessary wear and tear on the streets of Laguna Woods when Station 22 equipment is sent out
on such a high volume of simple medical calls. Replacement of one of the two Type 1 Engines
assigned to Station 22 with two paramedic squad vehicles would save the expense of wear and
tear, maintenance, equipment, and operating costs. It would also result in faster response times
since the time it takes for fire personnel to gear up and get the larger trucks to move out is at
13 OCFA Comprehensive Annual Financial Report,FY ending June 30,2021,pp. 135, 142-43.
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least two minutes longer than for the smaller vehicles to roll out.14 Although that approach adds a
fourth paramedic unit to the service area, causing a shift in assignments, additional staffing
would not be necessary. Additionally,the cost of two fully equipped paramedic squad vehicles is
less than the cost of a single Type 1 Engine. The typical cost for a fully equipped Type 1 engine
is between $750,000 and$1,000,000 as opposed to the typical cost for a fully equipped
Paramedic Squad vehicle (based on a Ford F-350 Super Duty Diesel chassis)which is under
$200,000."
Friction Between OCEMS and OCFA
Fractures between OCEMS, the OCFA, and independent city Fire Chiefs are apparent. This is
exemplified in a letter written to OCEMS from the Fire Chiefs that pointed to OCEMS's"offensive"
action in implementing policy changes without prior notice or collaboration. This complaint was made
despite the Fire Chiefs' specific acknowledgment in the same letter that a joint advisory committee had
been formed and had been discussing the issues.16
Despite the OC Fire Chiefs' complaint about OCEMS overstepping its authority,the only example
provided to the Orange County Grand Jury was the emergency action taken by OCEMS in 2021 when
hospitals were backed up. This caused long wait-times for first responders who transported patients to
the emergency room and kept them unavailable to respond to other emergencies. In response, OCEMS
introduced an emergency measure which allowed EMT and paramedic transporters to leave patients in
the hands of the hospital on a portable cot provided by the ambulance squad."Although the change
addressed the fire departments' problem of extended"wall time"for fire paramedics, it resulted in a
strong rebuke from Fire Chiefs for failing to provide adequate notice to them or provide an opportunity
to collaborate. Although OCEMS could possibly have provided better notice to OCFA and the
independent Fire Chiefs, the OCEMS appeared to be working in the best interest of all parties involved.
This was a fact that was, at best, only begrudgingly acknowledged by a few OCFA union representatives
and other fire agency personnel.
Tensions have been further exacerbated by COVID and the demand placed on ambulances that,
reportedly, have failed to respond to calls in a timely manner. The extent of the problem is debatable.
However, the OCFA Fire Chief took the problem into his own hands. In December 2021,the OCFA
Chief directed that all EMS responses be classified as Code 3 to speed up ambulance response times. A
'a Citygate Associates,Inc.,Standards of Coverage Service Level Assessment OCFA,p.8(June 2020).
15 OCFA Comprehensive Annual Financial Report,FY ending June 30,2021,p. 148.
16 Letter from OC Fire Chiefs Association to OCEMS,November 8,2021.
OCEMS Temporary Suspension of Diversion and Actions to Reduce APOTs,December 29,2021.
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Code 3 response requires lights and sirens.18 Code 3 responses have been shown to pose a significantly
greater danger to the public and emergency personnel.19 The Orange County Grand Jury is concerned
that this OCFA directive and the power struggles existing between the Fire Chiefs Association and
OCEMS may be viewed as self-serving rather than serving the best interests of the public.
Similar acrimony was evident when OCEMS received pointed criticism for taking a position on 2021
proposed legislation that was pending in Sacramento that directly affected OCEMS without conferring
with the OCFA or independent Fire Chiefs. While Orange County fire leadership is free to disagree with
the position taken by OCEMS, OCEMS had no obligation to consult with them prior to advocating for
itself in Sacramento.
There is consensus from both sides that the problems between these entities have escalated over the past
year; however,there have been some recent signs of better collaboration and communication.
COMMENDATIONS
• Fire department personnel for their professional service and steadfast concern for public
safety.
• All Emergency Medical Services personnel for their tireless efforts on behalf of Orange
County residents.
• Interviewees for their cooperation and time spent with the Orange County Grand Jury to
explore these issues.
• Special commendation to the City of Placentia for innovation in the face of concerted
opposition.
FINDINGS
F 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.
'$Correspondence from OCFA to OC Public Health,cc:County Executive Officer,January 25,2022.
19 Joint Statement on Lights&Siren Vehicle Operations on Emergency Medical Services(EMS)Responses
February 14,2022.
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F2 Despite use of a tiered dispatch system, OCFA's deployment of resources for medical
responses are the same for nearly all calls, resulting in unnecessary wear and tear on
expensive fire-fighting equipment and public infrastructure.
F3 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.
F4 There has been a breakdown of communication and trust between OCEMS and Orange
County Fire Chiefs.
F5 Over-deployment of firefighters for medical calls contributes to the current climate of
forced hiring and firefighter fatigue.
F6 Code 3 response is over utilized by OCFA, unnecessarily putting the responders and
public at risk.
F7 Since the outbreak of the COVID pandemic,there has been an emergency medical
personnel shortage. The pandemic also has contributed to longer wait times at hospitals
resulting in firefighter personnel being out of service for longer periods.
F8 There are specific areas within Orange County, such as Laguna Woods and Seal Beach,
that have an extremely high percentage of medical calls which, under the current model,
results in the stations servicing those communities to require two engines.
F9 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.
1710 Placentia's changes to the emergency medical response protocols after leaving OCFA
have resulted in improved medical call response times.
RECOMMENDATIONS
R1 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). F1, F2, F5
R2 By 2024, OCFA should station a paramedic squad vehicle, which is more nimble and less
costly to operate, in place of a second engine in stations with high volumes of medical
calls. F8
R3 OCFA should immediately stop the practice of requesting Code 3 responses on all non-
life threatening (BLS) calls. F6
R4 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
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R5 Departments with publicly owned ambulances should allow OCEMS to inspect their
ambulances for compliance with State EMS guidelines and adopt OCEMS
recommendations. F9
RESPONSES
California Penal Code Section 933 requires the governing body of any public agency which the
Grand Jury has reviewed, and about which it has issued a final report, to comment to the
Presiding Judge of the Superior Court on the findings and recommendations pertaining to matters
under the control of the governing body. Such comment shall be made no later than 90 days after
the Grand Jury publishes its report(filed with the Clerk of the Court). Additionally, in the case of
a report containing findings and recommendations pertaining to a department or agency headed
by an elected County official (e.g. District Attorney, Sheriff, etc.), such elected County official
shall comment on the findings and recommendations pertaining to the matters under that elected
official's control within 60 days to the Presiding Judge with an information copy sent to the
Board of Supervisors.
Furthermore, California Penal Code Section 933.05 specifies the manner in which such
comment(s) are to be made as follows:
(a) As to each Grand Jury finding, the responding person or entity shall indicate one of the
following:
(1) The respondent agrees with the finding.
(2)The respondent disagrees wholly or partially with the finding; in which case the
response shall specify the portion of the finding that is disputed and shall include an
explanation of the reasons therefor.
(b)As to each Grand Jury recommendation, the responding person or entity shall report one of
the following actions:
(1)The recommendation has been implemented, with a summary regarding the
implemented action.
(2) The recommendation has not yet been implemented, but will be implemented in the
future, with a time frame for implementation.
(3)The recommendation requires further analysis, with an explanation and the scope and
parameters of an analysis or study, and a time frame for the matter to be prepared for
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discussion by the officer or head of the agency or department being investigated or
reviewed, including the governing body of the public agency when applicable. This
time frame shall not exceed six months from the date of publication of the Grand Jury
report.
(4) The recommendation will not be implemented because it is not warranted or is not
reasonable,with an explanation therefor.
(c) If a finding or recommendation of the Grand Jury addresses budgetary or personnel matters
of a county agency or department headed by an elected officer, both the agency or department
head and the Board of Supervisors shall respond if requested by the Grand Jury, but the response
of the Board of Supervisors shall address only those budgetary/or personnel matters over which
it has some decision-making authority. The response of the elected agency or department head
shall address all aspects of the findings or recommendations affecting his or her agency or
department.
Responses Required
Comments to the Presiding Judge of the Superior Court in compliance with Penal Code §933.05
are required from:
90 Day Response Required F1 F2 F3 F4 F5 F6 F7 F8 ; F9 Fla
OCFA Board of Directors X X X X X X X X
90 Day Response Required R1 R2 R3' R4 RS
OCFA Board of Directors X X X X X
90 Day Response Required F l F2 F3 F4 F5 F6 F7 F8 F9 F 10
County of Orange Board of Supervisors X X X
90 Day Res nse Required R1 R2 R3 R4 :RS
County of Orange Board of Supervisors X
90 Day Res nse Required F I F2 F3' F4 F5 " F6 F7 F8 F9 F 10
City Councils of Cities of Anaheim,
Costa Mesa,Fountain Valley,Fullerton,
Huntington Beach,Laguna Beach,
Newport Beach,and Orange X X X X X
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94 Day Res nse Required R.1 R2 R3 R4 R5
City Councils of Cities of Anaheim,
Costa Mesa,Fountain Valley,Fullerton,
Huntington Beach,Laguna Beach,
Newport Beach,and Orange X X X
90 Day Response Required F 1 F2 F3'' F4 F5 F6 F7 F8 F9 F 1Q
City of Placentia City Council X X X X X X
90 Day Response Required R1 R2 R3 R4 R5
City of Placentia City Council X X XEI
Responses Requested
Comments to the Presiding Judge of the Superior Court in compliance with Penal
Code §933.05 are requested from:
60 Day Response Requested F1 F2 F3 F4 F5 F6 F7 FS F9 F 1 Q
Fire Chiefs for Cities of Anaheim,
Costa Mesa,Fountain Valley,Fullerton,
Huntington Beach,Laguna Beach,
Newport Beach and Orange X X X X X
60 Day Response Requested R1 R2 R3' R4 R5
Fire Chiefs for Cities of Anaheim,
Costa Mesa,Fountain Valley,Fullerton,
Huntington Beach,Laguna Beach,
Newport Beach and Orange X X X
60 Da Response Re uested F1 F2 F3 F4 F5 F6 F7 F8 F9 F10
City of Placentia Fire Chief X X X X X X
60 Day Response Requested R1 R2 R3 R4 R5
City of Placentia Fire Chief X X X
60 Day Response Requested F1 F2 F3 N F5 F6 F7 F8 F9 F1Q'
OCEMS Director X X X
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66 Day Response Requested RI R2 R3 R4 R5
OCEMS Director X
REFERENCES
2010-2011 Santa Clara County Civil Grand Jury Report, "Fighting Fire or Fighting Change?
Rethinking Fire Response Protocol and Consolidation Opportunities."
2011-2012 Orange County Grand Jury Report, "Emergency Medical Response in Orange Co.:
Where Did All the Fires Go?"
Anaheim Fire &Rescue Strategic Plan 2013-2018.
Anaheim Fire& Rescue Strategic Plan 2015-2020.
Assembly Bill Nos. 389 and 450 (Oct. 10, 2021).
California Emergency Medical Services "Scope of Practice,"(November 2017).
California Policy Center,Ring, E., "Firefighting in Orange County—Part Three, Placentia's
War for Independence"(July 1, 2020).
Citygate,Associates, Inc.,Standards of Coverage Service Level Assessment OCFA (June 30,
2020).
City of Placentia Fire and Life Safety Department Inaugural Report FY 2020-21.
Correspondence between OCFA, OC Fire Chiefs, OCEMS, OC Health Care Agency and Orange
County Board of Supervisors September 2021-February 2022.
Emergency Services Consulting International, OCFA Standards of Coverage and Deployment
Plan (2014).
EMS Matters, The Code 3 Response: The Paramedic Perspective (Sept. 23, 2021).
Fire Rescue 1,McDonough, S.,"Tucson Fire's Three-tiered Approach to Manage Increasing
Call Volumes"(May 11, 2020).
Fullerton Observer, Council and Fire Dept. Clash Over Agreement with Placentia (June 24,
2020).
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Int'1. City/County Management Assoc., "Success Story:Manager Champions New EMS
Structure"(2021).
Joint Statement on Lights & Siren Vehicle Operations on Emergency Medical Services (EMS)
Responses February 14, 2022.
Journal of Emergency Medical Services, Wood, S., "Too Many Medics? Debating a Tiered
Response vs. All-ALS EMS System"(Apr. 16, 2019).
OC Register, Saavedra, T. and Licas, E.,"OCFA Firefighters Burned Out By Overtime" (Oct. 29,
2021).
OC Register, Robinson,A.,Placentia Alleges Retaliation, `Unprofessional Behavior'After Vote
to Quit OCFA (June 28, 2019
OCEMS Agency Policy#330.70.
OCEMS Temporary Suspension of Diversion and Actions to Reduce APOTs, December 29,
2021.
OCFA Board Meeting, May 26, 2020, comments by City Councilman Craig Green.
OCFA Comprehensive Financial Report for Fiscal Year Ending June 30, 2021.
OCFA Standards of Coverage and Deployment (2012).
The Reason Foundation, Stuart,A., "The Alliance Model for EMS Lacks Competition, Oversight
and Accountability"(Apr. 26,2021)
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GLOSSARY
ALS Advanced Life Support
ALL HAZARD Emergencies, including but not limited to traffic collisions, hazardous
spills, cat rescues, natural disasters, house and car fires
BLS Basic Life Support
CBD Criteria-based dispatch
CODE 3 The use of sirens and lights on emergency vehicles
EMD Emergency Medical Dispatch
EMS Emergency Medical Service
EMT Emergency Medical Technician
EOA Exclusive Operation Area
LEMSA Local Emergency Services Agency—California's EMS Act authorizes
each county to develop an EMS program and to designate a local EMS
agency (LEMSA) for local control of emergency medical services
METRO NET Joint Powers Authority agency that provides professional dispatch services
for fire and medical services
MOU Memorandum of Understanding
OCEMS Orange County Emergency Service-Certifies Ambulances, Paramedics
and EMTs
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OCFA Orange County Fire Authority
OCGJ Orange County Grand Jury
PAU Paramedic Assessment Unit
PM Paramedic
SEVERITY MODEL A ranking, either alpha or numerical, on how critical the medical
emergency.
TIERED Calls are categorized by severity
TURNOUT TIME The time from the dispatch call and change their status to responding
TURNOUT GEAR Fire Fighters personal protective gear
TYPE 1 ENGINE Designed for structural firefighting. It will typically include a pump that
operates at 1000 gpm, a 400 gal/tank, 1200 ft. 2 1/2"hose,400 ft. 1 1/2"
hose, 200 ft. 1"hose, 20+feet of ladder, a 500 gpm Master Stream, and
minimum staffing of four firefighters. Some cities utilize Type 1 fire
engines with only three firefighters due to budget or other staffing issues.
WALL TIME The time the Paramedic or fire fighter spends at the hospital after
delivering a patient
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RESPONSE TO GRAND JURY FINDINGS AND RECOMMENDATIONS -CITY COUNCIL
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.
City Council's Response: Disagree
The Huntington Beach Fire Department leadership has addressed this finding in its
response and the City Council agrees that the City of Huntington Beach has adapted
appropriately to the changing environment of the fire service. We are proud of the
accomplishments and the progressiveness of our fire department. The Fire Department
demonstrated adaptability during the COIVD-19 pandemic by taking on many new
challenges and they proved to be capable of far more than firefighting and EMS. The
talented and dedicated personnel of the HBFD have consistently progressed with the
evolving needs of this community.
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.
City Council's Response: Disagree
The City Council supports the current service delivery model which meets the needs of our
dynamic community. As elected officials, we ensure that our department directors are
innovative and display fiscal stewardship in their respective disciplines.
Finding#4:
There has been a breakdown of communication and trust between OCEMS and Orange
County Fire Chiefs.
City Council's Response: Agree
The City Council has always been pleased with the way our Fire Department has
collaborated with local stakeholders, partner agencies, the community at-large, and
regulatory agencies in the protection of our community. Historically, our Fire Department has
placed a strong emphasis on maintaining relationships which includes OCEMS, even in the
midst of regional challenges.
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Finding #5:
Over-deployment of firefighters for medical calls contributes to the current climate of
forced hiring and firefighter fatigue.
City Council's Response: Disagree
The Huntington Beach Fire Department is appropriately managed and staffed. The Fire
Chief has been diligent in working with labor groups to address staffing and deployment to
ensure the best service is delivered to residents and visitors to the city.
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.
City Council's Response: Agree
The City Council sees no reason to invite a regulatory inspection process that we are not
subject to and has already been deemed unnecessary by OCEMS.
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
City Council's Response: Recommendation will not be implemented
This recommendation will not be implemented because it is not warranted. Explanation is
provided in the Fire Chiefs response.
Fire Chiefs 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.
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RESPONSE TO GRAND JURY FINDINGS AND RECOMMENDATIONS -CITY COUNCIL
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
City Council's Response: Recommendation has been implemented
This recommendation has been implemented. Explanation is provided in the Fire Chiefs
response.
Fire Chiefs 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
City Council's Response: Recommendation will not be implemented
This recommendation will not be implemented because it is not warranted. Explanation is
provided in the fire chiefs response.
Fire Chiefs 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 OCEMS
to determine if reinstating the process would be helpful and fiscally responsible.
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Huntington Beach City Council Response
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RESPONSE TO GRAND JURY FINDINGS AND RECOMMENDATIONS -FIRE CHIEF
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 Chiefs 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.
Huntington Beach Fire Chief Response
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RESPONSE TO GRAND JURY FINDINGS AND RECOMMENDATIONS -FIRE CHIEF
Finding#4:
There has been a breakdown of communication and trust between OCEMS and Orange
County Fire Chiefs.
Fire Chiefs 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.
Huntington Beach Fire Chief Response
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RESPONSE TO GRAND JURY FINDINGS AND RECOMMENDATIONS -FIRE CHIEF
Finding#5:
Over-deployment of firefighters for medical calls contributes to the current climate of
forced hiring and firefighter fatigue.
Fire Chiefs 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 Chiefs 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.
Huntington Beach Fire Chief Response
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RESPONSE TO GRAND JURY FINDINGS AND RECOMMENDATIONS-FIRE CHIEF
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). FI, F2, F5
Fire Chiefs 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 Chiefs 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 Chiefs 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.
Huntington Beach Fire Chief Response
298
�• CITY OF HUNTINGTON BEACH
2000 Main Street Phone: (714) 536-5553
California 92648 www.huntingtonbeachca.gov
September 6, 2022
The Honorable Erick L. Larsh
Presiding Judge
Orange County Superior Court
700 Civic Center Drive West
Santa Ana, CA 92701
RE: HUNTINGTON BEACH RESPONSE TO GRAND JURY REPORT
Honorable Erick L. Larsh,
The Huntington Beach Fire Department has reviewed the Grand Jury report titled "Where's
the Fire? Stop Sending Fire Trucks to Medical Calls". The report has been reviewed with our
City leadership as well as our elected body. Below please find our formal response to the
inquiries presented by the Grand Jury.
Responding to 911 calls to transport patients to the hospital is no longer the sum of our
Emergency Medical Services (EMS) delivery in the City of Huntington Beach. Today,
proactive efforts toward community risk reduction, attention to the underserved subsets of our
community and an increasing demand for behavioral/mental health services are a necessary
component of EMS.
Thank you for the opportunity to provide a response and look forward to any further
communication we may have.
Sincerely,
te
Barbara Delgleiz
Mayor
cc: City Council
City Manager
Fire Chief
RESPONSE TO GRAND JURY FINDINGS AND RECOMMENDATIONS -CITY COUNCIL
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.
City Council's Response: Disagree
The Huntington Beach Fire Department leadership has addressed this finding in its
response and the City Council agrees that the City of Huntington Beach has adapted
appropriately to the changing environment of the fire service. We are proud of the
accomplishments and the progressiveness of our fire department. The Fire Department
demonstrated adaptability during the COIVD-19 pandemic by taking on many new
challenges and they proved to be capable of far more than firefighting and EMS. The
talented and dedicated personnel of the HBFD have consistently progressed with the
evolving needs of this community.
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.
i City Council's Response: Disagree
The City Council supports the current service delivery model which meets the needs of our
dynamic community. As elected officials, we ensure that our department directors are
innovative and display fiscal stewardship in their respective disciplines.
Finding#4:
There has been a breakdown of communication and trust between OCEMS and Orange
County Fire Chiefs.
City Council's Response: Agree
The City Council has always been pleased with the way our Fire Department has
collaborated with local stakeholders, partner agencies, the community at-large, and
regulatory agencies in the protection of our community. Historically, our Fire Department has
placed a strong emphasis on maintaining relationships which includes OCEMS, even in the
midst of regional challenges.
1of3
Huntington Beach City Council Response
RESPONSE TO GRAND JURY FINDINGS AND RECOMMENDATIONS -CITY COUNCIL
Finding#5:
Over-deployment of firefighters for medical calls contributes to the current climate of
forced hiring and firefighter fatigue.
City Council's Response: Disagree
The Huntington Beach Fire Department is appropriately managed and staffed. The Fire
Chief has been diligent in working with labor groups to address staffing and deployment to
ensure the best service is delivered to residents and visitors to the city.
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.
City Council's Response: Agree
The City Council sees no reason to invite a regulatory inspection process that we are not
subject to and has already been deemed unnecessary by OCEMS.
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). FI, F2, F5
City Council's Response: Recommendation will not be implemented
This recommendation will not be implemented because it is not warranted. Explanation is
provided in the Fire Chief's response.
Fire Chiefs 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.
2 of 3
Huntington Beach City Council Response
RESPONSE TO GRAND JURY FINDINGS AND RECOMMENDATIONS-CITY COUNCIL
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
City Council's Response: Recommendation has been implemented
This recommendation has been implemented. Explanation is provided in the Fire Chief's
response.
Fire Chiefs 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
City Council's Response: Recommendation will not be implemented
This recommendation will not be implemented because it is not warranted. Explanation is
provided in the fire chief's response.
Fire Chiefs 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 OCEMS
to determine if reinstating the process would be helpful and fiscally responsible.
3of3
Huntington Beach City Council Response
RESPONSE TO GRAND JURY FINDINGS AND RECOMMENDATIONS -FIRE CHIEF
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 Chiefs 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 Chiefs 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.
Huntington Beach Fire Chief Response
RESPONSE TO GRAND JURY FINDINGS AND RECOMMENDATIONS-FIRE CHIEF
Finding #4:
There has been a breakdown of communication and trust between OCEMS and Orange
County Fire Chiefs.
Fire Chiefs 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.
Huntington Beach Fire Chief Response
RESPONSE TO GRAND JURY FINDINGS AND RECOMMENDATIONS-FIRE CHIEF
Finding#5:
Over-deployment of firefighters for medical calls contributes to the current climate of
forced hiring and firefighter fatigue.
Fire Chiefs 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 Chiefs 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.
Huntington Beach Fire Chief Response
RESPONSE TO GRAND JURY FINDINGS AND RECOMMENDATIONS -FIRE CHIEF
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 Chiefs 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 Chiefs 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.
Huntington Beach Fire Chief Response