Now, on to the EMS side of the department…our frontline paramedics are treating patients with the very best of care, while behind the scenes our EMS leadership careens downhill on a path of no return. More firefighter/paramedics are relinquishing their positions and “reverting” back to the H-2 rank and more laterals are leaving the SFFD to head back to their old departments. Their reason? The empty promises from the Presidio that they would all be riding engines anytime soon. With the next two classes of firefighters scheduled to come out of the Tower, the department will be approaching nearly 200 probies…leaving absolutely no room for medics on any rigs at all. Now, how this is factored into the H-3’s non-existent training program is anyone’s guess. It has now been four years since the DPH/SFFD merger, and the ALS engine “vision” is just that, a “vision.”

According to our leaders at the Presidio, the whole ALS engine program is contingent upon the dreaded “one and one” ambulance (one paramedic and one EMT). Accompanying the “1 + 1” ambulance on every run would be the ALS engine, with a paramedic/firefighter on the rig. Unfortunately, there are innumerable flaws in the program. Any time there is a full box, the supply of ALS engines in a battalion drops to approximately …zero. Any time there is a building alarm box, the supply of ALS engines in that particular neighborhood drops to …zero. Any time there is a greater alarm, the supply of ALS engines in that particular quadrant of the City drops to …zero. Any time there is a…well, you get the picture. The “1 + 1” system is full of flaws which will lead to diminished patient care. And this is the whole model upon which the Presidio seeks to integrate medics onto the engines…as fast as possible.

Perhaps the department should just slowly put the H-3 rank through a probationary period, with at most ten designated engines, and keep the ambulances staffed with 2 paramedics. All the while, the Presidio should just keep training firefighters to be paramedics, gradually increasing the number of medics we have. Once you reach a “critical mass” of medics, then you can fully implement the ALS engine program and maintain adequate patient care with 2 paramedic ambulances. Most major cities have abandoned the “1 + 1” ambulances, with the National Fire Protection Agency (NFPA) also about to come out with a recommendation for 2 paramedic ambulances. Why won’t the Presidio join this trend?

That would seem to make sense, but a lot of things that make sense have been ignored by the Presidio…Just recently, Chief McCallion emphatically stated to several medics that the H-3 training would not include truck training “ever.” So let’s get this straight…paramedics will be cross-trained to be firefighters without ever setting foot on a truck…and then what happens when promotional exams occur? Will H-3’s be considered “trained” and eligible to take a promotional exam having only learned half of the job? Or will they be forever stuck in the paramedic “caste” run by the Presidio “wise men”? Is this part of the long term “vision” of the Presidio, to keep all paramedics under their control with an intentionally “dead-ended” career?

As long as we’re on dead ends, let’s look into the dispatch system that the Presidio and EMSA won’t let go. Just recently, an EMERGENCY medical system ambulance bearing the SFFD logo was used to transport a patient between medical facilities, code 2. Transport between facilities? Is this what the EMS segment of the SFFD has in mind for our already overworked medics?

And lastly, the whole issue of run volume still needs to be addressed, with greater balancing between medical units, or more “floating” cars staffed by H-1’s in the downtown corridor and the Mission district. But again, these suggestions just reek of common sense, and that appears to be an unwelcome smell in the Presidio…

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