City Council Work Session   9/20/2021

PUBLIC COMMENT

• • SPEAKER_00
  • 00:00:05
    Wear a helmet and reflective clothes to be more visible to others If you ride after dark, remember to use a white headlight and reflectors
• • 00:00:49
    Music Music Music
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    Thank you very much.
  • 00:01:58
    Thank you.
• • SPEAKER_09
  • 00:02:56
    Kina, this is Brian.
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    You can record to Civic Clerk.
• • SPEAKER_05
  • 00:02:59
    Got it.
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    Thank you.
• • SPEAKER_13
  • 00:04:09
    All right.
  • 00:04:09
    Good afternoon, everyone.
  • 00:04:10
    I guess it's four o'clock.
  • 00:04:13
    Good to see everybody.
  • 00:04:15
    Dr. Hesedine Smith, the fire chief here at Charlottesville.
  • 00:04:18
    Fire, just need to do an audio check.
  • 00:04:20
    Is this how the protocol is?
  • 00:04:22
    I don't know what the protocols are.
• • Nikuyah Walker
  • 00:04:23
    Yeah, no, I'll just call the meeting to order and Ms.
  • 00:04:27
    Thomas will do roll call and then we'll- Sorry about that.
  • 00:04:31
    No problem.
  • 00:04:35
    I called this work session to order today.
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    We'll be getting an update from Chief Smith on the fire department.
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    Ms.
  • 00:04:45
    Thomas, would you do roll call, please?
• • SPEAKER_05
  • 00:04:49
    Mayor Walker?
• • Nikuyah Walker
  • 00:04:51
    Present.
• • SPEAKER_05
  • 00:04:52
    Vice Mayor McGill?
  • 00:04:54
    Here.
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    Councillor Hill?
  • 00:04:56
    Here.
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    Councillor Payne?
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    Here.
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    Councillor Snow?
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    Councillor Snowe?
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    Here.
• • Nikuyah Walker
  • 00:05:13
    All right.
  • 00:05:14
    Chief Smith, we'll turn it over to you and your team.
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    Thank you for joining us today.
• • SPEAKER_13
  • 00:05:20
    Thank you for having us.
  • 00:05:21
    Before I get started, I just want to say good afternoon.
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    City Manager Chip Boyles, Mayor Walker and council members, all protocols observed.
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    It's a pleasure to have this opportunity today to update you on the Charlottesville Fire Department.
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    So thank you in advance.
  • 00:05:42
    First, I'd like to introduce Dr. George Lindbeck, Associate Professor of Emergency Medicine and the Director of Emergency Medical Services Fellowship at the University of Virginia.
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    Dr. Lindbeck has been a cornerstone in this community for over 30 years as the medical director who is responsible for overseeing pre-hospital emergency medical services and the providers who practice under his license.
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    As a professor of emergency medicine and the director of the emergency medical services fellowship, he's considered the expert.
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    He currently serves as the state EMS medical director at the Virginia Department of Health.
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    So I'd like to welcome Dr. Lindbeck.
• • SPEAKER_10
  • 00:06:25
    Thank you, Chief.
• • SPEAKER_13
  • 00:06:27
    Thank you.
  • 00:06:27
    I'm also joined today by Deputy Chief Mike Rogers, who oversees business services for the Fire Department, which also includes fire and EMS operations, professional standards, and resources.
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    He too has been a cornerstone in the Charlottesville Fire Department and is considered the most knowledgeable regarding all elements of the department's operations and business practices.
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    He has been with the department for more than 20 years.
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    I think actually more than 21 years.
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    I'm very proud of the men and women who serve the city of Charlottesville every day as I represent them today.
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    They continue to give their all every day, day in and day out, often working 72 hours or more sometimes to cover our staff in deficits.
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    I would be remiss if I failed to acknowledge their contributions.
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    This month marks my 10th month with the city and I'm excited, still excited about the opportunity to be part of this family who continue to serve the city with our reservation and with a true commitment to family, integrity, respect and excellence.
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    I've been here close to a year and I appreciate from firsthand knowledge of working alongside our members and also observing cars as we provide services to our residents and visitors.
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    It's not lost on me to acknowledge that both agencies care much care just as much about this community as I do.
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    I'm appreciative of the many years of the contributions from CARS for over 60 years and for our fire department for over 165 years and agree that working collaboratively will be able to create a model system framework in this region based on 21st century concepts and strategies.
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    The content of this discussion will focus on efficiency, operational readiness, quality assurance from a quality assurance standpoint, and also suggest a vision for the future.
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    The Charlottesville Fire Department is committed to an all-hazard service delivery model in alignment with the concepts that are nationally supported within the 21st century fire and EMS departments.
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    It is my responsibility as the sworn fire chief to always find ways to be more efficient, effective, transformative,
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    and to provide the best all hazard services to our residents and visitors.
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    So with that, I'd like to focus this conversation on the information that we'll be going through instead of being distracted by any additional information or uncontrolled variables.
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    If you'd be kind enough to please hold your questions until the end of the presentation as there will be an opportunity for question and answers at the end of my presentation prior to public comments.
  • 00:09:00
    Thank you.
  • 00:09:01
    I'll share my screen now.
  • 00:09:24
    Can you receive my screen okay?
• • SPEAKER_09
  • 00:09:28
    Looks good, Chief.
• • SPEAKER_13
  • 00:09:30
    Thank you.
  • 00:09:36
    So as indicated, I'm Dr. Hezadeen Smith, the Fire Chief here at Charlottesville.
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    Just a quick background about my background.
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    I'm a military veteran.
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    I'm also a certified public manager, a doctorate in management focusing on organizational leadership,
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    I've been in the industry for over 33 years in public safety and emergency services.
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    I retired from the Orlando Fire Department with over 24 and a half years of experience.
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    I'm also an adjunct professor at a number of colleges, and I've been here with this organization since December 1st, 2020.
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    So when we talk a little bit about comparison Orlando to Charlottesville,
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    We look at my responsibilities prior to my retirement, being responsible for EMS service delivery for the city of Orlando in terms of operations.
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    And we have about 113 square miles, so it's about 70,000 EMS calls per year.
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    Here in the city of Charlottesville, we have 10 square miles with about 7,000 calls per year.
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    So when you take out the 13 extra square miles, which kind of is almost like the airport in Orlando, we're about a 10th
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    but the density here is such that it's a similar demographics and a similar timeframe in terms of response and call volume.
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    Three stations here compared to 17 stations, two ambulances here compared to 17 ambulances and certainly 18 engines and so on and so forth.
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    The core structure though, in terms of administrative functions, support functions, peer support, fire prevention, deputy chief, the rank structure,
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    very similar to what I was accustomed to for my years of service.
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    So it really makes me very suited to be in the situation here in the city of Charlottesville.
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    The mission of the department is to provide, to improve the quality of life in our community by consistently trying to make sure we strive to provide superior fire and EMS services focused on prevention, preparedness, response and recovery.
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    We're guided by four core values as depicted on, you'll see it on every slide.
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    family, integrity, respect, and excellence.
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    In terms of my vision as the fire chief, my vision is to enhance the department's culture and service delivery through transparency, innovation, trust, and integrity.
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    And with that, it's supported by eight pillars and
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    As you walk through our fire station here and a number of common areas we have have posted this communication.
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    So it's very clear that those principles should be embodied by everybody.
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    It's certainly that what kind of holds me together in terms of my framework and my context, keeping things in context as decisions are made and operational recommendations are also made in discussion with my leadership team.
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    Additional information speaks to my values, being mission driven, safety oriented, focus on collaboration, responsiveness, equity, inclusion, timeliness, and ensuring that there's a just culture.
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    So that's kind of the essence that really bounds me and my principles as I lead this organization forward.
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    And joining this organization, we were able to quickly adopt a new strategic plan.
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    It was in the works prior to my arrival.
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    However, on my arrival, I was able to review it and certainly give it my blessing, if you may agree with the ideas that were presented in terms of the commitment.
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    And we're guided by essentially six goals.
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    And the six goals
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    are also embedded in any decision that's being made within the organization.
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    We try our best to make sure that there's alignment.
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    When we talk about vision, alignment, and execution, I wanted to make sure that everything we do, there is some alignment with our strategic plan and certainly the city's strategic plan as well.
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    As you'll see, workforce health and safety communication
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    training services and support.
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    Those are key elements that will be embedded throughout this presentation and referenced throughout this presentation.
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    In terms of the 911 Center, we're very proud of the work that the team at the Emergency Communications Center does.
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    And I'm happy to say that we're moving forward with some initiatives that will ultimately guide our operational framework.
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    And in order for us to do that, we have to have that solid foundation in terms of
  • 00:14:00
    how we operationalize our response plans.
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    But essentially this medical priority dispatch system would replace the almost 25 or 30 year old system, if I may, that's being currently used to triage calls that are sometimes not necessarily 100% accurate because it relies on what the communication is from the 911 caller to what the dispatcher
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    ascertains and ultimately sends to the call.
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    So oftentimes there's an opportunity for us to really send a higher level capable unit versus sending a lower capable unit.
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    And we'll talk a little bit about that.
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    But before we get into that, there's some principles that
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    leaders across the United States have basically embodied as they talk about the 21st century fire and EMS services.
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    Basically, what they're talking about is that there's a number of dynamics that's important for organizations to think about as they think about moving forward and having a sustainable model.
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    It talks about inclusiveness, re-identification, it talks about culture, sustainability, and partnerships.
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    And what you see depicted here is that it is important that we in Charlottesville be prepared to embrace those forces that ultimately are impacting the 21st Services
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    21st Century Fire and Emergency Service Delivery Model.
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    As you see there, we have a number of vehicles depicted.
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    A collaborative approach is essential, and I am committed to that.
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    As you can see here, we have cars, we have the county, we also have our medical transport unit, we also have our community outreach unit, and we also have at the core that our firefighters that are committed to organizational delivery service delivery.
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    There's also another element that helps frame this conversation, and it has to do with what has been identified as the EMS agenda for 2050.
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    That means we need to be forward thinking.
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    We cannot continue to do things that we have always done for the last 50, 60, 100 plus years.
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    But ideally, the idea is that the guiding principles, as you can see here in the circle of the disk, if you may, it's a people-centered approach that we have to focus on here in the city of Charlottesville.
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    It is very important.
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    But additionally, it talks about EMS personnel must have immediate access
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    to resources that they need for patients, including healthcare providers, social services, and other community resources.
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    So this conversation will also address elements of this EMS agenda for the future, in addition to the 21st century forces that should be guiding us and moving us forward in the most appropriate direction.
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    Just a little bit about the organizational framework.
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    I'm not sure if you've been updated recently.
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    I had an opportunity to review our annual report.
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    But since me joining this organization, I've realigned the organization to address needs that are
  • 00:17:05
    certainly been present within the organization within the city.
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    One key element I had to quickly do was ensure that there was some realignment with our emergency preparedness.
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    And that's where I was able to utilize our institutional competencies that were already in place and put someone there who can really help the city of Charlottesville and the city in terms of the fire department and other elements within the organization to kind of move forward.
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    We also were able to create what we call a professional standards division, which basically focuses on training, whether it's EMS and fire training, and also making sure that professional credentialing and things of that sort are readily addressed.
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    Importantly, we introduced the concept, actually, we were able to identify a chaplain who agreed to volunteer to provide help to our providers.
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    and also reestablished or should I say realigned the peer support group by establishing an arrangement with a licensed mental health person to support the mental health needs of our firefighters.
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    Back in April, I met with the city manager to review elements of my 100 day report.
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    provided information about the areas that I examined, whether it had to do with organization dynamics, labor management, capital improvement needs, hiring and promotion, technology and policy and service delivery.
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    So that information was shared with city manager.
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    In brief, nine months of progress.
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    A lot has happened in nine months, but I'm happy to say within being here only nine months, we were able to accomplish a number of things.
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    22 new recruits created that professional standards division, secured a $26,000 grant to offset the cost of providing fire gear for our firefighters, our new firefighters.
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    Active Shooter Hostile Event Response Training in collaboration with CPD and also UVA Police as well.
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    We also made sure that we started to address implicit bias, having conversations about diversity, equity, and inclusion by incorporating implicit bias training and other additional types of training.
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    As it relates to public, should I say, professional development, establish a partnership with Columbia Southern University for scholarship opportunities and also reduction in
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    and Tuition so our firefighters can get back into school and continue with their educational goals.
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    Also established a internship program at Virginia State University where we had a political science major here with us during the summer to assist us with some review of policies and some additional things.
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    At this point, I'd like Chief Rogers if you just kind of talk a little bit about our bypass station and fire station at Ridge
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    the progress and where we are with this at this current time.
• • SPEAKER_14
  • 00:20:00
    Yes, sir.
  • 00:20:01
    You can see on the slide that Chief Smith has up that both of the stations that we have, the primary station at Ridge Street and then the bypass station that just has a single company and
  • 00:20:12
    Auxiliary EMS unit stationed at it at the present moment are both over 60 years old.
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    Ridge has had a couple renovations in recent past.
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    Most recently, the downstairs restroom facility was kind of re-envisioned to put a shower facility in it so that crews coming back from events where they may be exposed to any kind and type of carcinogen or anything else
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    would be able to shower before heading up to the clean space in the station.
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    Ahead of that, money was spent to renovate the dormitory area.
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    Used to be a large open dorm area.
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    The renovation allowed it to be split into single units for folks to keep their
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    bedding and everything personal in and have their own place to sleep, as well as the kitchen area at that station.
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    The other monies that were slated to do additional things at that station were partnered together with some CIP funds for the bypass station.
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    Initially, that station, when Chief Werner was here, was looking at a renovation, but as Chief Baxter came on board, he looked at that
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    and put a halt on the renovation and met with Mr. Jones at the time to get a better grasp on what it would cost just to replace the station altogether.
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    It pretty much served its useful life as far as capacity and infrastructure.
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    That money was initially allocated starting, I think, back as far as 2015, and there were some additional funds added to it to get where we are today.
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    We've been through a couple different design iterations with the replacement for that station just to basically upgrade the apparatus base, the living facilities, the kitchen, the areas where the firefighters congregate and work and train at during the day.
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    the fitness facilities which the bypass station doesn't have any to speak of that money was allocated like I say slightly yesteryear now in relation to this year or present days labor and construction materials costs so we're running into a little bit of a challenge there as well as water line that's needed to be run into that site they basically existing station had teed into a water line that was across the bypass
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    which doesn't meet as we understand today's needs or compliance.
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    So there's additional expense onto the project that wasn't originally anticipated.
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    So we're kind of at a holding pattern presently with that.
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    But those are about the two present states of the two stations at the moment.
• • SPEAKER_13
  • 00:22:49
    Thank you.
  • 00:22:52
    So if we talk about equity and inclusion, prior to my arrival, we were at about 12% in terms of
  • 00:22:59
    in terms of ethnicity, black or African-Americans and 87% white.
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    And certainly when we look at the females in terms of gender, we're at a count of three females on the entire fire department compared to 82 males.
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    So that's about a 96%.
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    Since my arrival, we have changed the dynamics of the organization by taking advantage of hiring individuals who
  • 00:23:25
    not only grew up in this community, but some of them actually served in the military and came from other professions as well, to now we are able to say we have about 16% Black or African Americans, which is a count of seven plus
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    what we started with.
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    We added seven to that.
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    And in terms of female, we're proud to say I was able to hire seven females.
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    So we now have a count of 10 females, which represents 9%.
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    So as we move forward, we're not only talking about demographics in terms of
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    diversity in terms of gender and ethnicity.
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    One of the things that was very important for me to really make sure is that we also looked at demographics as it relates to thought process, educational expertise, military background, and also certifications.
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    As you probably have heard, we are still struggling to get paramedics, attract paramedics, retain our paramedics here.
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    But certainly, as you can see there, our demographics are what they are in terms of department education, levels of education.
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    Certainly, we hope that we'll be able to attract additional paramedics as we move forward with a new hiring process coming up in the next, closing next Friday.
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    So that kind of speaks to a little bit about the diversity, equity and inclusion piece that
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    I take very I'm very committed to that, essentially.
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    Additionally, we have implemented the concept and we're continuing to implement the concept in terms of cultural change.
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    How do we change a culture or influence a culture that's been around for such a long time?
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    And one of the ways that we're focused on right now in addressing that is cultural changes through what we call just culture and examining what is going on with our firefighters in terms of what kind of challenges they may be faced with whether compliance with policies,
  • 00:25:13
    being safe on the fire ground, being safe on EMS scenes, identifying whether it's at-risk behavior or things that just happening because of human error, and what do we need to change?
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    Is it a system issue or is it a personnel issue that we need to address?
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    So that change obviously will happen over time, but that's one of the things that I've instituted since I've been in.
  • 00:25:32
    It's called a just culture approach, which stemmed basically from a hospital-based healthcare-type system, but certainly trans
  • 00:25:40
    translates and is adapted to the fire service and the EMS services delivery.
  • 00:25:46
    Data, being a data-driven fire chief is important, right?
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    And not only quantitative data, but also qualitative data, which is important for us because oftentimes you look at the numbers and sometimes the numbers tell you one thing, but the voice and the lived experiences of our providers certainly can tell you a lot.
  • 00:26:05
    But one quick thing I want to just discuss here is our neighborhood risk reduction.
  • 00:26:10
    I commend our staff for working
  • 00:26:13
    Timing, I mean, just working overtime essentially to create a process that's transparent and provides the community with information about what's going on in the neighborhoods as it relates to risk or whether it's fires, medical calls, or other types of situation.
  • 00:26:30
    And if you haven't seen it yet, I encourage I will be able to share this link with you.
  • 00:26:34
    But basically, I'll just kind of go through it as a quick demo, if you will.
  • 00:26:45
    So Chief Powers and his team worked very well in terms of developing this framework.
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    And basically what it does, it provides a number of hyperlinks here that allows our visitors, our residents, our stakeholders to really see what the fire department is doing, what the city has to offer in terms of risk reduction and what's going on in particular neighborhoods based on where individuals may live.
  • 00:27:13
    So, for example, we look at neighborhood risk.
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    There are 19 communities here that we have information on, and I'll be interacting with this as we go through this presentation.
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    But as you can see, you can actually drill down into the different areas.
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    Hopefully my screen is still good.
  • 00:27:28
    Thumbs up.
  • 00:27:31
    All right.
  • 00:27:32
    So for example, if you want to identify, you want to look at 10th and page, what's going on in 10th and page, you can say, okay, let's take a look.
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    Let's see what the community profile looks like.
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    And this is a compilation of various data sources that are out there, some readily available.
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    Some that's proprietary, some that's really part of our 911 system and also our report management systems as well.
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    We're able to actually share information with the community so they have an idea what's going on in their particular areas.
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    One of the key things for us on the fire department, however, is when we look at incident response, we're able to identify where the risk areas are.
  • 00:28:17
    And later on, when I get into talking about the response and the importance of timely response, we'll kind of reference some of these neighborhoods.
  • 00:28:26
    But as you can see, for example,
  • 00:28:28
    This neighborhood is first in cardiac arrest.
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    So what that means out of all the neighborhoods, there's likely to be a cardiac arrest in that neighborhood because it's the highest number of cardiac arrest in that out of the 19 jurisdictions.
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    Third for, ranked third, these are rankings.
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    Third for structure fires, diabetic emergencies, cardiac emergencies, falls.
  • 00:28:52
    So let's talk about falls.
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    So let's say, oh, you know what?
  • 00:28:56
    They're at risk for falls in this community.
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    What could the fire department do?
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    Who could the fire department partner with to make sure that they evaluate the homes and identify if a particular home has an LLB person and needs a ramp built?
  • 00:29:08
    These are things that the fire department and other stakeholders can work together
  • 00:29:13
    to provide resources and support for our community.
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    I'm not going to go through each one of them, but this just kind of gives you an idea what we're doing in terms of neighborhood risk reduction and how it ties in with our operational and our 21st century fire department service delivery model.
  • 00:29:31
    And then we have additional dashboards that we utilize that our system analysts put together in terms of providing me insight, our leadership team insight, our additional partners insight in terms of what's going on in the city.
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    And here's just another screenshot here that talks about it.
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    As you well know, we're reaching out to the community in a number of different ways.
  • 00:29:52
    And this is one of such ways as it relates to the vaccination efforts and the collaboration that's going on there.
  • 00:30:02
    There's been a lot of discussion about the need for whether it's a committee or whether it's
  • 00:30:09
    additional eyes to examine our service delivery model here in the city of Charlottesville, right?
  • 00:30:15
    So I had to go back in history to kind of look at what has been done before I arrived here.
  • 00:30:23
    And I went back about, it looks like about 15 years, 14, 15 years ago, and identified that there was a committee formed in 2007, as you can see here.
  • 00:30:31
    And I just basically did some snippets here.
  • 00:30:33
    But the key element that is still present today is that
  • 00:30:37
    The concern is that there may be a delay in the transport
  • 00:30:41
    of patients that could negatively affect patient outcome.
  • 00:30:45
    And we've heard from different experts who've come on based on previous meetings and so on and so forth.
  • 00:30:52
    But ultimately, we would all agree that patient outcome, the outcome related to emergency insult, whether it's traumatic, medical, or fire, it is important that we have a positive outcome.
  • 00:31:04
    So there's no debate about the problem definition from a research standpoint, if you may, or from a community standpoint.
  • 00:31:11
    So ultimately, a committee was formed, and Dr. Limbeck, your name's here, you're a part of that, so you could speak to that, and others from the neighbor, from the community, Dr. Correction, Dan Eggleston, the fire chief, I'm in close communication with him, I've been in close communication with him even before I got here.
  • 00:31:32
    Dr. Chief Eggleston and I are
  • 00:31:36
    have the same vision for this system delivery in this region.
  • 00:31:41
    So we have conversations about what the future should look like in this system.
  • 00:31:46
    So it's not that I'm coming here with an idea from a metro city to say, yes, we're going to do it this way.
  • 00:31:51
    It was important for me to get an idea of what had been done before, the path that was laid before.
  • 00:31:56
    And what are we doing now as we continue down the path to implement some of the recommendations that came out of this committee?
  • 00:32:02
    Dr. Limbeck, would you like to spend a couple of minutes just speaking to that, if you would, please?
• • SPEAKER_10
  • 00:32:08
    Well, the history, as I recollect, this followed on the heels of a study done by the Matrix Group that looked at fire rescue in Elmore County as well as the city.
  • 00:32:19
    One of the outcomes of that study was that they felt that we were about 1.5 units short on a regular basis.
  • 00:32:28
    Charles Werner, that is, Charles Werner put together a proposal
  • 00:32:32
    to stand up an ambulance with CFD.
  • 00:32:36
    My understanding was that the city initially funded that, but there was a lot of concern about that innovation, that new program.
  • 00:32:50
    So a task force, if you will, was put together in this
  • 00:32:56
    as part of the results of that task force.
  • 00:32:59
    Task force voted to reaffirm the city's commitment to that program, and you can see the representatives on the task force.
  • 00:33:11
    That was one of the first times I'd ever been involved in a fire rescue analysis or task force where we had members of the community involved, and it was really nice to have Martin Burks and Mary Lou Stavini on that committee.
  • 00:33:24
    It was really helpful.
  • 00:33:27
    That went back to city council.
  • 00:33:28
    I believe that city council voted in favor once again, but ultimately the program was not implemented.
• • SPEAKER_13
  • 00:33:40
    So with that, so fast forward to
  • 00:33:44
    Now, basically, there was some recommendations in terms of adoption of performance metrics, if you may, regarding response times and the things that we're discussing now.
  • 00:33:56
    And that full committee report is there, but we're beyond that, if you may.
  • 00:34:00
    However, those core things that were discussed and were a concern at the time
  • 00:34:06
    definitely have presented themselves to this day.
  • 00:34:09
    And it is important for us to recognize the importance of implementation of different recommendations from a body, a broader body.
  • 00:34:18
    So subsequently in 2017, another study was conducted.
  • 00:34:22
    and this was a broader study.
  • 00:34:24
    However, this study actually looked at the entire city but also made recommendations specifically to different areas within the city.
  • 00:34:34
    And what I did, I was able to simply extrapolate some information there that talks about ensuring adopted EMS service level standard for the city of Charlottesville.
  • 00:34:44
    It is important for communities to establish certain levels of standards for EMS services, right?
  • 00:34:52
    So what it also talks about is to ensure that the city and residents are receiving adequate services and that is my commitment.
  • 00:35:00
    It also says it's recommended that the city ensures that EMS service delivery standard or should I say service level is met.
  • 00:35:07
    And if CARS is not able to provide the desired level of service, the city may consider directly providing EMS services.
  • 00:35:15
    It still is a joint effort.
  • 00:35:17
    It still is a collaboration.
  • 00:35:18
    And I say that to say that we need CARS.
  • 00:35:21
    We want to work with CARS.
  • 00:35:23
    However, it is important that we all look at this from an objective level where we're here to serve the citizens, the residents of this community.
  • 00:35:31
    So ultimately, that is my goal.
  • 00:35:34
    And we're four years past this, and we are implemented a number of different things that is continuing to move us in the right direction.
  • 00:35:41
    So I think we're on the right path.
  • 00:35:44
    So what I did, I started back in December, and I think early into it, I wanted to evaluate our service delivery based on the benchmarks that I
  • 00:35:54
    been clearly adopted across the United States and certainly NFPA, the National Fire Protection Agency has its benchmark.
  • 00:36:01
    We're 10 square miles, so we're fortunate.
  • 00:36:04
    We're not 100 square miles where we're trying to get down the road in 15 minutes and so on and so forth.
  • 00:36:10
    We're a densely populated city and we have the ability with the street networks and so on to be able to provide the level of service that is expected to make a difference in outcomes for patients.
  • 00:36:26
    That information was also presented and also discussed with CARS and also city leadership as well in terms of city management.
  • 00:36:33
    So in summary, what we were able to identify over a four year analysis, 2017 through 2020, there's opportunities for improvement.
  • 00:36:44
    The idea is that no one agency is meeting the objective 100% of the time.
  • 00:36:50
    So there's opportunities for improvement.
  • 00:36:53
    And as you can see here, this is at the advanced life support level, whereas in 2020, the 90th percentile, which takes care of all the outliers, if you may, because sometimes you have
  • 00:37:04
    outliers where the data could be skewed if the outliers aren't, if you're using averages.
  • 00:37:10
    But as you can see there, there's an opportunity for improvement for both agencies in terms of response.
  • 00:37:16
    So that has been my commitment, identifying opportunities and identifying what we can do to improve our service delivery.
  • 00:37:24
    So then we'll also look at the basic life support.
  • 00:37:27
    There's a difference here as well in terms of 2017, 2020.
  • 00:37:32
    You see 8.3 here at the 90th percentile.
  • 00:37:36
    You see 6.7 here at the 90th percentile for CFD.
  • 00:37:42
    Again, opportunities for improvement.
  • 00:37:45
    And what you don't measure, you can't improve, right?
  • 00:37:48
    So with that, we also, I wanted to make sure, is it reasonable to expect
  • 00:37:54
    based on the level of service that is requested or needed to get to the different areas in the city within four minutes versus eight minutes and who can get there and who is most suitable to get the dispatch or should I say most suitable to respond to those areas.
  • 00:38:12
    So what we have done, we have a drive time analysis dashboard.
  • 00:38:17
    and what this provided me with information, someone who's new to the community to identify what is realistic.
  • 00:38:28
    So again, this is GIS information.
  • 00:38:34
    And what we have here is a depiction of what it looks like for four minutes in terms of response time.
  • 00:38:41
    So we'll start with our Fontaine Fire Station where I'm sitting right now.
  • 00:38:54
    Can you see this okay?
  • 00:38:55
    I know you can't see the street network, but you get an idea, the part of the city that can be covered within four minutes of travel time.
  • 00:39:03
    And this is not based on real traffic like today's traffic like in Google, but it's based on the street networks and the miles per hour calculated based on GIS technology.
  • 00:39:17
    Okay, so that's what it looks like we can cover for four minutes from Fontaine.
  • 00:39:21
    And then we add the bypass station, right?
  • 00:39:23
    So we add the bypass station, you see the coverage there of the bypass station.
  • 00:39:27
    What you're seeing here, this fourth station identifier here is actually cars.
  • 00:39:32
    So then you go, well, let's see what Ridge does.
  • 00:39:35
    Wow, we're able to cover a decent amount, but we also still need cars to cover another area.
  • 00:39:43
    And then there are some overlap opportunities
  • 00:39:46
    Well, based on our response, there's still a gap, as you can see here in this UVA area.
  • 00:39:54
    So with that comes our recommendations for, excuse me, whether it's a new station or a different deployment model, or if you say, well, based on the risk of these areas, what is likely to happen there?
  • 00:40:08
    Is it cardiac arrest?
  • 00:40:09
    Is it structure fires?
  • 00:40:10
    What is likely to happen in those areas?
  • 00:40:12
    But have a realistic expectation that
  • 00:40:15
    based on normal traffic patterns, we are not able to get to this particular area in four minutes.
  • 00:40:23
    So with our benchmarks, our goal is with a cardiac arrest, something that is very traumatic, something that requires quick response so we can get there stabilized and also transport, this is what we're capable of doing.
  • 00:40:38
    Is it reasonable?
  • 00:40:39
    Is it acceptable based on the risk?
  • 00:40:41
    So that's the discussion that sometimes we need to have.
  • 00:40:45
    Not sometimes, that's the discussion we always have to have.
  • 00:40:48
    So then we say, well, what's more reason?
  • 00:40:49
    Let's take a look at what can we do in eight minutes?
  • 00:40:53
    Because there's an eight minute idea for your stubbed toe or back pain, chronic back pain from the last period of time or some non-emergency type situation.
  • 00:41:04
    So let's turn it on.
  • 00:41:07
    So as you can see there, let me turn off.
  • 00:41:13
    So eight minutes, Fontaine Station could pretty much reach half the city.
  • 00:41:19
    We're good?
  • 00:41:20
    Thumbs up?
  • 00:41:21
    Are we good?
  • 00:41:22
    All right.
  • 00:41:23
    All right.
  • 00:41:24
    Cars?
  • 00:41:25
    can cover everything as well.
  • 00:41:27
    Bypass, you cover a lot too, and Rich can cover a lot.
  • 00:41:31
    So when we expect, when the customers expect us to get there at least within eight minutes, if it's not an urgent situation, I think it's realistic.
  • 00:41:42
    If you're having a heart attack, you don't want to wait eight minutes.
  • 00:41:45
    I want to be there in two minutes or four minutes.
  • 00:41:49
    So that's why when we talk about proximity dispatch in a few minutes, this puts it into context, essentially.
  • 00:41:57
    All right, we're going to go back to the slide.
  • 00:42:02
    So Chief, would you mind running through these next few slides?
  • 00:42:05
    I know I'm kind of going, taking it long, but I think it's important for us to go through the definitions, Chief.
  • 00:42:11
    Sure.
• • SPEAKER_14
  • 00:42:11
    There's a couple slides that Chief Smith has up that have some definitions that, like he said, he'll be going over in the next upcoming slides.
  • 00:42:19
    The call handling time, you can see on the screen, of course, is the time from the ECC or the 911 communication center picking up or answering the 911 call to a unit being notified.
  • 00:42:29
    So by the time it takes them to get the actual call, the call information,
  • 00:42:33
    put it in the system in the station to be alerted is the call handling time.
  • 00:42:38
    The turnout time is then once the station gets that call, the time it takes the personnel in that station to get on the unit and the actual unit beginning to move where they actually mark in route to the scene.
  • 00:42:50
    The travel time is then the measure from the time they start turning after the turnout, they start turning to the time they actually get on location at the incident scene or the address, at least if they were given.
  • 00:43:03
    So that's the definition of the travel time.
  • 00:43:08
    Got
  • 00:43:09
    And then the total response time is that aggregate of the previous three all kind of lumped together.
  • 00:43:15
    And that gives you from the inception of the call to the time the units got on scene, what that total response picture is.
  • 00:43:23
    And like you say, on some of the charts and slides you'll see here shortly, you'll see them broken down, but then you get the total picture at the end.
  • 00:43:31
    And then the unit best performance is the actual measurement of the travel time
  • 00:43:38
    the turnout and travel time using those two elements within that crew staffing a unit, what the travel time to the lesser extent safely traveling to the scene is, what is the best performance that unit could do at that particular given point in time with the response.
  • 00:43:58
    When we talk about ALS versus BLS, the basic life support level is the emergency medical technician basic.
  • 00:44:05
    That's a requisite for the jobs that the firefighters here at the Charlottesville Fire Department have.
  • 00:44:10
    And that's the basic level, bleeding wound care, CPR to the basic life support level, basic anatomy and physiology, being able to take care of the patient.
  • 00:44:26
    in a manner that you can assist them and get them transported, but you're not doing invasive procedures.
  • 00:44:32
    When you move to the advanced levels,
  • 00:44:34
    The more advanced, advanced EMT or the AEMT historically has been known in the Commonwealth of Virginia, at least as a trauma level.
  • 00:44:42
    And essentially that allows the EMT to begin to place IVs, give some limited amounts of medication.
  • 00:44:49
    The EPI, excuse me, the EMTs will give things like the EPI auto injectors, like aspirin, things like that.
  • 00:44:56
    But the advanced EMTs, they'll start to give things like glucose via IV for persons with low blood sugar,
  • 00:45:04
    They'll do some other things with allergic reactions and some other slightly more advanced procedures than the basic EMT will.
  • 00:45:13
    Then you move to the paramedic level.
  • 00:45:15
    That's more purely what's considered advanced life support in the Commonwealth now.
  • 00:45:20
    There used to be an intermediate level, and we still do have some personnel that practice at that level.
  • 00:45:25
    It's just no longer supported as a sole certification.
  • 00:45:29
    So they can recertify at that level, but we can't certify anybody at that level.
  • 00:45:33
    The paramedics are the ones that are actually doing the cardiac monitoring, giving the cardiac medications.
  • 00:45:39
    They spend a lot more time with the anatomy and physiology and understanding
  • 00:45:43
    the different progressions of acute illnesses, injuries, things of that nature, and trying to get what out of hospital care is best suited for the person to get them transferred to the hospital in a safe manner.
  • 00:45:58
    And then you can see the asterisk there with the EMT intermediate, which is there again, recognized in Virginia still.
  • 00:46:06
    ECC determines the type of response based on some
  • 00:46:11
    basically questions that they have that they ask of the caller once the 911 calls place.
  • 00:46:15
    They're in the process of upgrading to best practice or a third party vendor based system that will aid them in those questions.
  • 00:46:25
    The method that they've been using in collaboration with the operating medical directors has been more of a homegrown system for the last
  • 00:46:33
    for a good period of time.
  • 00:46:35
    It's served well, but they're looking to move forward to that vendor-supplied system presently.
  • 00:46:41
    So advanced life support, as you can read there, administration of medication, basic and advanced medical trauma procedures, and then with the basic life support, basic medical care provided by the EMTs in the ambulance or other settings.
• • SPEAKER_13
  • 00:46:55
    Right.
  • 00:46:55
    And I'll just add one thing.
  • 00:46:57
    You often will hear that
  • 00:47:00
    We mostly respond to BLS calls.
  • 00:47:03
    And what you're hearing is that, and Dr. Lindbergh can probably confirm this, the triage protocols that are in place are greater than 20 years old.
  • 00:47:14
    So the move to a 21st century protocol electronic framework is underway currently.
  • 00:47:24
    And oftentimes the basic life support, if the
  • 00:47:29
    if all you have on the scene is an EMT who cannot execute any advanced skills that patient does not have a chance of getting anything done pre-hospital unless there's a call for the fire department to come and provide ALS which oftentimes now delays care even more or the patient just is picked up and transported to the hospital like they used to do in the day scoop and run if you may and get them to the hospital.
  • 00:47:56
    So it is very important to realize that oftentimes, if it's a 1% chance, or if it's one out of 10 calls, that it turns out that the abdominal pain that the person's having now is actually a cardiac issue going on.
  • 00:48:10
    And you don't have the advanced providers there to do an EKG, then what do you do?
  • 00:48:18
    So let's talk a little bit now about the data review regarding ALS and BLS.
  • 00:48:24
    As I mentioned earlier, what gets measured gets improved.
  • 00:48:28
    And our goal is to ensure continuous quality improvement initiatives are done.
  • 00:48:33
    So we adopted a model as it relates to proximity to dispatch.
  • 00:48:37
    and this occurred in July, the 24th of July.
  • 00:48:41
    Basically what happens in the system now, the system sends the closest appropriate ambulance to ALS and BLS level calls based on the protocols that are in place and based on the use of what we call automatic vehicle locators and also the capability of the unit.
  • 00:48:58
    The fire department provides 100% advanced life support where we have a paramedic on board, our ambulances all the time.
  • 00:49:07
    Prior to the change, ambulances were often sent to scenes with longer response times while the advance ambulance sometimes would be in quarters and an ambulance would drive by that ambulance that's in quarters, hence a longer response time.
  • 00:49:23
    so very frequently pass the station with an appropriate life support unit readily available.
  • 00:49:30
    So improvement was necessary for providing a timely response to the highest level of out-of-hospital medical care to neighborhoods such as Tenth and Page,
  • 00:49:40
    Fiveville, Fry Springs, Ridge Street, Woolen Mills, and others.
  • 00:49:44
    So when we go back to the neighborhood of risk, you want to look at that to kind of say, why is it important for us to send the most appropriate and the most timely unit to get to these particular neighborhoods?
  • 00:49:55
    And it impacts the care that we provide to our residents.
  • 00:49:58
    10th and page, again, number one for cardiac arrest, number three for diabetic emergencies and cardiac emergencies in fall.
  • 00:50:06
    So the EMS system must ensure time and responses to all neighborhoods.
  • 00:50:12
    For cardiac arrest, the closest unit going to get the call based on this algorithmic approach.
  • 00:50:18
    I don't want to bore you with the details.
  • 00:50:21
    But basically, it provides, it accounts for all capable units within the system, depending on where the unit is and depending who is closest to the call.
  • 00:50:31
    And the 911 CAD system actually uses a millisecond, takes even a millisecond to actually determine who is the closest unit based on again, AVL and iPads that we have, and obviously the GPS infrastructure that's in place.
  • 00:50:46
    So the implementation of proximity dispatches caused a lot of concerns or discussions.
  • 00:50:52
    And what I've implemented is nothing different.
  • 00:50:55
    And I think I mentioned that earlier, we don't have to look far.
  • 00:50:59
    Chief Eggleston and I are on the same page.
  • 00:51:02
    He implemented, the system implemented it 2016, 2017 in the county.
  • 00:51:07
    We're just implementing it now here in the city of Charlottesville.
  • 00:51:10
    So we would probably all agree that I am not doing anything different than what the county is doing.
  • 00:51:16
    We're in complete alignment, essentially.
  • 00:51:19
    Certainly they have different geographic region and there are some intricacies there, but ultimately what you see highlighted here is what we call the response plans that are built within the 911 system.
  • 00:51:33
    So implications.
  • 00:51:34
    There's also been referenced that 83% of all patients only required BLS care.
  • 00:51:39
    What I say to that is
  • 00:51:41
    counselors is that 100% of the patients that are transported must get basic life support care.
  • 00:51:49
    However, if there is not an opportunity to provide a higher level of care and it's necessary, they may not get that higher level of care because BLS staff ambulances only provide basic care.
  • 00:52:02
    So there's a limited opportunity to receive a higher level of care.
  • 00:52:05
    And if an advanced level of care is needed, then what?
  • 00:52:09
    I mentioned that earlier.
  • 00:52:12
    So reviewing a small sample, not a big sample, abdominal pain, for example, about 18% of those patients got admitted to the hospital.
  • 00:52:19
    And normally, if you get admitted to the hospital, that means you probably have something else going on.
  • 00:52:23
    And Dr. Lenbeck, you and I spoke recently, you had some takeaways on the abdominal pain in terms of the quality of care and the experience that our residents probably, not probably, need to have.
  • 00:52:37
    Mind talking about that just a little bit, doc?
• • SPEAKER_10
  • 00:52:41
    What we've talked about for several years is that although the transport could be affected by a BLS unit and a patient would get to the hospital, we have opportunities to improve their care in the field with a medic level provider.
  • 00:52:58
    And that could be things like pain medications, anti-nausea medicines, IV fluids that can be provided on route.
  • 00:53:08
    Is that what you were referring to, Keith?
  • 00:53:09
    Yes, sir.
• • SPEAKER_13
  • 00:53:10
    Yes, sir.
  • 00:53:11
    Yep.
  • 00:53:12
    So when we look at outcomes, we have an opportunity as well to engage with our local hospital partners in terms of what we call hospital data exchange.
  • 00:53:20
    That doesn't exist currently in the system.
  • 00:53:22
    And what that means is that every patient that we transport, we want to get automatically notified what type of diagnosis did that person
  • 00:53:33
    have.
  • 00:53:33
    Were they discharged immediately or were they not?
  • 00:53:36
    That is well needed in our system.
  • 00:53:37
    It doesn't exist today.
  • 00:53:39
    However, it is important to note that based on proximity, response has improved in service delivery areas such as related to travel time, total response times, and unit best performance time.
  • 00:53:51
    And I'll show you that here in a moment.
  • 00:53:53
    Collectively, Barracks Road, Green Bar, and these additional areas, Lewis Mountain, Locust Group, there have been a 17% improvement collectively in travel time since we implemented proximity dispatch based on the data from our system analysts.
  • 00:54:08
    10% improvement in total response time.
  • 00:54:11
    Keep in mind, it's a small sample of about 300 calls that we examined, right?
  • 00:54:16
    So CFD currently, in spite of what you may have heard, we rarely send multiple units of the same type to medical scenes.
  • 00:54:23
    When I arrived here, it was very evident.
  • 00:54:26
    I witnessed sometimes two fire engines, two ambulances, and a car trying to make it work for a advanced level care need on a scene.
  • 00:54:36
    Total inefficient use, in my opinion, of resources.
  • 00:54:39
    So we had to find more efficient ways in terms of using our resources.
  • 00:54:44
    because if we don't find more efficient ways, it's costing dollars.
  • 00:54:48
    It's making units not available for calls.
  • 00:54:50
    So here's an example of our data analysis.
  • 00:54:53
    The number of times EMS incidents had multiple units between 724-20 and 9-7, which was
  • 00:55:02
    last year and the current year, 247 times versus once we implemented proximity dispatch, we're down to a 113.
  • 00:55:10
    We have moved from an average daily response with multiple units to 2.5 on an average for multiple units.
  • 00:55:19
    And this is based on us strategically creating a process that sends the most appropriate unit, the most proximal unit to these calls.
  • 00:55:31
    cardiac arrest, I'm sorry cardiac arrest, we looked also the number of runs in the UVA city UVA that result in a call for engine and a fire truck on a BLS call because generally a BLS call does not necessarily require that but based on us redesigning the response plan you can see it's a short period of time there's been a decline where we're sending a fire engine and truck or tower truck on a BLS level call okay
  • 00:55:58
    So improved efficiency already being realized and reducing the use of our firetruck BLS calls.
  • 00:56:07
    Data Sources, our data analysts were able to pull information from what we call the CAD table, the FRITS table, if you may.
  • 00:56:13
    Image Trend is where we document like the types of call, what we did on the call, the outcome, was it a refusal, did the patient get transported, which hospital they went to, and so on and so forth.
  • 00:56:25
    And then we also imported the data into ArcGIS, which helps us with the geographical comparisons that need to be made.
  • 00:56:36
    And then we applied filters to control for outliers, because there's oftentimes in any data set, as many of you know, you have outliers, right?
  • 00:56:44
    And the outliers kind of look, we wanted to make sure that call handling times needed to be less than five minutes, because sometimes if you actually started an incident in the CAD and nothing really happened, that call handling time could be longer.
  • 00:56:57
    So we wanted to make sure that we eliminated the sampling error, if you may, based on how we do research.
  • 00:57:04
    Turnout times, wanted to make sure it's less than five minutes.
  • 00:57:08
    Travel times, less than 25 minutes.
  • 00:57:10
    I think we can get to anywhere in the city within less than 25 minutes.
  • 00:57:14
    And then total response time, if anything exceeded 30 minutes, those times were eliminated as well.
  • 00:57:20
    And with any issue, any survey, any research, there's also a concern about validity.
  • 00:57:26
    So we were able to, obviously, we identified opportunities for us to control, ensure validity as best as we can to make sure that we are able to effectively evaluate what we were doing and compare numbers, apples and apples, if you may.
  • 00:57:42
    Speaking of apples and apples, we looked at a date range that was 15 weekdays and six weekends.
  • 00:57:50
    So prior to proximity and post proximity, we wanted to look at the same sample size because in research they talk about unequal sample sizes.
  • 00:57:59
    We wanted to make sure that we address those limitations by making sure we had equal sample size when we're comparing pre proximity to post proximity.
  • 00:58:08
    Are we good?
  • 00:58:10
    Good.
  • 00:58:12
    I apologize, but I think it's important for us to kind of go through this whole thing so everybody has an understanding of exactly where we are.
  • 00:58:19
    So then we kind of looked at neighborhoods with 10 or more incidents, because when you talk about 90th percentile, you don't have enough elements, 90th percentile is not necessarily going to be reliable when you're looking at trending.
  • 00:58:31
    So we use a threshold of 10 incident to make sure we had at least 10 incidents in each period to make sure that when we're doing the neighborhood analysis, we're looking at apples to apples.
  • 00:58:44
    All right, so only neighbors with 10 or more responses, incidents in the two study periods.
  • 00:58:54
    That's the areas we focused on there on the right.
  • 00:58:57
    And we'll talk about 90th percentile and what the outcome looks like.
  • 00:59:01
    So here we go.
  • 00:59:02
    So 10th and page, for example, as we already know, cardiac arrest, first for cardiac arrest, diabetic emergencies, cardiac emergencies.
  • 00:59:12
    What you're seeing on the right is an export from the data analysis.
  • 00:59:17
    And basically what we're seeing here prior to prior to
  • 00:59:23
    proximity dispatch, you see that there are seven calls, eight calls respectively, 53%, 47%.
  • 00:59:31
    Once the decision was made to send the closest unit, that did shift a bit because obviously the fire department's proximity based on the neighborhood, it's more proximal and the unit was readily available based on the call types.
  • 00:59:47
    So as you see, and I want you to kind of focus, don't worry about the call handling, focus on travel time,
  • 00:59:53
    and total response time and also best performance.
  • 00:59:57
    So when it's a negative number, that means there has been a reduction or improvement.
  • 01:00:02
    When there's a positive number, that means it's not a significant, not improvement.
  • 01:00:08
    So I have it highlighted in red.
  • 01:00:10
    So when we talk about travel time, 10% change there.
  • 01:00:14
    Total response time, 17%.
  • 01:00:17
    The unit best performance, which is the bigger period of time, there wasn't a significant change there, if you may, from 5.2 to 5.3, a small 2% change.
  • 01:00:25
    But the key here is the travel time,
  • 01:00:33
    and a total response time improvement noted for this particular neighborhood.
  • 01:00:38
    So we would all agree, while it's a small sample size overall, and I'll show you a summary here, there for this particular neighborhood, CFD and the system is performing or it appears that it's performing as expected.
  • 01:00:55
    Let's look at Fiveville.
  • 01:00:58
    five bills, second for asthma, second for strokes, third for seizures, disregard the typo.
  • 01:01:07
    Travel time change, 36% change, 17% total response change from 9.9 pre to 8.2 because we're sending the closest unit.
  • 01:01:22
    And the best performance time, it was a significant change there.
  • 01:01:34
    So overall, when we look at this overall, our end, if you may, we compared 357 incidents to 338 incidents together.
  • 01:01:45
    And based on that huge number, there was a 6% change in travel time, a 4% change in total response time, and a unit best performance change of 4%.
  • 01:01:58
    Now some may say, well, that's not a big deal.
  • 01:02:03
    You're one page.
  • 01:02:05
    If you're one of those calls and it made a difference and a unit got there faster, then you're probably happy.
  • 01:02:14
    So ultimately, when we talk about service delivery and making sure we provide the most timely response to our customers, it is very important and we're committed to that.
  • 01:02:23
    Fry Springs, proximity.
  • 01:02:26
    Fry Springs didn't have any incident response ranking based on the information that's provided.
  • 01:02:30
    However, the travel time change there is 55%.
  • 01:02:34
    while the call numbers, 18 before, 10 after, still you're seeing a 40% total response time change.
  • 01:02:44
    Now, again, remember, we're not able to quickly pull outcomes information back from the hospital, but I can make an assumption that we're making a difference.
  • 01:02:54
    Either A, we're making a difference in the outcome, or B, we're making a difference in the lived experience of our community and our residents and individuals that call for the fire department for EMS services.
  • 01:03:08
    Belmont, interestingly,
  • 01:03:13
    interesting and is very transparent.
  • 01:03:15
    We did not see a significant improvement here, but keep in mind
  • 01:03:21
    that the responses are based on unit availability and resources and also proximity to the area.
  • 01:03:29
    Or if an ambulance is coming back from the hospital and they're driving by a call, they actually will get dispatched to the hall if they have the appropriate level of personnel on board.
  • 01:03:39
    So Belmont wasn't significant.
  • 01:03:41
    Belmont didn't look so pretty.
  • 01:03:44
    It didn't look so pretty.
  • 01:03:45
    But ultimately, our goal is to make sure that we continue to measure and identify opportunities for improvement.
  • 01:03:53
    We're almost there.
  • 01:03:54
    And this is in summary, this is all the neighborhoods together where we didn't have enough total number of calls.
  • 01:04:00
    But basically, you're still seeing a 17% change with all these communities collectively and about a 10% total response time change here as well.
  • 01:04:09
    Cardiac arrest is too soon because we don't have a lot of cardiac arrest every month.
  • 01:04:13
    So the time, it looks like it's on a downward trend in terms of our ability to get to a cardiac arrest a lot faster.
  • 01:04:21
    And our, you know, at the end of the day, we have to have enough additional information to really make a conclusive decision or should I say recommendation or feedback.
  • 01:04:32
    And as we start wrapping up, there's a concept called our ability to look at our standard of response compliance, essentially.
  • 01:04:44
    And what this does, we looked at it from a fiscal year perspective and identified how are we doing overall in a system based on cars versus CFD information.
  • 01:04:56
    And basically, it just looks at gaps within turnout time versus travel time,
  • 01:05:01
    versus total response time and how we're doing in terms of system performance, right?
  • 01:05:07
    So 71% of the time in FY21, the first arriving cars unit on the scene met the performance benchmark for turnout and time.
  • 01:05:15
    Not bad, actually decent, but there's opportunities for improvement.
  • 01:05:21
    87% of the time in FY21, the first arriving cars met the performance for travel time, complimentary.
  • 01:05:29
    However, there's always opportunities for improvement.
  • 01:05:33
    So we look at now we're looking at the medical level, or should I say the trauma level, which is usually ALS type incidents, we're at a 10%
  • 01:05:43
    in terms of meeting the benchmark and 22% in terms of meeting the benchmark.
  • 01:05:48
    The system is designed in a way that the numbers for ALS versus BLS aren't necessarily clearly defined because the protocols vary and how the system was set up.
  • 01:06:00
    But essentially there's opportunities for improvement.
  • 01:06:02
    Now we look at the fire department's response, based on its geographic locations across the city, 96% of the time, CFD was meeting their performance for turnout and travel time.
  • 01:06:13
    98% of the time, for the first arriving unit, they met the benchmark for travel time, as you can see the greens there.
  • 01:06:23
    And this was, I should mention, that was at the ambulance level, which is the basic level response.
  • 01:06:29
    And then here we have a 58% metric that we're not doing well.
  • 01:06:35
    There's opportunities for improvement again here for CFD as well, 75% of the time.
  • 01:06:43
    And this is based on how the previous system was designed, meaning that we weren't doing proximity dispatch.
  • 01:06:49
    So that influences how our benchmarks ultimately will reflect.
  • 01:06:56
    So as we transition towards the end of the presentation, there are other community needs.
  • 01:07:01
    You know, we consider the Fire Department, the 21st Century Fire Department as what we call an all-hazards Fire Department.
  • 01:07:08
    So the future relies on partnerships.
  • 01:07:12
    So it is important, and I'm committed to that, in that
  • 01:07:17
    The fire and emergency services, we are in an inviolable position in the community, as we are well positioned to be the hub, and this is not my saying, I just made it, I just kind of put it out so we can all see, for many supporting agencies already found within the community.
  • 01:07:36
    Okay, so when we talk about 60 years of service, 165 years of service and how we've always done things, I'm here to transform our service delivery model and contribute to that transformation by working with partnerships, creating partnerships, partnerships with allied health, mental and behavioral health providers and social service agencies to leverage the talents.
  • 01:08:02
    of each agency to focus on improving services to the community.
  • 01:08:06
    It's too often that agencies respond multiple times to the same individual who calls 911 because that's all they know.
  • 01:08:14
    So as you have probably heard, some of you probably have heard that we have an initiative that our community of risk reduction has taken the lead on and has worked and continues, I was on a meeting today, continues to work with partners within this community.
  • 01:08:29
    So while we're focused on, oh,
  • 01:08:32
    911, 911, we need to really look, what does the future hold for this region?
  • 01:08:38
    We have a lot of initiatives that we're focused on, but the fire department can't do it all.
  • 01:08:43
    Mental health task force, sister cities arrangements, cultural change, collaboration,
  • 01:08:53
    trying to address our policy gaps, right?
  • 01:08:56
    Here's an opportunity.
  • 01:08:58
    What can we do with our mobile units that are available?
  • 01:09:02
    What should we be doing with our opioid task force?
  • 01:09:06
    What could we be doing to save a life from a traumatic injury?
  • 01:09:10
    CPD carries their tourniquets.
  • 01:09:12
    Should we be training individuals in the community to stop the bleed?
  • 01:09:17
    from gunshot wounds and other traumatic incidents.
  • 01:09:19
    Should we be training, continuing to train the community to do hands-only CPR?
  • 01:09:24
    These are all initiatives that we can be engaged in as a system, not just the fire department, but as a system, a comprehensive system, okay?
  • 01:09:37
    So the future, hopefully the audio will play.
• • SPEAKER_08
  • 01:09:42
    Can you hear the audio?
  • 01:09:42
    No.
  • 01:09:42
    No.
  • 01:09:43
    Standby.
  • 01:09:43
    Technical difficulties.
  • 01:09:44
    Let's see.
  • 01:09:44
    Just needs to be louder.
  • 01:09:45
    Got it, sir.
  • 01:09:46
    How about now?
• • SPEAKER_02
  • 01:10:00
    Dr. Aaron Yao and Dr. Justin Mutter tell me with our country's aging population, a significant number of people need to receive medical care at home now.
  • 01:10:09
    But many of these patients go unseen because there aren't enough resources or staff to meet the demands.
• • SPEAKER_17
  • 01:10:15
    Only about 15% of our frail and homebound patients have ever received medical care at home.
  • 01:10:22
    So the good majority, they're just sick and have lots of problems at home.
  • 01:10:27
    And a lot of our colleagues call them the invisible.
  • 01:10:30
    They're invisible to the society, to the healthcare system.
• • SPEAKER_02
  • 01:10:34
    Dr. Yao says home care is taking a backseat.
• • SPEAKER_17
  • 01:10:37
    Only about 0.7% of Medicare physicians or physicians in Medicare programs are providing routine home care nowadays.
• • SPEAKER_02
  • 01:10:50
    Yao says this is because at-home care is often more costly and time-consuming.
• • SPEAKER_17
  • 01:10:55
    It's really a hard life for a lot of these patients and
  • 01:11:00
    and their family members bear a lot of burden of carrying these people without any support from our health system.
• • SPEAKER_02
  • 01:11:07
    Dr. Justin Mutter says there needs to be a concerted effort at the state and federal level to incite real policy change.
• • SPEAKER_16
  • 01:11:15
    We need to think about how to innovate and change that status quo to deliver care in the home rather than in office-based settings for these populations.
  • 01:11:24
    We need our
  • 01:11:25
    various payers in the healthcare system and people in the policy world to really think about this population particularly.
  • 01:11:31
    This is a very high risk, high need population.
• • SPEAKER_02
  • 01:11:34
    To address the issue on a local level, he started UVA's Virginia at Home program to bring home medical care to central Virginia.
• • SPEAKER_16
  • 01:11:42
    We really see this need profoundly, not only in the city of Charlottesville, but in many of our surrounding counties.
  • 01:11:50
    And so we serve both
  • 01:11:52
    urban and rural populations.
• • SPEAKER_02
  • 01:11:54
    Dr. Mutter is optimistic the problem can be resolved beyond just Charlottesville.
• • SPEAKER_16
  • 01:11:58
    If we bring this person-centered care to individuals and caregivers in their homes, everybody wins.
  • 01:12:04
    You know, there's a lot of patient satisfaction that comes out of this.
• • SPEAKER_02
  • 01:12:08
    In Charlottesville, Riley Wyant, NBC 29 News.
• • SPEAKER_13
  • 01:12:13
    So is that the future of this EMS system?
  • 01:12:15
    We can work collaboratively to make this system work.
  • 01:12:21
    because ultimately we're here to provide a service.
  • 01:12:24
    We're here to provide resources for our residents of this community.
  • 01:12:32
    You've probably heard that we started with the COVID vaccination efforts.
  • 01:12:35
    We have partnered with UVA and we're out in the community already.
  • 01:12:41
    So there's opportunities for us to continue to build this model.
  • 01:12:46
    Cars is involved, social services is involved, a lot of folks are involved.
  • 01:12:51
    So let's shift our mindset and think about a people-centered approach to service delivery here in Charlottesville.
  • 01:13:00
    That is my commitment.
  • 01:13:02
    So there are opportunities to create partnerships, as I mentioned before.
  • 01:13:06
    And what's next?
  • 01:13:09
    What's next for us?
  • 01:13:11
    We need a new fire station.
  • 01:13:13
    Our health and safety of our members are very important and we want to see that hopefully come out of the ground soon.
  • 01:13:21
    Pulse Point is another initiative that will be rolling out soon that people will be notified if there's a cardiac arrest and if they're trained appropriately, they can respond.
  • 01:13:29
    We talked about Pro-QA, which is that 21st century 911 dispatch protocol that's being adopted and will be implemented prior to the end of the year, which will further solidify our response mechanism.
  • 01:13:41
    So no longer will an abdominal pain just be an abdominal pain.
  • 01:13:44
    There'll be categories of an abdominal pain.
  • 01:13:46
    And based on the criteria, the appropriate resources would be dispatched.
  • 01:13:50
    There's continued discussions regarding mutual aid.
  • 01:13:53
    Chief Eggleston and myself, we meet frequently in terms of how can we help each other.
  • 01:13:58
    We'll work closely with our UVA partners as well in terms of making sure that we have the appropriate resources readily available to support emergency services delivery.
  • 01:14:06
    CARS, CPD, NCFD, we're working on mental health initiatives within the community.
  • 01:14:12
    I already spoke about the frequent 911 users.
  • 01:14:16
    This is one thing we haven't even discussed.
  • 01:14:18
    Prevention of Hospital Readmission.
  • 01:14:20
    There's an opportunity there.
  • 01:14:22
    If we have volunteers
  • 01:14:24
    that are readily available and they're going to become doctors in the future and they're volunteering their time.
  • 01:14:32
    What better opportunity for us to really engage with individuals who've just been discharged from the hospital, follow up with them a couple of days later, a week later, make sure that their medications are being taken care of, they're taking their medications, check their vital signs and things of that sort, prevent them from calling 911.
  • 01:14:51
    Can you imagine?
  • 01:14:52
    That's something we call mobile integrated healthcare, okay?
  • 01:14:56
    So NFPA, I mentioned that earlier, is the national standard for fire departments.
  • 01:15:01
    And as an accredited department, we're committed to improving the EMS fire system through a collaborative approach with all stakeholders.
  • 01:15:09
    Our commitment is on maintaining our accreditation status and ensuring that all hazards preparedness meets the needs of our community.
  • 01:15:18
    We must transition to becoming a 21st century community with fire and free hospital medical service delivery that is consistent with the needs and expectations of our residents and visitors.
  • 01:15:34
    So with that, I'll be happy to
  • 01:15:39
    answer questions.
• • Nikuyah Walker
  • 01:15:43
    Thank you, Chief Smith, Deputy Chief Rogers and Dr. Lindbeck.
  • 01:15:50
    Counselors, do you have questions or comments at this time?
• • Lloyd Snook
  • 01:15:57
    One question that I had
  • 01:15:59
    How much of this, I mean, is there a reason why call handling times or turnout times would vary depending on the proximity dispatch or is that just an anomaly of how it happened those particular days?
• • SPEAKER_13
  • 01:16:14
    Yes, sir.
  • 01:16:14
    It's basically two different elements, if you may.
  • 01:16:18
    So call handling has a lot of uncontrolled variables, right?
  • 01:16:23
    So when a caller calls in, oftentimes they're very anxious, right?
  • 01:16:27
    and it's the dispatchers training and competence that requires them to navigate through that anxiety.
  • 01:16:34
    And oftentimes the questions that need to be answered sometimes don't get answered in a timely manner.
  • 01:16:40
    So ultimately they're going through and they're trying to ask the questions and calming the person down.
  • 01:16:45
    And oftentimes they may be even trying to give information about what should be happening while they're preparing to send a unit.
  • 01:16:53
    So there are a number of variables that
  • 01:16:55
    Sonny and his team have to deal with.
  • 01:16:58
    And then there's some elements there that in terms of the timestamps may not necessarily be 100%.
  • 01:17:03
    So with the implementation of the pro QA model that they're talking about, they will have a more algorithmic approach to triaging the calls.
  • 01:17:14
    And ultimately, once the answers get to a certain point, it triggers what they call a recommendation.
  • 01:17:20
    So those are variables that are really, we're not able to control it, especially the fire department side is not able to control it.
  • 01:17:26
    And also internally within the ECC, there's opportunities for them.
  • 01:17:30
    And there's certainly a challenge in trying to control those things.
• • Lloyd Snook
  • 01:17:33
    So would it be fair to say that one of the things that happens is that the triaging that has to be done when the call comes in may take a little bit longer, maybe a few more questions that have to get asked?
• • SPEAKER_13
  • 01:17:47
    Correct.
  • 01:17:48
    And as we move with the new model, some of the call taking or call handling time may get longer because let's say, for example, they call 911.
  • 01:17:56
    What's your address?
  • 01:17:57
    Is the person breathing?
  • 01:17:58
    If they say the person is not breathing, right then and there, I reckon they
  • 01:18:02
    hit the button and a recommendation comes up.
  • 01:18:05
    If the person's breathing normally, are they awake?
  • 01:18:07
    And those questions as the answers to those kind of dwindling, yes, he's breathing, yes, he's awake, yes, she's this, yes, she's that.
  • 01:18:14
    It can continue down this algorithm and they may get to a point where so the only problem the person has is their toe hurts.
  • 01:18:22
    So at that point, at that point, the recommendation then would be to send an ambulance.
  • 01:18:28
    Now, it may be appropriate to send a basic life support ambulance, certainly, in that situation, and that's how response plans are being built.
  • 01:18:36
    But again, proximity is also important because the reality is, and subtoe is probably not a great example.
  • 01:18:44
    I like to use the abdominal pain as an example because that can go either way depending on how long, the age of the patient, and so on and so forth.
  • 01:18:51
    They have different levels.
  • 01:18:53
    Alpha, Bravo, Charlie, Delta, Echo are basically levels within the new protocol that will give us some ideas on what is the most appropriate recommendation or unit to send to that caller's bedside.
• • Lloyd Snook
  • 01:19:09
    The other question that had come to my mind, looking at your maps and the four-minute response in particular, there's a large area that I think corresponded to like Barracks Road Shopping Center
  • 01:19:21
    and so on that is not in anybody's four minute response.
  • 01:19:25
    That's correct.
  • 01:19:26
    Is that something that is a significant problem that you ought to be doing something to address or that you ought to be asking us for money for something to some way to address?
• • SPEAKER_13
  • 01:19:36
    You will see some information about that and recommendations for an actual fire station site.
  • 01:19:44
    But importantly, we talk about priorities, certainly, right?
  • 01:19:47
    The schools and so on and so forth.
  • 01:19:48
    So we have to kind of look at that.
  • 01:19:50
    But what's also important is to analyze the risk associated with that particular area.
  • 01:19:54
    So that particular area, there's a high amount of renters in that area as well.
  • 01:19:58
    And potentially, certainly we're able to get there.
  • 01:20:01
    Now, we talk about that four-minute response time.
  • 01:20:03
    We're talking about critical incidents, right?
  • 01:20:05
    We're talking about strokes, heart attacks, and things of that sort.
  • 01:20:10
    So give or take a little bit, I don't want to say we have some flexibility there, but in terms of, okay, how do you prioritize what needs to happen there compared to what we need for
  • 01:20:20
    for bypass station or what we need for the Ridge Street Station, which is also needs to be addressed.
• • Lloyd Snook
  • 01:20:27
    I'll let somebody else ask a question.
  • 01:20:30
    I've got a couple of others, but I'll let somebody else get in the act.
• • Heather Hill
  • 01:20:34
    We're just giving some examples of just some cases where there is some thought around it's less about proximity and more about like if there's a clear thing like you used, I know, stubbed toe or whatever, but can you just help me understand like is this a kind of a hybrid way of thinking about this that there's more than like proximity is a consideration by recognizing that we have limited resources in terms of these advanced
  • 01:20:55
    that can go and respond to these things that are not BLS.
  • 01:20:58
    I'm just trying to understand like kind of how that comes to play when it's a clear decision making that we don't have an emergency situation here and it may be better suited from a BLS.
• • SPEAKER_13
  • 01:21:06
    So the idea of sending a less, should I say, a BLS response, it is appropriate at times to send a BLS response, but it will be up to you as a team, as the
  • 01:21:26
    Stakeholder, but really what does the community expect?
  • 01:21:29
    Do they expect, regardless of the complaint, do they expect to wait 10, 15 minutes for an ambulance if they call an ambulance?
  • 01:21:37
    Is it acceptable?
  • 01:21:39
    Is that what the system needs or is it appropriate to send the most appropriate unit based on their availability?
  • 01:21:48
    Because there's one thing for certain, we cannot predict when the next call is coming in and we could sit back and wait for the next call
  • 01:21:55
    But the idea really is what services do we need to provide to our citizens?
  • 01:22:02
    So I don't know if I answered your question, but essentially the priority dispatch will actually give us a better sense of what we can accept within the system.
  • 01:22:12
    But keep in mind we're on 10 square miles.
  • 01:22:14
    So ideally at a BLS level, basic life support level, you saw what eight minutes look like, right?
  • 01:22:22
    and eight minutes is travel time.
  • 01:22:24
    And not going emergency, ideally, you should be able to get to the different areas if the appropriate unit that's within proximity actually is dispatched.
• • SPEAKER_15
  • 01:22:40
    Thank you.
• • SPEAKER_13
  • 01:22:41
    You're welcome, ma'am.
• • Nikuyah Walker
  • 01:22:43
    Any other?
  • 01:22:48
    Well, thank you.
  • 01:22:52
    Go ahead.
• • SPEAKER_06
  • 01:22:53
    Thank you.
  • 01:22:56
    How does UVA fit into this?
  • 01:23:00
    Into, I mean, I know UVA takes up pretty much left of barracks there and I'm just trying to figure out how,
  • 01:23:15
    UVA fits into the ambulance calls.
  • 01:23:19
    I understand that they rely on us for a lot of the fire department fire engine calls, correct?
• • SPEAKER_13
  • 01:23:30
    And EMS as well, ma'am.
• • SPEAKER_06
  • 01:23:33
    Okay.
  • 01:23:34
    So is that part of that contract that we have or?
• • SPEAKER_13
  • 01:23:39
    Yes, ma'am.
  • 01:23:40
    So we are committed to all hazards response.
  • 01:23:44
    So from a medical perspective to special operations to fires, fire alarms, and so on and so forth.
  • 01:23:51
    But one thing is important to remind you, prior to my arrival, we had what we call area-based focus.
  • 01:24:02
    So what that meant was the UVA medical call for an abdominal pain often may get an ambulance coming further away as they drive right by
  • 01:24:13
    Fontaine Fire Station, and Chief Rogers probably can speak to that a little bit in terms of our arrangement with UVA, but we provide equitable services regardless of the neighborhood.
• • SPEAKER_14
  • 01:24:26
    Yeah, historically, the UVA contract, when it was last penned, so to speak, just mainly dealt with the fire services aspects, like you were saying, because at the time the contract was written, that was all that the city of Charlottesville was really providing to the campus.
  • 01:24:42
    Predominantly, all of the EMS, the 911 EMS came from the volunteer agency from CARS onto campus.
  • 01:24:48
    The contract was slated to be renewed in 2021 due to COVID, some changeover.
  • 01:24:54
    at UVA and some changeover in the city.
  • 01:24:56
    The decision was made in consult with the city attorney's office to push that to 2023 for a two-year extension.
  • 01:25:03
    We were hoping for a one, but UVA wished for a two.
  • 01:25:07
    So it's 2023.
  • 01:25:08
    But even back to when Chief Baxter was still with the department and subsequently now that Chief Smith's on board, that is part of the equation going into that new contract period with the document, adding in that EMS layer that wasn't historically there before.
  • 01:25:23
    So it's on the table.
  • 01:25:25
    But the contract's more purely fire-based right now.
• • SPEAKER_10
  • 01:25:30
    The only thing I would add, this George Lindbeck here, is that the health system does have a medical transport network that meets transport needs for the contiguous areas of the medical center.
  • 01:25:43
    So that's primary transports between different buildings of the medical center, the long-term acute care hospital out on Northridge,
  • 01:25:54
    Fontaine, for example, but it's not designed to meet calls on, for example, the grounds, the academic side, visitors to campus and things like that.
  • 01:26:06
    The Department of Emergency Medicine has a special events medical management service that meets a lot of the university's needs for medical standby for university events, sporting games, concerts, graduation would be an example.
  • 01:26:24
    and they meet most of those needs.
• • SPEAKER_06
  • 01:26:28
    So the university is in Albemarle County and Albemarle County since 2016 or so has been doing this distance proximity dispatching.
  • 01:26:47
    How has that been kind of getting
  • 01:26:51
    confused with our own.
  • 01:26:52
    I mean, I know it's weird because it's kind of like it's a donut with a donut hole in the middle of it.
  • 01:27:01
    How has that been affecting responses
• • SPEAKER_14
  • 01:27:05
    The county doesn't respond primarily under the fire services contract with the university.
  • 01:27:10
    That's an agreement with the city.
  • 01:27:12
    So that boundary area is actually, even though, like you say, a majority of it is county parcel or county land, it's identified in the dispatch system or the CAD system as a city response.
  • 01:27:24
    So there's UH is the type of that area when chief spoke to the area-based response.
  • 01:27:29
    Now it's basically which city units in closest proximity to that university location.
  • 01:27:34
    But prior to that, the different university parcels, whether it was off of Ivy Road, whether it was near the medical center, whether it was on central grounds were parsed out by the station that was most closest to that location.
  • 01:27:47
    So the county, like Dr. Lindbeck was saying, they have response to some UVA properties like at North Fork off of 29 North, somewhat down to Fontaine on different kinds and types of responses, but central grounds primary is all city fire department response.
• • SPEAKER_06
  • 01:28:05
    So our 10 square miles that we're responding to is 10 square miles plus that donut hole that's not being counted in the 10 square miles.
• • SPEAKER_15
  • 01:28:15
    Yes.
• • SPEAKER_06
  • 01:28:16
    Okay, again, just trying to make sure I'm clarifying all some of these eccentricities of Charlottesville.
• • SPEAKER_14
  • 01:28:21
    Yeah, and the student population and some of the funding formulas we get from the state and some other things, a lot of times the student population is not counted on top of that city population number so that we do garner that extra amount of populace that's in that bubble, like you say, that we don't a lot of times get credit for.
  • 01:28:41
    if we're just looking at the 40, between 40, 50 city that may be upwards of 20 plus UVA students aren't always factored into that number.
• • SPEAKER_06
  • 01:28:55
    Any other questions?
  • 01:28:58
    I apologize, Chief Smith.
  • 01:29:00
    I just, I just, this was being answered and I don't think my brain was quite ready to receive the full information on it, but when there are events
  • 01:29:10
    at the ball fields, at the football stadium.
  • 01:29:14
    That is our EMS that has to be responding and on ready for that, correct?
• • SPEAKER_14
  • 01:29:23
    It depends on where, like at the Scott Stadium event, the special event medical management group that Dr. Lindbeck spoke of, they basically handle the immediate vicinity of the Scott Stadium property, interior of Scott Stadium with their crews.
  • 01:29:39
    The personnel that we have on scene from a fire department standpoint are mainly there from a fire service perspective for outside fires, car issues, tailgating issues.
  • 01:29:51
    responses in that immediate bubble that our outside units may have trouble with the traffic and density getting to on a normal basis.
  • 01:29:59
    So we're kind of there primarily for fire standby, secondarily to help UVA, but any 911 calls that come in to the area surrounding that stadium during a football game or whatever the case may be, the 911 services would still predominantly handle.
  • 01:30:15
    The on-site units there through that special event medical management are there pretty much for the venue for the event.
• • Heather Hill
  • 01:30:24
    Just like a regular emergency situation on grounds anywhere, not related to an event.
  • 01:30:29
    Who goes to that?
  • 01:30:30
    I'm sorry, I'm still confused.
• • 01:30:32
    911.
• • SPEAKER_14
  • 01:30:32
    Yeah, anyone.
  • 01:30:33
    Yeah, if they dial 42012, which is an internal UVA number, that'll go to 911.
  • 01:30:38
    or 911 that's gonna get a 911 based response from either cars or the Charlottesville Fire Department.
  • 01:30:44
    In some cases, if all the units are tied up, it may be Albemarle County.
  • 01:30:47
    In rare instances, there had been some lack of better word handshake agreements with some of the medical transport crews over the years at UVA to where they may pick up a third or fourth or subsequent multi-patient call that may be just on the periphery of grounds like Dr. Limbeck spoke of on the academic side.
  • 01:31:07
    somewhere.
  • 01:31:08
    But routinely, they're not a 911 response agency.
  • 01:31:11
    So most of their ground transport units are doing inter-facility.
  • 01:31:15
    And then like Dr. Lindbeck mentioned, the event management are doing graduation, football, soccer, track meets, things like that inherent to the university.
  • 01:31:24
    And then Pegasus, of course, their response wing, and they've got neonatal response that goes inter-facility.
  • 01:31:30
    So it's really not a 911-based system.
• • SPEAKER_10
  • 01:31:34
    I'm sorry.
  • 01:31:37
    I was going to say, if you go to a concert at JPJ and you see some EMS responders in those fluorescent shirts inside JPJ, or you're at the football stadium and you see them on television or in person, that's UVA special events medical management inside the venue that are providing EMS support there.
  • 01:31:56
    Does that make sense?
• • SPEAKER_06
  • 01:31:59
    Yes, but what about like a student at Lambeth Hall calling up with chest paints?
• • SPEAKER_10
  • 01:32:05
    That'll be city fire.
  • 01:32:07
    through the 911 system.
  • 01:32:07
    All right.
• • Nikuyah Walker
  • 01:32:17
    Well, mainly I just have comments.
  • 01:32:22
    I do have a question about staff hours.
  • 01:32:25
    I'll just start there.
  • 01:32:26
    Has the new staff that you've been able to hire
  • 01:32:31
    Have they helped alleviate the number of hours that staff is working?
  • 01:32:35
    Because you still mentioned what seems like just a heavy work balance.
  • 01:32:43
    And at what point do you feel like that'll get better?
  • 01:32:47
    And what are your needs there?
• • SPEAKER_13
  • 01:32:49
    Currently, we're in the process of doing a staffing analysis.
  • 01:32:52
    But to answer your question directly, the 22, which seven of those are based on attrition,
  • 01:33:00
    It has reduced the total overall number of hours for overtime.
  • 01:33:06
    However, what we're seeing now is that individuals with specialties, i.e.
  • 01:33:12
    paramedics,
  • 01:33:13
    are overworked in terms of those hours.
  • 01:33:17
    And the specialties that include the drivers and the tillers on the trucks, there also is a need for us to have more of those as well.
  • 01:33:26
    So that's an internal situation, but the paramedic thing is a retention and recruitment issue that I think is a, I know is a priority for us to address as it relates to pay
  • 01:33:38
    and benefits and so on and so forth.
  • 01:33:40
    So I've framed out some of the asks that we need to really look at as a team because it's important for us to address the mental health needs of our providers.
  • 01:33:53
    And, you know, they are working hard.
  • 01:33:55
    They're working very hard and they're committed.
  • 01:33:58
    But we have seen some transition that has occurred.
  • 01:34:01
    certainly prior to my arrival and also during my arrival.
  • 01:34:05
    So I'm interested in having that dialogue.
  • 01:34:08
    And thank you, Chip, for your documents that you completed today.
  • 01:34:13
    But we need to hire more paramedics.
  • 01:34:17
    And we need to look at how they're compensated ultimately.
  • 01:34:20
    And I realize that we're part of the pie, if you may.
  • 01:34:24
    But ultimately, our first responders
  • 01:34:27
    there has to be some priority in terms of our salaries and our benefits and what we do to show them that we're committed to their long-term retention here in the city of Charlottesville.
• • Nikuyah Walker
  • 01:34:45
    And my second question was just the bypass station.
  • 01:34:50
    Are we simply talking about that we would like a new building and conditions
  • 01:34:56
    or are conditions of the building leading to potential health implications of the firefighters?
• • SPEAKER_13
  • 01:35:02
    So I would say that there's, and we have yet to realize it, but, you know, there's cancer initiatives out there that are concerning for me as a leader in the organization.
  • 01:35:14
    And without getting into personal things there, you know, there are risks, there are real health risks there, in my opinion.
  • 01:35:22
    I'm certainly public,
  • 01:35:26
    Public Works and the team there have worked cooperatively to examine the building and ensure that the air quality and things of that sort are in place.
  • 01:35:35
    But the lived experiences of our firefighters, it's concerning to me.
  • 01:35:41
    It's quite concerning.
  • 01:35:42
    I don't know how many of you walked through that building, but I know Chip has walked through it personally and Sam walked through it recently with me as well.
  • 01:35:52
    I'm very concerned.
  • 01:35:53
    I'm very concerned that it's taken this long, and I realize that we're part of the pie and there are priorities, but I think your firefighters should be right there in terms of number one and number two in terms of priority, in terms of making sure that they're able to be in a safe environment where they live and spend probably a third of their lives away from their families and newborns.
• • Nikuyah Walker
  • 01:36:22
    And my only other comments, I mean, I really, I think we received an update maybe a little over a year ago from Chief Powers and I was the needs assessments and then neighborhood feedback.
  • 01:36:40
    I think it's just, you know, really good information to highlight like the health needs in the communities.
  • 01:36:46
    And I'm sure that some of the other communities in the areas
  • 01:36:49
    because the demographics of their neighborhoods are changing because of gentrification that those numbers are better than they would have looked previously.
  • 01:36:59
    But I think for a neighborhood like the 10th and Page neighborhood that was highlighted,
  • 01:37:07
    which is one of the, you know, African American communities in the town and the understanding of heart issues, cardiovascular issues and wanting to make sure that the response because of the detrimental effect that those diseases are having in their body anyway, I think that
  • 01:37:31
    us starting to highlight that and then the collaborations that you talked about, that they are going to be, you know, critical, you know, for health needs.
  • 01:37:42
    And I do really like the fact that the city, anyone who's interested can go on there and see the
  • 01:37:51
    you know what those needs are and what the primary calls coming in you know are and hopefully as a city we can start tying that in being forward thinking to how do we start eliminating those being the major health needs so every time I've seen that that's been my thought so that we give fewer 911 calls and fewer needs for medics because people are in healthier spaces and that's going to take
  • 01:38:22
    You know, a much broader, you know, commitment from all parties involved.
  • 01:38:28
    So, including the type of care that's received once they arrive at the hospital.
  • 01:38:33
    And I think you touched on a big piece that I've been interested in for a long time, but the follow-up care that people receive.
  • 01:38:42
    And, you
  • 01:38:45
    and the primary care that people often don't receive that results in those calls.
  • 01:38:49
    So thank you for spending time on that.
  • 01:38:53
    And I know there's a lot of talk about just diversity for diversity sake and hire the best person and what does that look like?
  • 01:39:03
    And everybody based on who you're talking to have their own ideas of who, why departments look as they do today.
  • 01:39:12
    But
  • 01:39:14
    to make the commitment, not just in race, but in gender and to be moving the department in that direction, but also be very cognizant of the diversity and thought
  • 01:39:31
    and what that looks like is just a I think it's huge and it'll be huge in the future for, you know, the community, you know, overall.
  • 01:39:42
    So when you talk about hiring additional
  • 01:39:50
    You know, Black firefighters, women, as a woman, everyone knows the kind of care women give to people just naturally.
  • 01:40:01
    And to know that the response that people will be getting, that they'll be helping to influence that.
  • 01:40:07
    And when you talk about neighborhoods and underserved neighborhoods and that people will see firefighters,
  • 01:40:14
    who are Black and from the community.
  • 01:40:17
    I think that's just a plus, and I hope everybody sees how that just serves us well and gets us closer to what the goals of those 21st century models have highlighted.
  • 01:40:27
    So thanks just for highlighting that too.
• • SPEAKER_13
  • 01:40:31
    Thank you.
• • Nikuyah Walker
  • 01:40:33
    If there are any other questions, we do have to make time for public comment, and then we have a closed session.
  • 01:40:42
    Are there any comments before I turn it over to Mr. Wheeler?
  • 01:40:44
    All right.
  • 01:40:49
    Mr. Wheeler, turn it over to you for public comment.
• • SPEAKER_09
  • 01:40:53
    Thank you, Mayor Walker.
  • 01:40:55
    At this time, if you'd like to get in line to address counsel, please click the raise hand icon in the Zoom webinar.
  • 01:41:02
    Each person will have up to three minutes to make their remarks.
  • 01:41:06
    We have eight people in the audience right now, at least two hands up.
  • 01:41:12
    and our first speaker is Forrest Calland.
  • 01:41:15
    Forrest, you're on with counsel.
  • 01:41:16
    You've got three minutes.
  • 01:41:17
    Thank you.
  • 01:41:17
    Would it be possible to share my screen?
  • 01:41:19
    No.
• • SPEAKER_07
  • 01:41:19
    Okay.
  • 01:41:21
    This is Forrest Calland.
  • 01:41:22
    I'm a trauma surgeon at the University of Virginia.
  • 01:41:24
    I'm the former state chair for the Commonwealth of Virginia Trauma Performance Improvement Committee looking at all outcomes across the Commonwealth of Virginia.
  • 01:41:36
    I am a tenured faculty member here and have published more than 50 peer reviewed scientific publications.
  • 01:41:44
    I just want to give you some of my credentials so you know I'm qualified to ask questions about this.
  • 01:41:48
    I have a few questions for Chief Smith.
  • 01:41:50
    First of all, if you acknowledge that five different studies have shown that
  • 01:41:57
    penetrating trauma outcomes are better from lay providers and BLS providers than from ALS providers.
  • 01:42:02
    Why does your protocol specifically neglect closer BLS units and choose ALS units instead?
• • Nikuyah Walker
  • 01:42:13
    If you want to ask all of your questions, then he'll
• • SPEAKER_07
  • 01:42:19
    Okay, great.
  • 01:42:20
    The other question I have is that with regard to abdominal pain, we don't have to actually hypothesize whether or not patients would benefit from additional care.
  • 01:42:28
    This was actually studied by Tiffany Abramson and published in the Western Journal of EMS in 2019, which actually systematically examined whether or not patients with abdominal pain benefited from ALS versus BLS and found absolutely no benefit.
  • 01:42:44
    from ALS care.
  • 01:42:45
    So I was wondering if you could explain why your feeling is that patients with abdominal pain in Charlottesville would benefit from this when the scientific literature demonstrates no benefit.
  • 01:42:57
    Third, I wonder if you'd comment on the fact that it seems from my reading that every major city in the United States has moved away from two paramedic responses to actually having paramedic single responses in chase cars, acknowledging that paramedics are hard to hire and don't demonstrate any benefit in outcomes for more than 90% of calls.
  • 01:43:18
    Why are we moving back towards two EMS systems when the majority of large cities are moving away from that?
  • 01:43:25
    My next question is, why would we build a new water unit, water rescue response unit when CARS has had a fully functioning water response unit for more than 50 years?
  • 01:43:35
    Third, I mean, next, is it true that we only have eight paramedics left in the city working for the Charlottesville Fire Department and that they're working unsafe shifts over time in order to staff the three medic units?
  • 01:43:47
    Is that safe?
  • 01:43:50
    Finally, isn't it fair to say that cars met every single safety standard that was ever put forth by Chief Baxter, the City Council and all the committees, and that the four minute response time you specified was for the engine company to arrive.
  • 01:44:04
    I think it's been a little bit misleading that you have said that cars was not meeting its responses.
  • 01:44:10
    And then finally, you said that we need paramedics.
  • 01:44:13
    I think I've already spoken to this, that there's just simply absolutely no evidence pointing to the benefit of having response times under four minutes for BLS calls.
  • 01:44:22
    And there's absolutely no evidence that sending paramedics to BLS calls is of any benefit.
  • 01:44:27
    Your system is going to cost $2.5 million additional per year once your grant runs out.
  • 01:44:34
    Is the city council prepared to take this money out of the taxpayers pockets when cars was providing this service for free for the last 50 years?
• • Nikuyah Walker
  • 01:44:44
    Thank you.
  • 01:44:44
    You want to take all the comments and then we'll get to the responses.
• • SPEAKER_09
  • 01:44:52
    Yep.
  • 01:44:52
    Our next speaker is Sean Tevendale.
  • 01:44:54
    Sean, you're on with council.
  • 01:44:55
    You've got three minutes.
  • 01:45:03
    How about now?
  • 01:45:05
    Sean, try again.
• • SPEAKER_12
  • 01:45:05
    There we go.
  • 01:45:08
    I think you can hear me now.
  • 01:45:09
    My name is Sean Tevendale.
  • 01:45:11
    I am the vice president of the Charlottesville Al Mar Rescue Squad board of directors.
  • 01:45:16
    I want to thank everybody for the time that you're putting into this very serious topic for all of us.
  • 01:45:21
    I think that it is notable that the letter we sent to city council as well as to the city manager and to the fire chief requesting the formation of a
  • 01:45:33
    group to examine the city fire and EMS response be looked at very carefully in this light.
  • 01:45:39
    Right now, there's a lot of opinions being brought to the table.
  • 01:45:41
    There's a lot of science and a lot of hard numbers.
  • 01:45:44
    I commend Chief Smith for the hard work that he is doing and trying to increase inclusivity and to increase the ability to respond adequately into our community.
  • 01:45:55
    I think that it is prudent and
  • 01:45:57
    and absolutely crucial that we bring cars to the table with Chief Smith and allow all of us to examine this as a team.
  • 01:46:07
    We have made multiple requests to meet with Chief Smith and have not been able to do such.
  • 01:46:12
    At this time, I see a lot of planning that appears to be occurring on his part with ideas of how cars will be utilized in the future.
  • 01:46:20
    and a large portion of it has not been disclosed to us up until this planning session discussion meeting that you guys are holding right now.
  • 01:46:29
    In this, I think it is very crucial that the city councilors together decide that we need to get everybody to the table and form a board to look at this from a community and an EMS response perspective.
  • 01:46:41
    Thank you.
• • SPEAKER_09
  • 01:46:47
    Thank you.
  • 01:46:49
    Mayor Walker, I don't see any other hands.
• • Nikuyah Walker
  • 01:46:50
    All right.
  • 01:46:52
    Thank you.
  • 01:46:53
    Chief Smith.
• • SPEAKER_13
  • 01:46:57
    All right.
  • 01:46:58
    The first speaker had quite a bit of questions and I'll do my best to address them.
  • 01:47:05
    Certainly, I just want to reiterate today's focus is on providing an update and a vision for the future and not debating historical practices versus 21st century concepts.
  • 01:47:18
    There was some discussion about, there was a question regarding traumatic penetrating injuries.
  • 01:47:26
    We're guided by the principles that has been established by the state medical director whose license we practice under.
  • 01:47:36
    Dr. Lindbeck, he had to take off here.
  • 01:47:40
    The recommendation is to provide the most appropriate service delivery model, i.e.
  • 01:47:45
    capabilities.
  • 01:47:47
    Nowhere in my discussion did I mention that I have to have two medics on an ambulance.
  • 01:47:54
    There was a reference regarding
  • 01:47:57
    the number of paramedics.
  • 01:47:58
    We also have advanced practitioners.
  • 01:48:00
    We also have intermediate providers as well as paramedics.
  • 01:48:05
    I do agree that we have a need.
  • 01:48:06
    We have a deficit as I've communicated earlier.
  • 01:48:09
    However, I am not proposing that we continue to staff our ambulances with two paramedics.
  • 01:48:16
    That is not a model that I implemented in the city of Orlando.
  • 01:48:20
    Nor is it a model I expect to implement here.
  • 01:48:23
    However, what I do plan to implement is the most appropriate level of care for our citizens and our responders.
  • 01:48:30
    You mentioned there's a lot of debate on abdominal pain.
  • 01:48:33
    There is a reason why the pro-QA, the folks that established EMD, emergency medical dispatch protocols that are adopted by accredited agencies, have about seven levels of responses for abdominal pain.
  • 01:48:49
    hence the one model that we have here that we've used over 20 years that only sends one ambulance at a basic level to abdominal pains.
  • 01:48:59
    It's probably time to re-examine that because the system is moving to an adopted model that is adopted by a lot of systems across the United States.
  • 01:49:08
    You mentioned chase cars.
  • 01:49:12
    I'm not going to debate that.
  • 01:49:13
    I travel the country, I do research, and I probably can't tell you how many places have chased cars.
  • 01:49:19
    There's nothing wrong with that model.
  • 01:49:21
    However,
  • 01:49:23
    My objective here is to ensure that we focus on providing the most appropriate level of care to our patients that call.
  • 01:49:33
    You mentioned something about water rescue units and having available resources.
  • 01:49:39
    Why should we implement it?
  • 01:49:41
    I'll allow Chief Rogers to speak to why we've made a decision to ensure that we have an up-to-date equipment and staff readily available to deploy resources in times of emergencies on the water.
• • SPEAKER_14
  • 01:49:55
    Yeah, more recently, in the more recent years or time, Almar County Fire and Rescue has brought on a water rescue capability at their Monticello station on the outskirts of the city.
  • 01:50:06
    Some, probably a handful of years ago as well, cars did approach us at that time.
  • 01:50:12
    about whether we wanted to or not getting to the water rescue business and Chief Baxter at the time didn't have it as one of his priorities.
  • 01:50:20
    We had in turn and since kind of worked with ACFR on some other initiatives as far as technical rescue goes and water was kind of the next facet of that so that we're able to co- or cross-respond across the agencies.
  • 01:50:34
    It's not eliminating cars from the equation.
  • 01:50:37
    They would be kind of that third
  • 01:50:38
    Grant, Juandia, Wes Bellamy, Ph.D.
  • 01:50:39
    : Entity that would be able to respond in those kinds and types of emergencies.
  • 01:50:42
    Fortunately, they're not super frequent in the city, but at times when they do pop up, there is a redundant need for resources in the whether it's on the river or a flood situation at the origination of the call point downstream any other kind of areas that may need to be identified or searched out the plans.
  • 01:51:03
    Broadly in the community have pulled resources as far away as Lake Monticello and Western Albemarle into the city on general water responses.
  • 01:51:12
    And it wasn't very timely in that sense.
  • 01:51:15
    So to add a redundant layer in locally made sense and Chief Smith wanted to pursue that initiative once he came online.
• • SPEAKER_13
  • 01:51:24
    And when we talk about having personnel
  • 01:51:28
    on duty 24 hours a day readily available and trained to deploy immediately at the time of a 911 call versus waiting to see if a unit is available or somebody is able to drive a unit also led me to that recommendation and that decision.
  • 01:51:45
    Additionally, I'm not going to get into the legal aspects of
  • 01:51:49
    of the second person's question, but the reality is there's a reference about 2.5 million.
  • 01:51:55
    We all agree that the SAFER grant has been put in place to provide firefighters to ensure that we have adequate staffing.
  • 01:52:03
    And that is the purpose of a SAFER grant, ultimately.
  • 01:52:07
    But at the end of the day, when we talk about high risk, low frequency,
  • 01:52:12
    I would not be satisfied having insufficient firefighters on the fire ground and potentially risking losing a firefighter.
  • 01:52:20
    So ultimately, the staffing limits have to be addressed, the gaps have to be addressed, and we sought the opportunity to identify a grant and get that support.
  • 01:52:30
    Ultimately, we talk about what does the future hold?
  • 01:52:35
    We talk about this has not been discussed with me.
  • 01:52:38
    Well, I don't think I've met you before, sir.
  • 01:52:40
    And part of me, I don't think you've I never had the opportunity to come to a board meeting as Chief Baxter did.
  • 01:52:47
    But again, I am happy to meet with you when it's appropriate, because legal has been engaged based on my initial conversation in February, I think it was
  • 01:52:58
    where communication started in a way that didn't seem to be productive.
  • 01:53:04
    And I'm not gonna get into those details, but the idea is that I'm willing to work with everybody.
  • 01:53:09
    And as you can see, counselors, I've shared my thoughts.
  • 01:53:14
    Yes, he's correct.
  • 01:53:15
    I haven't shared my vision.
  • 01:53:17
    My ideas as a 21st Fire Service leader, EMS leader in the industry known across the United States.
  • 01:53:25
    But the idea is to have a conversation because what we have done for the last 60 years or what we've done for the last 165, if we continue to do that, I don't think we will move forward in meeting the needs of this community.
• • Nikuyah Walker
  • 01:53:37
    All right.
  • 01:53:41
    Thank you.
  • 01:53:42
    And thank you all.
  • 01:53:43
    Are there any other questions or comments from counselors?
  • 01:53:46
    We have to go into closed session about 20 minutes behind now.
• • Heather Hill
  • 01:53:53
    It was my general understanding that there was going to be a convening of both parties over the course of the next several months to come to the table and just be able to have a dialogue.
  • 01:54:02
    So I certainly am optimistic about the opportunity and certainly would support that.
• • Lloyd Snook
  • 01:54:09
    I would as well, I would further note that when two people who know far more about this than I do, both Chief Smith and Dr. Lindbergh
  • 01:54:24
    Well, okay, three other people.
  • 01:54:27
    When people start talking about various medical studies and so on, the last people that I would want to have make the decision would be a bunch of city councilors.
  • 01:54:39
    I really think that this is something that deserves a lot more study and a lot more opportunity for Chief Smith to be able to have a dialogue with those other people
  • 01:54:53
    rather than just to have sort of statements going past one another as we get in a meeting like this.
  • 01:54:58
    Not to fault Chief Smith, not to fault the others, just reality is this is not a particularly good format for having that kind of discussion, but it is an important discussion and I hope that it will be had.
• • Nikuyah Walker
  • 01:55:09
    So I'll just chime in again from my understanding and after meeting with CARS and talking to Chief Smith and talking to
  • 01:55:20
    Chip and understanding that future meetings were put on hold based on the recommendation by legal.
  • 01:55:27
    I think part of the energy that we've been receiving with cars thinking that the meeting has not taken place because of Chief Smith, I think that'll help eliminate some of the negativity I think that's been associated because I
  • 01:55:43
    have commented on the letters that have received.
  • 01:55:46
    And if I were a professional, I would have some problems with receiving a letter that questioned my expertise in that way.
  • 01:55:53
    I hope that moving forward, we are able, as I've stated before, focus on the needs of the community members.
  • 01:56:03
    And I hope based on the needs assessment that I highlighted that I think is a great tool
  • 01:56:10
    that Deputy Chief Powers and other team members have been working on, that that shows us who in this community is most affected and afflicted by medical issues and may need 911 services, and that people who may not be in and of those communities just base decisions on what those community needs and not
  • 01:56:34
    again on what may have they may feel have worked in the past.
  • 01:56:42
    And I think my last thought is just a coming together where people are open minded about moving forward and what that looks like versus
  • 01:56:54
    are coming together where demands are placed on leadership or ask from intervention from council members.
  • 01:57:03
    I think that is the wrong type of intervention.
  • 01:57:07
    And we've just seen how those type of interventions play out in the police department.
  • 01:57:13
    So hopefully we do not allow that to happen again.
• • Lloyd Snook
  • 01:57:17
    Mayor Walker, I'm curious about the statement that somehow lawyers prohibited
  • 01:57:23
    them from meeting.
  • 01:57:25
    What's the story there?
  • 01:57:26
    I don't understand.
• • Nikuyah Walker
  • 01:57:27
    Steph, do you want to answer?
• • SPEAKER_11
  • 01:57:29
    Yes, I can, Mayor.
  • 01:57:30
    Thank you.
  • 01:57:32
    Initially, some of the discussions started to co-mingle the MOU that the city has with cars, and we were mixing up the operational services with the funding agreements and funding parameters.
  • 01:57:48
    What we're, just as you said, Mayor, what we're most interested in is what is the best service for the citizens.
  • 01:57:56
    That's what I think we need to move forward with now.
  • 01:57:59
    We'll then discuss separately the MOU and the funding of those services based on whether it's to cars or to the city.
  • 01:58:11
    That was the initial reason of why we didn't meet is because both of those were overlapped over each other and they needed to be separated.
• • Lloyd Snook
  • 01:58:25
    So presumably there is no legal bar to having the kind of discussion that Councillor Hill mentioned.
  • 01:58:32
    No, sir.
  • 01:58:34
    Good.
  • 01:58:34
    Okay.
  • 01:58:36
    Thank you.
• • Nikuyah Walker
  • 01:58:39
    So I didn't state that there was a legal bar.
  • 01:58:41
    I'm stating that Ms.
  • 01:58:43
    Robertson recommended that the meeting not occur and that until I wasn't a part of that conversation.
  • 01:58:52
    So someone else would have to answer that.
  • 01:58:55
    But after, oh, Lisa, do you want to?
• • Lisa Robertson
  • 01:58:59
    Yeah, so I have had a couple of different meetings where I've discussed directly with
  • 01:59:07
    an attorney that's assisting cars.
  • 01:59:11
    And our discussions are focusing, as Mr. Boyle said, on whatever documentation will ultimately be needed to update what cars in the city agree to operationally and financially.
  • 01:59:28
    As Mr. Boyle said, there's been a lot of discussion about the contents of the different MOUs and whether or not
  • 01:59:37
    the city and cars budgeting practices are compliant.
  • 01:59:42
    And over the last few months, I have done my best to be supportive of Chief Smith.
  • 01:59:50
    But on occasion, it's been unclear to Chief Smith, I think, whether or not the matters that he wished to discuss needed to include a legal component.
  • 02:00:06
    But we
  • 02:00:07
    Mr. Boyles and I continue to encourage both CARS and the Charlottesville Fire Department to sit down together and work all of this out and just today I've exchanged a communication with CARS attorney and we both want to stand down until the parties have worked these things out among themselves and then he and I will assist everyone recommendations as to what paperwork should go with documenting
  • 02:00:37
    what's worked out between the parties.
  • 02:00:44
    But it has never been anyone's intention on either the city side of things or car side of things to say that the two parties shouldn't sit down together and work through these issues without necessarily having lawyers in the room.
• • Nikuyah Walker
  • 02:01:05
    Okay, I think that's helpful because when I followed up after my meeting with CARS, with Chief Smith and Chip, I think there was at that point, from my understanding, there was a recommendation since CARS had attorneys involved to not meet.
  • 02:01:22
    And maybe that two issues were conflating, but that's the conversation.
  • 02:01:27
    Because I was interested based on the fact that I have in it.
• • Lisa Robertson
  • 02:01:31
    So am I
  • 02:01:33
    I think the two issues were definitely conflating and they need to be separate.
  • 02:01:39
    The financial relates to the other, but they're two separate issues.
  • 02:01:46
    But in both issues, both the city manager and the fire chief will have to sit down with cars and work through both sets of issues, both the budgetary issues as well as the operational issues.
  • 02:01:59
    And it's absolutely not
  • 02:02:03
    ever been my intention to tell anyone that you can't sit down and talk to each other because of legal issues.
  • 02:02:09
    These are almost purely sort of operational and financial issues.
  • 02:02:13
    And I will help Chief Smith and continue to help both Chief Smith and the city manager prepare whatever documentation at the end of all this will best serve the city's interests.
  • 02:02:28
    But we're not there yet because we haven't
  • 02:02:31
    worked through the discussion of all the issues.
• • SPEAKER_13
  • 02:02:35
    Thank you.
  • 02:02:36
    And if I may add, I appreciate that clarity being provided there for all.
  • 02:02:42
    But importantly, Chapter 12 of Municipal Code speaks to the fire department and its responsibility as it relates to emergency incidents within the city.
  • 02:02:52
    So as a sworn fire chief here, it is my responsibility, my commitment to engage in dialogue
  • 02:02:58
    that is productive but that focuses on operational effectiveness and efficiency ultimately and be guided by those processes that are accepted practices across the United States and certainly through a lot of accredited agencies that provide similar oil hazard services to communities that may be smaller or larger
  • 02:03:19
    than what we have currently today.
  • 02:03:21
    So again, it's important to note that the county and city fire leadership were in complete alignment regarding the direction of EMS service delivery and the model in this area.
  • 02:03:32
    Again, I meet with Chief Eggleston very frequently
  • 02:03:35
    and we continue to engage in 21st century fire service delivery concepts.
  • 02:03:40
    We're in complete alignment.
  • 02:03:42
    So we're hopeful that we'll have collaboration, cooperation, and effectively be able to move forward with meeting the needs of our community, which is our ultimate goal.
• • Nikuyah Walker
  • 02:03:50
    All right.
  • 02:03:54
    Thank you.
  • 02:03:54
    And thank everyone for the information that you've shared today.
  • 02:04:01
    And we have to go into a closed session that's now
  • 02:04:06
    will be 30 minutes long, so thank you all.
  • 02:04:10
    Councilor Hill, would you like to read us into closed session?
• • Heather Hill
  • 02:04:15
    Yes, pursuant to section 2.23712 of the Virginia Code, I hereby move that the city council close this open meeting and convene within the closed meeting as authorized by Virginia Code section 2.23711A1 for the purpose of discussion of the appointment of individuals to fill vacancies that exist on 16 city boards or commissions.
• • Nikuyah Walker
  • 02:04:33
    Second.
  • 02:04:37
    Thomas?
• • SPEAKER_05
  • 02:04:38
    Mayor Walker?
• • Nikuyah Walker
  • 02:04:40
    Yes.
• • SPEAKER_05
  • 02:04:41
    Vice Mayor McGill?
• • Nikuyah Walker
  • 02:04:43
    Yes.
• • SPEAKER_05
  • 02:04:44
    Councilor Hill?
• • Lisa Robertson
  • 02:04:45
    Yes.
• • SPEAKER_05
  • 02:04:46
    Councilor Payne?
• • Lloyd Snook
  • 02:04:47
    Yes.
• • SPEAKER_05
  • 02:04:48
    Councilor Snook?
• • Lloyd Snook
  • 02:04:49
    Yes.
• • Heather Hill
  • 02:04:49
    Okay.
  • 02:04:52
    Thank you all.
  • 02:04:52
    Brian, when we come back, we're coming back to a