Transcripts For SFGTV Fire Commission 20240711

This meeting will be conducted via webex. Okay, lets see here. Sorry about that. This meeting is being held by webex, pursuant to the governors executive order and proclamation declaring the existence of a local emergency during the coronavirus disease, the Fire Commissions regular meeting room at city hall is closed and meetings of the Fire Commission will convene remotely. You may watch live on www. Sfgovtv. Org and to participate by Public Comment by phone, please use the call in number 4156550001, access code 1465020961. Members s members of the pubc will have opportunities to participate during Public Comment. The public is asked to wait for the particular agenda item before making a comment on that item. Comments will be addressed in the order they are received. Members of the public can raise their hand by pressing star 3 and you will be queued. Callers will hear silence when waiting for your turn to speak. The operator will unmute you. When prompted, the callers will have the standard 3 minutes to provide comments. Please ensure you are in a quiet location, speak clearly and turn off any tv or radios around you. Item one, roll call. Francee covington. Present. Your camera is off president covington. It is . I didnt do anything. Let me see. Vice president feinstein. Present. Stephen a. Nakajo. Present. Ken cleaveland. Present. Tony rodriguez. Present. And chief of department, Jeanine Nicholson. Present. Item two, general Public Comment. Members of the public may address the commission for up to 3 minutes on any matter within the commissions jurisdiction that does not appear on the agenda. Speakers shall address their remarks to the commission as a whole and not to individual commissioners or Department Personnel. Commissioners are not to enter into debate or discussion with the speaker. The lack of a response by the commissioners or Department Personnel does not necessarily constitute agreement with or support statements made during Public Comment. Madam secretary, can you see me now . No. Okay, i thought you could see me earlier. Ill keep trying to figure this out. There should be a video button on the bottom of your screen. I did do that and i dont know whats happening here. We do have Public Comment. We do have okay, lets go to Public Comment. Thank you. Member of the public, you may speak, you have 3 minutes. Thank you. Good morning commissioners. Im a proud member of the San Francisco Fire Department from 1990 to 2019. Im calling in reference to a presentation that was given by captain tillman at your last meeting. I submitted a letter last week and the purpose of my Public Comment today is to touch on the points i conveyed. Many of the assertions made were factually incorrect and in my opinion, irresponsible. Specifically twice during the presentation, it was asserted that i hired 82 entry level classes and there were no black members. That is unacceptable and its unacceptable to me as well. What i find unacceptable is the false information that was provided and allowed to go unchecked and unchallenged. It should be noted that all h. 2 entry level classes that i hired are comprised of a diverse pool of candidates, including black candidates. Im hoping by now you had the opportunity to review the hiring data and i appreciate commissioner nakajos question for data. As noted in my letter, the United States department of labor acknowledge and recognized the San Francisco Fire Department as one of the most diverse Fire Departments in the nation in a report titled promising practices for increasing diversity among First Responders. My command staff, which many of you knew over the course of 15 years has changed but it always reflected consistently the diversity of our department and we strive for and work diligently to ensure fairness, equality, equity, inclusion, and opportunity for all sffd members as evidence in our entry level h2 classes and promotional exam processes, which create opportunities for advancement. Although improvements can always be made, the commission should be proud of the departments diversity. Its what i think sets the department apart, as one of their biggest strengths. I would put the San Francisco Fire Departments diverse, competent and professional workforce against any other Fire Department in the nation. We are a rich blend of members that truly reflect the community we serve. The San Francisco Fire Department serves as a role model to other departments that continue to struggle with recruitment and retention. Several departments requested site visits and interviews regarding the tremendous efforts and success related to diversity. Although im retired now and very happy to be retired, i still care deeply for the department, its members, and its reputation as one of the most diverse departments in the nation. There is so much to be proud of. Thank you so much for your time. Are there any other members of the public that would like to speak at this time . There are no other members on the public call in line. Okay, thank you. I still just am a disembodied voice . Yep. Okay, im not sure what to do. Can you im going to hit every button so i may disappear all together, but please continue. Okay, item three, approval of the minutes, discussion of possible action to prove the meetings from the regular meeting october 28, 2020. There is no public oh wait. Hold on. Caller, would you like to make a Public Comment on the minutes . No Public Comment. Okay, thank you. I will close Public Comment and also fellow commissioners, i would like to table this item until our next meeting. There are some substantial changes that i think are required. If anyone else has any changes to put forth for these minutes as they were submitted, please feel free to do that now. Is there any commissioner that would like to add anything . Yeah, its Katherine Feinstein speaking and i just am ho hoping that there will be amendments to the minutes and were going to defer approval that we have an opportunity to comment and discuss them. Well, if there are going to be changes, then we should discuss those changes now. Thats why im asking if anyone else has changes to the minutes. Its very disconcerting for me to see you and you not to see me. [laughter] i understand. Im not sure what to do. Do you have any changes proposed . I just think it required i mean how can i say this. The question is whether the minutes correctly reflect what was said, whether we agree with what was said or dont agree. Thats what minutes are. If there is a disagreement about what was said, then no, i dont have any further comments. If there is some desire to correct what was said, i dont think its appropriate to amend the minutes because the minutes reflect what was said. So, thats why i think we may need to have a decision discussion on it. Okay, thats fine. I agree with you. The minutes are what exactly was said and what happened. My hesitation on the minutes is that they were truncated, the statements were truncated in some cases and i think they need to be added too, not subtracted and not explained. There are some additional statements i thought were needed in there that dont appear. Well, im not sure what perhaps madam secretary, you wont know what the process is if there is a proposal to amend the minutes . I do not know. They can be amended, absolutely. If i understand what commissioner feinstein is saying, you know we had minutes read i was a member of a union for 37 years. If there is a problem, i think what were saying is or at least what i would like to see happen is if someone feels that something needs to be amended, deleted or changed, thats okay, but i think the rest of us need to hear what that is before we agree to what it is. There might be a difference of opinion there and then we can sort it out. What i think im hearing commissioner feinstein saying is that if someone feels like theres changes or omissions or that we need to all be an i aware of what those are before it becomes fact. Thats what i think. Thats correct commissioner rodriguez. Thats the point i was trying to make. Thank you. I believe youre on mute. I would concur with commissioner rodriguez and Vice President feinstein. If there are changes to the minutes, lets hear what those changes are. Okay, let me get my glasses. Madam secretary, can you please find out how i can fix this so that i am a part of the meeting instead of just a voice in the wilderness . Down at the bottom there is a mute. Im not there right now. Let me get my glasses. Its not something i can fix from here. I dont think city hall is opening up until june of next year. Are you serious . Yeah. Very. Wow. And we can have teams and webex until then. [laughte [laughter] maybe we can learn how to make it work. Okay, i hit every button here and i cant show myself. Sometimes i gotten out and got back in and it works. Thats what i did this morning and last week. Okay. I will try that. In the meantime, since were going to be having a conversation regarding the minutes in the meantime madam secretary, were going to table this item for a few minutes and then can you please go to the chiefs report. So were coming back to item three . Yes. I am going to sign off and try to get back in. Okay. Thank you. Item four, chief of departments report. Report from chief of department, Jeanine Nicholson, on current issues, activities, and events within the Department Since the Fire Commission meeting on october 28, 2020, including budget, academies, special events, communications and outreach to other Government Agencies and the public. Report from operations, deputy chief bryan rubenstein. Report on overall field operations, including greater alarm fires, emergency medical services, bureau of Fire Prevention and investigation, homeland security, and Airport Division. Good morning everyone. Welcome to our staff. Welcome everyone. Thank you all for being here. I appreciate your time. I know how valuable it is. I dont know if i announced myself. This is commissioner nicholson. So i know that president covington wanted more information on the transport bus and our relationship with muni around it. Its my understanding that we have to have a muni driver drive it for us when we want to deploy it. Sometimes they are not available right off the bat. So, if i can turn to chief [inaudible] good morning commissioners, president covington and Vice President feinstein, and chief. The bus holds 20 patients sort of in a laid down format. There is also seating they can sit in if necessary. I will confirm all of those numbers for you and send that to you. We do have at this time sort of an inability to deploy it immediately when necessary. We do have some restrictions with the muni drivers. They are available to us as much as possible, however our best use of the buses is usually if we can preplan that. Otherwise, we are sort of left to the availability of the drivers in immediacy and then it does take up to a couple hours for us to for muni to get a driver if we told them of an immediate need. Thanks very much. We had a significant amount of challenges and tragedies and i had been spending a significant amount of time with families, with stations, at the hospital, ensuring that you know, everyone is getting what they need and that were taking care of business for our people. Ive been doing a lot of that. You know, fortunately one of our in the hospital right now, both are improving. That is really good news. Yesterday i did go to lieutenants memorial service. His family kept it really small. There were about 10 or 12 firefighters there. I came in and it was really shocking that he died a couple weeks ago after an elective surgery. Theyre all just broken hearted about that. So blessings to him and his family. I want to tell you a little bit about the city e. M. T. Program that has been getting traction. Were working with the economic and workforce development, director davis, as well as department of human resources, as well as a couple of nonprofits to build the program out with the hopes that it will launch in 2021. Now this is the program i spoken to about before that will bring in atrisk youths from 18 to 24, young men into a wrap around program, whether its trauma counselling, they get life coaching, they get academic assistance, they take an e. M. T. Class and they get assistance with that. Most of them actually pass or obtain their e. M. T. License at the end. They also get a stipend at the time. So this is a big collaboration of a lot of people and im really looking forward to figuring out how to provide opportunities for those kids in the department. Its a work in progress. Im really excited about it and im hoping it will launch in early 2020. We are going to have a 127th academy. Hopefully in the early 2021, i believe february. I initially spoke last time about wanting to have a class of 30, but due to covid, we can only do 24. So were hoping to have a second class of 24 during the summer. So we are there will be meet and greet invites. The invites have gone out. I expect to meeting with the other candidates next week. So that is exciting. So i know that chief rubenstein and dan are available to speak about that and the scrt, we have our Fabulous Team from e. M. S. Here to speak about that. I also believe that i hope its on the calendar for next time, but we will have captain presenting our Racial Equity action plan and yeah. That concludes my report for today and i also want to welcome chief rubenstein. [inaudible] thank you chief and also welcome chief rubenstein. Are there any comments im still trying to work on this folks. Im so sorry. Are there any comments on the chiefs report . There is no one on the Public Comment line. Okay, thank you. Public comment is closed. I will go to my fellow commissioners, beginning with commissioner rodriguez. Thank you. Chief, thank you very much for your report. I do have a few questions. The first question was you referred to the class where you have i guess, classes, but you mentioned men only. Was that just a mistake or is that class also for women . That is a great question commissioner and im glad that everyone is on top of this. It is only young men for this first time. The reason is that were basing this on a program that has been deployed and worked in the Los Angeles Area and it has only been men. The first class were doing is only of men. Then we are planning on the second class to be a class of women. Its my understanding that when they started this, it was called e. M. S. Core. I believe the first class they tried to have a mixed class of men and women and it didnt work out for a number of reasons. One of them was being trauma groups that they were all trauma counselling and some other distractions as well. So, yes, its going to be split. Okay, i understand. And the other question i had, it kind of i was going to refer to the last Commission Meeting but actually you talked about a class coming in, in february. So, during the last reading of the minutes. Im new, so i dont understand a lot of this stuff. There was a report in reference to special calls by you and captain tillman, i guess regarding when this recruitment, special calls made to applicants or whatever. I like to understand that. Also, you mentioned something about a National Testing network, why it has an adverse effect. So yeah, so we looked at the data and it does have an adverse impact on women. So we are looking at the testing, which does not have that similar, that same impact. Its more equitable as to why it impacts women and African American, i cant answer that. We know that it does. So we are looking at attending that in the future, which is in many places and you know, steve can give you more on that if you like. Do you want to hear more from him . No, i was just kind of curious. I mean the research that you just provided that it has an adverse effect on African American women. Not just African American women, but African Americans and women, both groups. Okay, thank you. Yes. Then special calls im not sure what tillman well, i know what he was referencing but thats not how i work. I do not [inaudible] it gives people an unfair advantage. Thats of the distant past, what he was referring to when the department was predominately white male and everybody wanted to get their sons in or what have you. Its a different ball game these days. So those special calls, those would be to you then . Is that correct . Yeah. I believe so. Okay. So yes. And some people who are no longer in the department, i do not i have not responded to them. Okay, good enough. I just wanted to know the context of that. Thank you very much. Youre welcome. Thank you for it again. Theres our president. Oh my goodness. I hit every button imaginable. Thank you very much. Im going crazy here. So that completes the report chief . Youre on mute. Okay, chief . Commissioner rodriguez asked a question and i did finish answering them. Yes. Now you are on mute madame president. All right, how am i now . Youre good. Loud and clear. Oh my goodness. All right. So lets see, commissioner cleaveland, do you have questions for the chief . I do, thank you. Chief, you mentioned on the mass casualty bus that sometimes it takes up to two hours to get that bus and get a driver for that mass casualty bus, which is absolutely not acceptable. I mean were having a mass casualty event. We need to have that bus deployed asap, not two hours later. Is there any way that we can i dont know what the reason is for muni not allowing us to train our own people to drive that bus, but can you explain the problem there chief . Yeah, im going to let someone else who knows more about this take this question. I believe he can handle that. Thank you. Sure, i can start. Good morning commissioners, president , Vice President. The issue is the apparatus. The muni bus is an old model and is only able to be driven by a few operators in muni, while they have a vast fleet of new buses that now are only the newer drivers are only trained for that. So were working on getting two more of those newer apparatus, newer buses so they can be trained on that and outfit the new buses with the equipment of the old munis use to have. So its a matter of enough operators that are trained to use the old buses and when we take time to do it, its because they need to find the right people that are trained for that. So were working with them, communicating with them and making sure theyre training and we have a newer fleet and they can have more and they will have more operators available and we believe that will reduce the time to be deployed. Okay, if i hear you correctly chief, we are getting some new mass casualty buses, is that what were doing . Were getting newer buses so well have more drivers available to drive them . We are in conversations to get two buses that will replace the old buses we have right now. Once we have that, then we can have more operators. When is that going to happen . Whats the timetable . I dont have the timetable, but were looking at the next few months. Okay, so pretty quickly in other words. Yes. Its just not acceptable to have a two hour wait to get a mass casualty vehicle. So the sooner, the better on that. Im surprised that muni is going to allow our people to be trained to drive their old buses. I dont understand why that territorial dispute has to happen. Okay. So i had a question, thank you for that response chief. I had a question on the early, the atrisk youth e. M. T. Training, which i think is a great idea. I want to know a little bit more about how many are recruited into that class and how are they being recruited . How are they selected . So thank you for the question commissioner cleaveland. So, this you know, i brought this idea to a couple of people in the department and outside of the department and they started to run with this. So it is a nonprofit, as well as the original founder of e. M. S. Core that is doing the recruiting and they will be doing the teaching and all of this in the community. So its folks within the community and i have nothing to do with choosing the people that get in. It is done by this nonprofit and member of the community. Chief, are we seeking to recruit City Residents or is it open to anyone that the nonprofit occurs whether they live in the city or santa clara county. Were looking at district 10. I know they are talking about district 5 as well. The class right now is going to be located in district 10. Okay, and their emphasis is trying to recruit City Residents . Correct. Yes, that is correct. Good, good, good. Okay. One final thing for you chief or chief billo, are we going to do away with the National Testing system and what is the name of the second test that were going to use . Quite frankly, whats the difference between these two tests and why are we making the change . So were making the change [inaudible] because of adverse impact on women, African American, with the National Testing. The other thing about the Testing Network is that its bringing in people from kentucky, from texas, from everywhere. So we are looking at the f. C. C. So f. C. T. C. , its a testing that is done caljac and it create as people within the pool of california. This is something thats coming from the react that well present to you in the next month, is that its less impactful. Some of the components of the tests that they do on are not as impactful and also like chief said, its only for california. Its full of qualified members and candidates throughout the state, and we can pull from that too. So using this new testing system, does that exclude people from outside of california . Well, i dont know about excluding them but its based on california, so they would need to take the test in california. I have to look into that. So does the test only administered in person or is it going to be an online test . I believe its online. I have to get more information from the folks from the Recruitment Section of it, but i believe its online. Some sections can take it too. Ill have to look into that commissioner. I also want to make sure that the quality of our testing is not somehow, in some way impacted. So thats important. Thank you. No more questions . Thats all my questions madam president. Thank you. Thank you. Lets see, i will go to Vice President feinstein. Yes, thank you madam president. I have for the chief the most mundane, boring request, but youre boss of the department so im turning to you. She had to endear endure this from me before, chief rubenstein, youre next up to get it. Is it possible that somebody could make us a complete directory of abbreviations . I mean i do read these reports carefully and i really struggle figuring out. I know im new and maybe everybody else understands what it is im looking at but i look at charts that have initials at the top that i have no clue as to what they mean. So the report, theyre both equal in terms [inaudible] im wondering for commissioners going forward, i think it would be a really helpful thing. Can we do it . Vice president for the question and yes, we can do it and we will make it happen. I will work with chief rubenstein on this. [inaudible] i can see he is thrilled. [laughter] i think its just going to help all of us understand the reports better. You do speak a special language over there just so you know. We do, and there is e. M. S. Language and suppression language, and yes we do. Im not suggesting that its urgent, but it would really help get through and process whats going on. Thank you. We will handle it. Thank you, thats my only comment. Okay, thank you madam Vice President. Commissioner nakajo. Thank you madam president. At this time i do not have questions for the chief of the department. If i do, i would like to return to that when he does his presentation. Thank you sir. All right. Chief of the department nicholson . Yes president covington . Yes, i know that there is at least one member of the department that is a former employee of muni and bus driver. Hes been in the department now for maybe four or five years. So, if we have an old bus that is our mass casualty bus, it might be helpful to know if he still has his license to drive a bus. That might be one of the ways we stay informed about how to deploy a mass casualty bus do you know who im speaking of . Yes, i do. Just for my fellow commissioners, i know that you know that we have people of various backgrounds in the department and lots of different skills that you wouldnt associate with the Fire Department. We do have a muni bus driver that perhaps can be, you know, on call for this kind of thing, of course with munis approval. I just wanted to throw that out the there. Thank you very much president covington. Thank you. And there was also the book of abbreviations. I think that would be good. Thank you for suggesting that Vice President feinstein. There was also a question ill hold that question for another time. Are there any other comments or questions from commissioners . Okay, seeing none, madam secretary please call the next item. Ive already called it, reports from operations. Okay, thank you. Report from operations. Good morning president covington, Vice President feinstein, commissioner nakajo, cleaveland, and rodriguez. Im bryan rubenstein, and i would like to share with your my october report. Lets see if i can make it work. Does it look okay to everybody . Looks great. All right. So heres my report for suppression. We had another busy month. We had 13 fires. We answered a lot of calls for service. In mutual aid, we sent companies up and down the state of california. There were two new things that happened this month. The governor prepositioned some apparatus and they were able to contribute in southern california. In Orange County i will show you a short clip of this news report that went statewide. You can see San Francisco is well represented here in Orange County and when they pan up, you can see how much they did. These homes were truly threatened. Theres the fire right there. We also sent out individual resources of the field observer, which is a prestigious thing to contribute to the neutral aid system. We work with our partners, fire operations, sheriffs, and e. M. S. Had over 7,000 responses to medical calls. Youre going to hear a lot more about this precrisis Response Team soon. There was a very good e. M. S. Town hall. It was well attended. The e. M. S. System is doing so well that one of our top users of the system is working his way, engaging with his rehab and has reached out to providers to celebrate. Im proud of whats going on with e. M. S. Theyre out there all day, all night, all corners of town. We did training with the sheriffs and on to our Fire Prevention and investigation. We celebrated Fire Prevention month with our community and we continue to inspect and were approaching the covid numbers. There were questions about shared spaces. The brief version of that is that it was highly regulated before covid. In june of 2020, the city initiated a quicker permitting process for removable furniture only. These permits were issued and sent out and it spread like wildfire. It became more and more permanent. The inspections are conducted by the San Francisco Fire Department. The Fire Marshals Office is forward with looking at how thats going to affect the safety of the public and our ability to respond and through their advocacy we proved the permitting process. Anyone interested in doing a web search of sfgov shared spaces, it will bring you to a web page that the city has put out to assist Business Owners in this process. For a fraction of whats been contributed by the Fire Marshals Office and we cannot permit these to obstruct our emergency access. [inaudible] you can see there is a lot of detail available on the web page for Business Owners. Here is one of the requirements that the barriers should be 42 inches high. Moving around the city you see that some of these structures are bigger and they wouldnt permit us to see in there. Many of the violations that ive been issued have been resolved and were going to continue to work with that. Supervisors are barely engaged with this. The permits were meant to expire at the end of this year but theyre being extended through june and winter is coming so the Business Owners are going to try to weather rise and make sure that these changes comply with the requirements for First Responders and the safety of our citizens. The shared space is in the report, so theyre not going to be going away in june of 21. Our Airport Division then is keeping busy responding to incidents and drills. Public Information Officers carrying on his good work with engagement with the public. He was recognized with a National Community Service Award and were proud of his work. I think everyone knows and she is engaging with the department and coordinating all of our needs and was instrumental in the Action Plan Development in the visual memorial and the plans running up to the election. Also, the mayor declared october 17th official recognition for 30 years. I like to close with a couple of photographs remembering. I dont know how you can take control away from my powerpoint but thank you. Thank you for the opportunity. Thank you. Thank you and i think that was a very good voyage for you chief rubenstein. All right, lets see. Are there any questions for the chief . Ill begin with Vice President feinstein. Yes, i had just a couple of questions. Welcome, welcome to your First Official position meeting and first presentation. That was quite comprehensive in terms of the written material and i know that thats a new thing for you. Congratulations. You did a great job. I had a couple of questions again, just sort of trying to get a better handle on acronyms and what have you. What i would like to ask you and i dont know if this is better directed to chief or not, but im looking at the activity and it breaks down e. M. S. , transport, and then under e. M. S. , it said p as in paul, 90 minutes. I did not know what that meant. Can i ask you to answer questions about this report . Good morning Vice President feinstein. So the p90 is the percentage, 90 of the time we meet those times. I see. Very good, thank you. Thats a direct answer. I also did mark and i know you mentioned it chief in your report the fact that you had a frequent client, so let me get that off. So who calls to e. M. S. To remind you that it was his birthday and to come and visit. To me, that just shows a real connection to me. The hope for progress with that individual, he wants you to come wish him happy birthday. That speaks very well for the e. M. S. Program. I wanted to commend you on that. I shall not bring up f. U. D. Because i will receive that in my dictionary. I had one question about its on page 14. Im sorry chief. When you have an ems6 call, its self assigned, a special call, what does self assign m n mean . Does special call mean a phone call . What does that mean . So the self assigned is if they hear a call coming out on the radio, they will then dispatch themselves on it or they can also on view and put themselves on that call. Special call is if generally when the ambulance finds one of the ems6 clients and they special call and call them and have them respond as well. Okay. That really helps me. My last few questions and i know he likes to stay hintdden. Fire marshal, are you with us . I see your square there, but i dont see you. He blends in. Ah ha, trying to hide. It wont work. You caught me. I think chief rubenstein addressed some of it. Im watching the shared spaces and i realize you know, i got to be in my bonnet about it and thats just the way it goes. I am seeing more shelters. Im seeing people putting what i consider to be essentially flammable material on the roof and installing gas heaters or whatever those outdoor heaters are called. Im seeing extension cords. I think i mentioned it at the last meeting, but more of them running from buildings across, through trees and across the sidewalk to the roof or something, seeing what would strike me as almost Christmas Tree lights, but theyre bigger in places and yeah. It really just worries me. I see the roof of the shared spac spaces being ignited by something. I dont know how youre going to keep up with the number of these. I dont know what the plan is. They just make me really nervous. Understood commissioners. Stereo we have 12 inspectors as far as responding to shared space inspections. So what weve done is we made it a priority to go out and take a look at every single shared space. So we looked at 800 so far. We divided our district inspectors times up in the morning and in the afternoon, its shared space. So up to 800plus sites we visited, we have written violations and notices of correction. We put those in two different buckets. We have priority violations and standard violations. Priority violations are those that rise to a higher level, a significant hazard in our opinion. Then the standard violations, we have more time and flexibility to work with the Business Owners. So we have between 50 to 60 priority violations, and were down to 15 right now. Were getting compliance with that. So with regards to extension cords and heating and you know, that is something we look at as far as ground operations and firefighter operations. When we go out one week, everything looks fine. When you go out the next week, things change. We try to get out there. So we do have a process in place and with regards to heaters, we conducted off hour inspections to see whats out there. We received 90 applications for permits for heaters out of shared space sites. We are being proactive and sending our team out there to gather information. [inaudible] we have four or five sites that people have done that, people were sitting in unsafe areas. Its like the ghost ship incident in the past. We done that in the past and we have the ability to do that as well. It is worth noting and im not here to pass the buck, but it is worth noting that we are not the permitting agency for these shared spaces. I understand, yes. So we have our guidelines, five or six bullet points posted on the website that addresses Fire Department access. We focus on that and also when we focus on Fire Department access, we look at what are our challenges before that we had to deal with before the shared space platform. Before we had parking spaces. You had cars, trucks, delivery trucks and we were able to maneuver and manage that. So lets try to maintain the same level of hazard and not increase the asrd hazard. Thats why we came up with the height restrictions of 10 feet. So we didnt want to create a more hazardous condition. In doing so, the challengings we had, again, how do you get power to these sites . These are things that are casebycase that we review. All right, i really appreciate it. I see all the things on your plate from your report and i dont mean to Everything Else youre overseeing and doing. I thank you very much for that and just keeping an eye on it. One thing about being on this commission for not all that long, you gain a real fear and respect for fire. You know, im starting to see hazards where maybe they dont exist or maybe they do, but i think its of importance that some roof on a shared space restaurant. I can see it igniting and the people underneath it not fairing so well. So that explains the b in my bonnet. We understand commissioner. We made it a priority. So we have an assistant fire marshal, one captain, 12 inspectors and 1 district lieutenant that addresses shared space. We are being proactive. I think you are too and i really thank you and commend you for that and especially Everything Else i see that youre doing. Thank you and i appreciate your time. Thats it for me madam president. Okay thank you. Lets see, commissioner cleaveland. Thank you madam president. First a couple of comments. First i would like to welcome chief rubenstein to our to the leadership there and welcome on your first zoom call with the commission. I like to congratulate lieutenant baxter. Thats all i have. Okay thank you commissioner cleaveland. Excuse me, commissioner nakajo. Thank you very much madam president. Thank you very much chief rubenstein for your comprehensive report. I have a couple of comments from questions. In terms of your report, again, part of this is that its a comprehensive report. I think the various commissioners give note as what stands out and the information that is presented from myself as well. Your greater alarm page, there were no greater alarm fires within this period. What i wanted to note too to the chief and our fellow commissioners that the p. I. O. Report on page two, the Fire Commission report on october 1st to october 31st, lieutenant johnston baxter, and again there were remarks by the commissioners on how much we need and take in detail all of these reports because we do read it, we do digest it, and we do have questions, and we do have comments that beyond the greater fire report, i find that lieutenant baxters report on the Fire Commission and the back of your docket, when it comes to the sections in the back of incidents, working fires and greater alarms, a monthly report to calls is comprehensive. So as i looked at lieutenant baxters report, what stood out in my mind commissioners was then the month of october, from the 1st to the 31st by my indication of identification. I saw 17 encampment fires, in terms of water rescues, i saw 12. In terms of reports of alarm fires, they generally dont show up. In terms of the greater alarms, i saw 17 incidents. These greatly help chief rubenstein, in terms of identification to the commissioners, how much is happening with the department in a daily, weekly, monthly basis. [inaudible] describes where it happened and the incidence around it and i wanted to let you know how much we appreciate that part of the report. In terms of the e. M. S. Report, chief as always, its a comprehensive report with a lot of information. Just like Vice President feinstein, you can go out there on the commission, every once in a while there is an acronym that comes out that i dont know either. Im glad on this report, it shows it means street crisis Response Team. It helps anything that has to do with ems6. Ill hold that until i get the presentation because then were going to talk about what were going to be doing and i also remarked and looked at page 11 when they have the ems6 target population and the amount of incidents that occurred and the recording of that. Also on page 13, the conservatorship still remains a challenge. Im just letting you know that in terms of us, the commissioners, were looking at that. In terms of successes chief, just as a point of clarification, i see Emergency Department Case Management, page 13, encourages e. M. S. To prioritize our clients. Our clients are medically complex or coherent s. U. D. What does s. U. D. Mean . Good morning commissioner nakajo. I also need a glossary. I will refer it to yeh or chief pang. So its referring to Substance Use disorder i believe. Apolo apologies. I will work with the team in making sure we have a glossary because there are definitely a lot of acronyms and an alphabet soup that can be confusing to everyone. So it refers to Substance Use disorder. So Substance Use disorder. Then it says h. U. M. S. , what is that . Yes, hums is a little bit of a San Francisco custom act niac high users of multiple systems. We refer them as frequent users or frequent utilizers. San francisco has a systemic way of identifying those individuals as having data that suggests they are utilizing multiple systems of care, hospitalizations, e. M. S. Use, psychiatric, detox so its probably appropriate to consider them as our frequent utilizers. And you referred to the comment from the Vice President , as well as the commissioners. It would help in terms of digesting the material. Moving on to chief rubenstein, the bureau of prevention and investigation, welcome back chief. I got the information from the report and i do appreciate chief rubenstein identifying the website that says San Francisco governor gov shared space. There is a lot of information. Thank you for reinforcing where the permits are issued and again i see that the issuance is june 2021. I think it seems like its going to go beyond june of 2021. I know were putting a lot of manpower and supervision and oversight. I know were not being reimbursed by our activities. Are we recording the number of hours that our staff is doing when we do our shared space work oversight . Yes, thats covid related. We track all activity covid related. So were tracking that time. So you can show the city and county what the Public Health how much work were doing. At some point being beyond good partners, i wish there was some compensation for the work. Thank you for that. Moving on chief rubenstein to home land security. On page 33. The beginning of your report, can you let us know what e. A. P. Means . Yes. [inaudible] its a plan and role related to an event. [inaudible] excuse me. Could you please speak up . Yeah. Can you hear me now . Yes, thank you. In the initial [inaudible] okay, you were muffled. There is an acronym ncric, could you explain what that is please chief . Yes, i can. Also a network of [inaudible] thank you very much for that clarification. I appreciate it. At this time i have no more questions. Madam president , thank you very much chief rubenstein. Thank you. Thank you everyone. I didnt hear from commissioner rodriguez. Okay, thank you madam president. So, chief rubenstein, can i give you a report . Excuse me for some of these questions. I keep telling people im new and i dont know a lot of whats going on here. In reference to the first one, i counted 22 in fires and we talked about this before. I agree with the commissioner nakajo about the cost of repe repeated stuff that everything could be averted but still its pretty constant and if were having to deal with a lot, especially now with the winter coming, or winter is here, i dont know. This is going to be an ongoing thing. Im sure we keep track of this. This needs to be included in that. I dont know if it is or not. It doesnt seem that this is going away. Who do we deal with to raise more awareness just within the Fire Department that could help deal with this problem . Like i said, its not going to go away. It seems to be increasing in my opinion. Thats number one. I can go question by question or do you want to respond to that first . Thank you for your question commissioner rodriguez. Welcome, there is nothing wrong with being new and having questions. Im doing it everyday. [laughter] we are seeing more encampment fires and that is an atrisk population that is, you know, having accidental fires with very little that were not trying to do and making other opportunities for them. Some people refer to live in encampments. Okay. I just didnt know if maybe we could reach out to the other authorities, maybe the Police Department, i dont know. Keep an eye on the encampments as they get larger and we can help them be safer. Okay, thank you. The next two questions can be combined. You know, i dont know what the program is. Also the other is outreach. I seen a lot of good stuff here, but i am just curious outreach to who . Who is the process on who you go out to or how does that happen . So excellent question. We receive requests often from schools and different groups to go out and we have people in the field that report back. Those are the things we would identify through outreach, through us. But what is the list up program . [inaudible] chief can take that. Say again . Thank you madam president , commissioners, chief of the departme department. I appreciate being here. The list is what we teach to the community. We do not have a program. It has a lot of the elements of the nert program, especially the taking care of yourself, the family, the fire extinguisher. The origin was in Santa Barbara coun county. Its a partnership we made with the statewide entity, with our Spanish Speaking firefighters and members of the community and so the instruction, and outreach is done by both firefighters, as well as Community Members due to the sensitivity around citizenship and others closer and into a more testing relationship and deliver the Key Information very similar to nert. Thank you. That answers that one. I guess the last one that i wanted well, there were two more. I dont know if one was regarding the conservative conservatorsh conservatorship. Is that going to be taken later on . I imagine it will come up with e. M. S. Support, they can address it then. Okay and then the last one would be, i guess regarding School Inspections and im curious when those inspections are done, and deficiencies, who do they go to to be addressed . Yes commissioner. The School Inspections, the any notices or items that need to be corrected goes to the principal of the school. Okay, good enough. Thank you very much. Now thats the end of my question. Thank you chief rubenstein for your report. Okay, thank you. Lets see. The list was mentioned and we saw photos of the meetings and it is a very good program. Then lets see. In regards to Vice President feinste feinsteins concerns, all citizens are welcome to call and report any situation they believe may be hazardous. Feel free to call in about those things that concern you. I think that would be helpful rather than waiting until we have another meeting about these things. Thats something else, perhaps this should be an agenda item at some point so we can go into more detail about it. May i, madam president , ask a related question to that . Most certainly. And i dont know i see chief tong, i dont know he got all dressed up but chief pang disappeared on me. Its okay. I had an incident the other day where i was driving down oh there he comes. Good. Hi. Where i was driving down bush street and there was a woman and im not going to form an opinion as to what her status or issue was but i have one but i will keep it to myself. She was walking down the center lane of bush street with a very covered and dirty blanket from st. Francis hospital to grant avenue. I was terrified that somebody was going to come around the corner and run over here. I didnt know what to do so i just drove behind her with my flashers on, obviously with people honking at me because im going, you know, not even 5 miles per hour. I didnt know who to call. I didnt know what to do. To me she was an extreme danger to herself. Yeah, people do just drive by. They dont necessarily care. I followed her until she went back on the sidewalk and continued going in a different direction, but on the sidewalk. It was terrifying. I am not like you all. I am not use to i dont want to see catastrophe unfold before me. I didnt know what to do. I didnt know what to do. You know, i would appreciate if chief, if you whoever, i mean how do citizens i mean i do not want to just call the police. I know hes ill and im not a doctor, but you dont need to be one to know that. You know, i felt very helpless and useless. Following her with my flashers on, i dont know if that was stupid or not. I didnt want her to get run over. Help me here. Help me figure it out. Vice president feinstein, youre hired. [laughter] i dont want to be hired. I dont know what im doing. Well take you on ems6. Thank you. Vice president , i think that the way youre describing someone thats walking in traffic without regard to traffic and theyre imminent to self harm because of it. At the moment, the best thing to do is to call 911 and that would be a police code 800a. Dr. Yeh, correct me if im wrong. That means they respond immediately. Thats how the system works. A priority a response, or it would be the police or some iteration down the road, it would be a Police Response and street crisis Response Team, but that is the only recourse we have now. Okay. All right. I just dont know why. It didnt sort of feel right to do that. Yeah. Its funny when these things happen. You think you know what youre going to do and its not always what you end up doing. We can discuss my job terms later. [laughter] madam Vice President , youre talking to the subject matter expert. This is an appropriate time for the use of the 911 system. When you call that, youre not just calling the police, youre reporting what youre seeing and well send the appropriate resources. All right, i appreciate the guidance. I just couldnt figure out im watching her and watching traffic and you know, trying not to hit her. It was really frightening for her because it was frightening for me. Thank you, now i know. Okay. Thank you Vice President feinstein for your own version of the military escort. [laughter] we appreciate it. Madam president . Yes. I was going to make my comments. I didnt get a chance to say anything yet. Yes commissioner nakajo. Just to comment to chief rubenstein. I know there was a fire that had solar panels on the house as well and at some point chief rubenstein when its appropriate, can you please describe to the commissioners that the challenges that are facing when they have to a respond to a fire with solar panels. So thank you very much madam president for allowing me to remark that to chief rubenstein. Thank you. All right. Chief rubenstein, youre up again. So noted. That was a november fire. I will be sure to talk about the solar panel in that report. In your next report . I could speak about it now but it was in the november fire. If you feel comfortable discussing it now, you may not have all your details in front of you but now would be a good time. Since youre having him report it in november fire, i know thats not part of the report. Your prerogative chief sense youre chief of the department. Thank you very much. The material list is available to me. They present a couple of different problems for us and they provide a debt load and there is the opportunity for them to be energized. This fire was at 2 00 a. M. , so that was a problem for us. The debt load in this case, we were able to access with an aerial shot. An outstanding job by the firefighters. There were other issues i will go over in more detail, but they provided the challenges and we have a plan. Thank you madam president and chief rubenstein. Thank you both. Just returning to my comments, i had a question about the encampment fires. I am also concerned about the onset of winter and all of the people who are who dont have homes trying to keep themselves warm as the temperatures plummet. Im wondering when we do have fires where people are displaced, the red cross is called. Do we also call the red cross in these circumstances . The act ability of the red cross to respond hasnt changed. Also in every case of the encampment fire has left the scene with no one to interface with. I see, the people that are in the encampment, are they still there on the scene . No, they gone as well. Thank you for that. I want to again welcome you chief rubenstein. Its good to see you. I will share with you that when the chief of the department was making her selection for your position, she said i need someone who really, really can handle a five alarm fire. I said oh, i definitely understand what you mean. You have been mentioned in the report just a month prior. I have the utmost confidence in you. I just wanted to share that. Thank you madam president. And also congratulations to lieutenant baxter for his recognition. All right. So i know that we have. I know we have an important presentation coming up but i want to return to item number 3 now that we just to let you know, there is no Public Comment on chief rubensteins report. Okay, thank you. Okay, back to item three. Approval of the october 28, 2020, minutes. Yes. Thank you, is there any Public Comment on item 3 . No, there is not. All right, thank you. Public comment is closed. I have a number of things, again, my concern was in expa expanding what is included in the minutes and not taking anything out. So i have im sorry for this level of detail, but i havent had a chance to review it since i read it over the weekend. The report from the administration, i felt that it was truncated and i need more information about the matters at hand. Thats on page 2. I had a question about water rescues and captain tillman had a comment about the water rescues. He was saying essentially that since he is an experienced surfer, our waters are not conducive for beginning surfers. Thats one of the reasons that the numbers were going up. That was not reflected in the minutes. So you want me to add that he was an experienced surfer . Captain tillman added he seen a huge influx of surfers out there that are inexperienced with the dangers of ocean beach. And he said thats definitely the reason why. So yes. You want me to add that hes an experienced surfer . Yes, and thats his opinion as to why the numbers are going up. Okay. Yeah. This is a small one. On page 3, we had this conversation before madam secretary of when i think the Vice President s name was not used so it was where do you see that . No, im just referring to the past. Sometimes we do talk about just these minor changes as opposed to content changes. So, president covington, commissioner covington. Okay. Then down here Vice President feinstein stated, skipping down to the next to last line. Cap for fire occupancy reserve and then one, two, three, four four lines up include the business where it says perm permitted that they have been very active inspecting to make sure that permitted businesses comply. Excuse me, that the businesses need to be included there. Then over here over where . I havent said it yet. I have to figure out my own handwriting here. Item number five, presentation from black Firefighters Association. Okay. Please add captain tillmans first name, then, one, two, three, four, five lines down its the Martin Luther king day parade instead of march. Then one, two, three, four, five, six, seven, eight the 11th line, that local 798. Okay. Then going down, one, two, three, four, five lines oh, excuse me. Five lines up from where . From the bottom of that large paragraph. Okay. It says renaming of a street after earl, not early. Okay. Then yikes, three lines up, African Americans and now if comprised of asians, blacks can a capital b, latinos and caucasians. One, two, three, four lines up, it says the use academy, its the black Firefighters Association youth academy. Otherwise it sounds like its our academy, the departments academy and it isnt. Okay, then over here ill skip down to page five. On page five, there is let me see. Now to the second paragraph, opportunity should be for everyone and everyone should have a chance to be promoted. All right. Then the next paragraph that begi begins with commissioner rodriguez, where he confirmed the building is located at the address. And the whole conversation with commissioner rodriguez regarding the black Firefighters Association owning the building is not presented here. On page six, im almost done here. Commissioner nakajo thanked captain tillman, skipping down, this needs to be a separate paragraph where chief nicholson begins to speak. Was chief nicholson added . Yes, thats a separate paragraph so it doesnt get lost in Everything Else thats there. Then there was also in my remarks, i said much more than is represented there. I think thats enough of the things i had. Okay. Those are the changes i have. I will entertain at this time a motion to approve the minutes or if there are things that i brought up that commissioners dont agree with, please chime in. Madam president , with those changes dually noted, i would move to approve the minutes. Seconded. Ill do a roll call. President covington. Yes. Vice president feinstein. Yes. Commissioner nakajo. Affirmative. The motion is unanimous. Okay, thank you. Thank you everyone for your patience and me trying to read my own handwriting. Lets see, please call the next item. Item five, ems6 community pair medicine in the sftd presentation. Chief pang, captain sloan, captain mason, and dr. Yeh to provide an overview of the ems6 community pair medicine in the sffd. Who is up first . Captain pang, you have it under your name. Are you able to upload the just walk me through it. There is a button on the bottom that says shared content or up above that says share and my screen. Thats a good question. Okay, here we go. Yes. Nice. So to begin with, ill have dr. Yeh give a short introduction. Thank you chief pang, im glad we got that sorted out. Its really extent to be able to join the rest of the group here and present this information. Im about to hand it over because we have a lot of content to share with the group but i was just reflecting on the fact that i believe come january, e. M. S. 6 will have been in operation for five years. So, this is really a monumental achievement by the department in terms of advancing this team, serving our community, and it is with the tremendous support of this commission that all of this has been accomplice accomplished. And before we formally begin the presentation, i want to reemphasize that there is not a secret sauce, but with ems6, a patient centered design in which we are looking to find the unmet needs of clients in our community. You heard of some particular cases, you will hear more. Also, there is a relentless desire to collaborate. This succeeds because were able to rely and bring all of our partners together for a shared goal. So with that in mind, im going to turn over the precipitation to chief pang, as well as captain sloan and captain mason. So simon, go ahead. Thank you for the opportunity to present today. It has been one year since our last presentation and there is a lot to share. So ill begin straight away. The mission of ems6 is to improve the health and well bag of individuals dependent on Emergency Services. We connect them to appropriate support services in lieu of the Emergency Service system. We now have seven full time positions, captain level and we have coverage from 6 00 a. M. To 2 00 a. M. , seven days a week. Since may of this year, we have five personnel that has been activated by the Covid Command Center. We have site 42 and one position assigned to the healthy street Operation Center. Vice president feinstein, i might be referring to h stock in the presentation. A person at the center as dr. Yeh just said, the secret to the success is that. We had a lot of luck actually, i believe we have nurtured it. Its the idea of a team and High Performance team. We have all of our members are problem solvers, people who are motivated to create change and to make a difference and i come to work and see and hear what our team members are doing and i have been inspired by them. So, in case youre wondering what it is that we do out on the street, here is a short list of activities, by no means an exhaustive list. I want to say that the value of having a paramedic in this role is because a seasoned urban 911 paramedic knows what sick is. We know sick when we see it and we know what to do. We are first and foremost First Responders and we are use to dealing with all hazards. With those individuals most dependent on Emergency Services, we engage them on the scene of an emergency and then we follow them to the hospital and then we meet them in the community. One of our Health Department partners, ems6 is trauma informed and relentlessly compassionate. So this is for the first 10 months of 2020. Im very proud of these numbers. Let me see if i can walk you through this. On a monthly average, there are approximately 545 frequent 911 users in San Francisco. We define that as someone who uses San Francisco Fire Department ambulances four or more times in a 30 day period for ten or more times in a 12 month period. On a monthly average, these frequent utilizers generate 670 calls a month. We have approximately 7 of the population of 911 users who are using 18 of our resources. So you can see this is not an acceptable thing and this is really what the reason that ems6 got started five years ago. It is to understand whats going on and understand that the population of people who are dependent on 911 and see if there is a way that we can better serve them. Our connection rate has been 51 , which is if youre in the industry, understand that, that is a very respectable number. Total referrals are 1,360. We refer people to conciliation of resources, ranging from shelter, to alcohol detox programs, Substance Use treatment, Mental Health treatment, primary care, primary Mental Health care. So you know, we have become quite verse in what resources the city has to offer and we know how to manage the very arcane referral processes that many of them have and we managed to have a 691 connection in the first of each year. We have 26 encounters per day on average, over the first 10 months we have diverted 584 emergency room chance transports. An ambulance has shown up to or we directly went to the scene or we consulted with the crew and found a nonemergency resource for that person to go to. Its the top 20 highest callers and we see how we can effect their utilization for the month to come and we have a decrease in utilization of 45 . So we are involved in seven distinct projects. Weve been very busy and the thing i want to take away from this is that we are very versatile. Community paramedics, i know commissioner rodriguez, i dont think you were present for our last presentation. So thats a paramedic with extra training in an expanded role. We are versatile and we have a skill set and resources that uniquely put us in a position to innovatively bridge gaps and services and cared delivery. Some of these projects we are going to go to in detail, so i will not talk about them now. Emergency triage treatment and transport, that is a five year federal grant administered by the center for medicare and medicaid to sponsor innovative ideas in the delivery of care. The San Francisco Fire Department applied for that with a lot of we wouldnt have gotten that without the support of dr. Yeh and mike. I want to make sure thats recognized. The idea is that we want to get away from the payment, the transport payment model of e. M. S. Delivery. So some of the ideas would be having the Fire Department reimburse for assess and refer, Something Like telemedicine in the field and transporting to alternative destinations like a Sobering Center. So we think that the initial reimbursement will be small because not a lot of people are transported to the center have medicare, but once we start this process, it would be the beginning of something that will grow into a large reimbursement stream. Lets see if there is anything else here that we wont be talking about in detail later. I think in the slides to come, we will touch on all of these projects. Next slide. Okay, im going to hand it over at this point to our captain april sloan. Thanks chief pang. Good morning president covington, Vice President feinstein, commissionerers commissioner commissioners. Its a 15 million project managed by the California Department of healthcare services. The city was provided funding to test initiatives aimed at providing integrated care to adults, vulnerable adults experiencing homelessness with the target population of longterm homelessness and special focus on high users of multiple systems, which is where we commend and coincides with our mission. We have two projects within it, one on the Client Program, which im going to talk about first and then our shared priority project. Next slide please. Hang on a second. How do i get to the next slide . There we go. Okay, so our managed Client Program reduces utilization by developing a prehospital action plan. So clients are selected based on the utilization history. They usually are dual diagnosis, meaning they have a co occurring Mental Health diagnosis and Substance Abuse disorder. We meet with the team one day a week and develop a prehospital action plan. We assess the barriers in their care and we identify nonemergent resources we can direct them to. Once this plan is approved and implemented, other providers can see it, the other e. M. S. Captains know it, and when a managed client transport, theres an alert that the paramedics use. So sometimes were notified that way but more often than not, these clients are wellknown and they will call us directly. We will respond to the scene and assess and engage them. If appropriate, divert them to a less emergent resource such as shelter, their primary care physician, maybe housing assessments, whatever it is that we identified. So with that we had an across the board, with the 32 active clients, a 34 decrease in their utilization history. Next slide please. Okay, i just want to emphasize what april just said. 34 decrease. I will fix that on the slide after the presentation. Okay, this is the case study. These are the incliclients you referring to earlier and we visited him on his birthday. Its an overview of how disorganized he was. He was 5150 eight times in the four month period. And in an eighth month period we engaged with him 185 times. Things that we so he became a managed client in august. Our plan included referrals to psychiatric Emergency Services, door urgent care, a psychiatric facility, humming care and navigation shelters and three different shelterinplace sites, three Different Hotels rooms. Because of his behavior, he was often not allowed to come back to these sites. Its a very continuous amount of support that was needed. We linked him to intensive Case Management and that was a near daily multiple times a day talking to his case manager as his whereabouts and it resulted in united advocacy for him to be stabilized in Psychiatric Services and had him agree to a medication to help him with his Mental Health services. He did required urgent care but he entered a Treatment Program where he has been for 2. 5 months now and he reached out to us at the end of the month and we went to visit him on his birthday. Its a remarkable change in his presentation compared to when we first engaged anymore in the springtime. Lets see, next slide. Thank you. So our second project then is the shared priority project. So this is a very busy slide. Were not going to go through it in complete detail. They update us as to the progress of 237 individuals that were identified by the department of Public Health and h. S. H. Homelessness services and housing. These individuals were assessed for housing. In addition, nay they were identified as particularly vulnerable because they had a diagnosis of Mental Health disorder and psychosis. You have to have a diagnosis of psychosis and co occurring Substance Abuse disorder. This population is vulnerable in that theyre disorganized to do follow ups for housing. The primary goal of this program is to house these individuals. So to outreach this particular population, we informed d. P. H. And hshc the high intensity care team. With the exception of we dont have accidents for these individuals but an alert set up. When a paramedic starts writing a chart and their identifying information is entered we get an alert that they have been contacted so we can either respond to the scene or to the hospital and assess these clima clients and our goal is to connect them to services in that moment. We then send out a follow up email to all of the providers involved in their car and update them on the events during the call, what we were able to link them to and any follow up. Were the essential care coordination piece within the project, as well as we were especially well suited for given our response capabilities because these individuals dont go on a monday through friday basis, 9 00 to 5 00 type thing. So it will be suited and help these individuals get link to care. Do i have another slide . One more. I think thats it april. Okay, unless you do you want to go over the covid19 response . Im ready for it. So when it comes to covid19 in our response, i feel that ems6 really stepped up and took on any role that was handed our way. Weve done a lot of things. The isolation and quarantine site, which turned into the shelterinplace site 42, we co staffed that with the Sobering Center and had remarkable results there. I will have a slide just for that in a second. The mobile Response Team. Were familiar with street medicine. A street medicine is a fantastic group. We partnered with them with the care team that april just described. We partnered with them with the medical Response Team. What we did there, we have a provider from street medicine go with us and we go to the community and the streets and we did community streaming for covid, covid testing, and we went to shelterinplace sites and had the goal of trying to prevent unnecessary e. R. Presentations in the world of covid. I imagine you dont want to do anything that may spread the virus. Weve been partnering with them for that. We know that the facilities are the hardest hit by covid and you might have a facility with over 100 residents that suddenly do not have any staff available because the staff is either sick or in quarantine and now you have 100 vulnerable residents, most of them elderly and most with chronic medical conditions with no one to care for them. The Covid Command Center asked us if we could get involved and we have plans ready. We would be the task force leader. For the first 12 hour operational period, we would be there to stabilize the residents and to make sure that staff was coming to take care of them. The a. M. A. Recovery team. There were many individuals. When the pandemic first started, this was a greater problem. It is still a problem but not at that level. There might be individuals who were either covid positive or a person under investigation and pending terrorist results that left an isolation and quarantine site without medical advice. This could be a real problem with someone that has a chaotic lifestyle that is in and out of Emergency Rooms and First Responders vehicles and mingling with the community that are at risk of becoming super spreaders. We get a daily list of people who the Health Department would like to reintroduce to isolation and quarantine. We have our botlof list. Be on the look out for list. It has a picture of the person and description of where the person was last seen and if anyone encounters one of these individuals, they contact ems6 and ems6 is charged with offering them a quarantine site and escorting them there. It is voluntary. There is no mechanism in the City Ordinance that compelings someone to go. Its something that we have to utilize our verbal skills to encourage people to accept isolation and quarantine. We have been successful with it. Covid testing i already mentioned that. All ems6 personnel have been trained to do swab testing for the community. There was a tenderloin mobile testing site that was put up five days in a row and the ems6 captains siferved as the manage for that site and the Covid Response unit. We made plans for this, but it was never we never had to set it up because the idea was that if the city of San Francisco reached a surge level b and surge level b would that is defined by a constellation of triggers, including very high covid rates, hospital overloads, ventilator status, then we would hit a level b and then ems6 would be repurposed. We would temporarily stop our utilization and become the Covid Response unit. The idea here is that we want to minimize the exposure of we want to minimize exposure of our personnel. So we have one specially Trained Group of people that would preferentially be sent to all 911 calls where someone had flulike symptoms. I was quite impressed with the team that we had when we had the opportunity to take on all of these roles, everybody enthuse asically said yes. We can do it. We want to do it. We are prepared if the second weave comes around and that requires a Covid Response unit, were ready to do that. So this, this slide is specifically about the Sobering Center, isolation and quarantine site, which turns into a shelterinplace site. We can costaffing that in may of this year. When the pandemic hit, shelters closed down, Navigation Centers were no longer accepting people and this is before the shelterinplace sites were stood up. There was really no place to take people. It was a very difficult time for us. We were still bringing people to the Sobering Center. Thats the one place where we could harbor somebody for a while. They had a covid outbreak there. They had to close the Sobering Center down. The Covid Command Center was called the e. O. C. , the Emergency Operation center and in 48 hours, we managed to stand up a special site to give a quarantine site for those with severe alcohol use disorder and had nowhere else to go. When the city started standing up the shelterinplace site, we recognized there were a group of people that didnt fit in. Imagine someone has to drink every four hours, if they do not drink every four hours, they will go to acute withdrawal and have a seizure and potentially die. If you want to have a population shelterinplace, you cannot have someone leave, come and go as they wish, to panhandle to get their next drink. Its not compatible. People were getting kicked out or they werent allowed in. Thats what this program was started for. One of the unique characteristics of the program is that they have a managed alcohol program. There is something called a standard drink equivalent. Its 50 milliliters of alcohol. This is a medical thing that the Nurse Practitioners and nurses there take vital signs and assist withdrawal symptoms on a precise schedule or give someone a standard drink equivalent to prevent them from going into withdraw. With the help of the Community Paramedic that were on site 24 hours a day, we did a fantastic job. We got a cohort of 14 people to stay put for weeks on end. Everybody that went to this site had an improved quality of life. Let me turn to my notes so i can give you a few more examples of things that happened. One person had to be in there for two weeks, decided to quit drinking. Then he said that he wanted to get a job. He asked us if we could be used as a what am i thinking . Reference. As a job reference. He asked us if we could provide a job reference for him and he since went out and got a job as one of the city streets ambassadors and hes still doing that. He is no longer drinking and using ambulances. What helped him here was the possibility of stability. People who have been so out of control for so long were provided a piece of stability so they can begin to clear. So i like to mention their names, they have done such a phenomenal job. Its sherry mahoney, christina couch, patrick renshaw, lonnie jones. They engaged these individuals with enthusiasm and creativity. Here you have picture of artwork that some of the residents have done. Pumpkin carving and decoration and pingpong table was donated to the site and here you have people, those people that you would have seen on the sidewalk, on the corner with soiled clothing and you dont know what to do are now playing pingpong. Its amazing. The decrease in utilization is just off the chart. Its a 91 decrease in utilization. So i took some notes on what that means. This cohort of people, if left to themselves in one yearss time, and this is based on a 90 day record analysis. In one year they would have accounted for 1,051,056, 911 calls. Based on their utilization rates while they were at this site,. This is a savings of 960911 960, 911 calls. I want to make sure its understood. If they were at the site and the ambulance was called for them, it was not for a frivolous reason. We have nurses and paramedics at this site. They know when people need a higher level of care and so they were taken to the hospital for legitimate reasons. Okay, i think ive been rambling enough on this. There are many, many just Inspiring Stories that have happened because of site 42. Okay. Now switching gears entirely i would like to hand it over to captain michael mason. Thank you chief pang. My name is michael mason. Im a rescue captain with ems6 and broad Community Paramedic. I am going to give a brief overview of the healthy streets Operation Center and im showing detailed pictures of street conditions before and during the covid19 pandemic and our role as Community Paramedics in improving the health of our neighborhood. Chief pang can jump in here but for those who dont know, the healthy streets Operation Center is a long standing, several year collaboration between literally dozens of city agencies and departments to address street conditions for house and unhoused residents of San Francisco alike. Please note that while some of the following data references tense, all work is on providing shelter and shelter alternatives. Tents are an indicator or easy measure of unsheltered homelessness. I remind everyone here that we should be mindful of the folks actually inhabiting them. With that said ill start with some quick figures surrounding street conditions precovid. The city east last head count was 600 with 19 large encampments, defined with camps withi with six or more tents. Then covid struck. Our shelter system was forced to depopulate due to social distancing purposes, resulting in the loss of 1,800 shelter beds. Homelessness was estimated to have increased by 20 nationwide due to economic hardship. Individuals just werent able to stay with friends or relatives like they were use to. There is concern about having someone crash on your couch for the night. As you may have seen yourself, and i know Vice President feinstein you have spoke to this earlier. There was a large and visible increase of tents citywide, especially in the tenderloin neighborhood. So how does this impact the Fire Department . Well, i cant speak to some of the Empirical Data at present regarding encampment fires but we know based on experience that there is a lot of potential there. There is a potential for increase in e. M. S. Call volume. Prior to covid we saw that 30 to 40 of all San Francisco Fire Department e. M. S. Calls were for individuals reporting no identifiable home address or identifying themselves as homeless. We also know and some of the other members of the meeting spoken to, there is an increased potential for encampment fires. Beyond the direct impact of the Fire Department, covid and the street conditions directly impacts the city we care for and we serve. Next slide please. So what did we do . Our original mission became even more imperative. Hsoc reduced the number of unsheltered san franciscans by referrals and shelters and safe sleeping sites. A strategic framework was set in place to address some of the citys largest encampments and this was happening at the Emergency Operation center. In midmay, Community Paramedic captain, myself, was activated as a Disaster Service worker and assigned to serve as the Incident Commander for hsoc field operations. This will serve as leaders for dozens of encampment resolutions to follow. Now you heard this narrative before and especially from chief pang, but it turns out a Community Paramedic was the right fit for this situation. Many unsheltered folks have received transport from our e. M. T. S and paramedics. I was able to provide that Compassionate Care to our unhoused residents and to support the city departments and coordinate them in this effort. Next slide please. So what does this effort look like . What was a day on the ground and continues to be a day on the ground . We refer to it as a resolution when we engage an encampment and heres an example that was highlighted by mayor breed on june 12th, a neighborhood which saw a dramatic increase in unsheltered homelessness due to the pandemic. The day of operations we coordinated nine city departments on site to provide care, assessments, transport intake referrals to 23 individuals. That doesnt even count some of the Community Based organizations and nonprofits involved in the staffing of the shelterinplace hotels. On this particular date, 21 folks went from the street to the shelterinplace hospitals. Prior encampment resolutions, prior to covid and prior to this activation took days or weeks to coordinate, but the urgency of our work required each resolution to be completed in a matter of hours. I think rank played no small role in providing shelter and shelter alternatives to our unhoused residents. Next slide please. So thats an example of one individual resolution. Now whats been done to date and what does our near term work look like . The healthy streets Operation Center has resolved over 60 encampments, 30 of which were in the tenderloin neighborhood, all clients were offered shelter during these operations. Hsoc provided sheltering alternatives to over 1,100 individuals. Out of the folks that we encountered, over 70 of individuals accepted services, which is an extremely high Service Acceptance rate. In early october, 2020, hsoc conducted a tent count and found 700 tents and 28 large tent encampments, a reduction since may. Thats the work done to date and now looking ahead. As of november 5th, there are 13 large encampments remaining in the city, thats 6 fewer than prior to the covid epidemic. Hsoc anticipates having no large encampments by the end of the year and we seek to reduce the number of individuals inhabiting those to 400 tents. I know our departments coordinated efforts will contin continue. I thank you the commissioners and chief for your time this morning and your continued support for the Community Paramedic programs. Thank you. Thank you very much mike. I know mike stated it clearly there, but i want to say it again that the hsoc encampment resolution has been extremely succe successful, more than in the past for many reasons. One is the availability of shelterinplace sites that you can bring people to. Another one is mike masons personal ability, hes very good at what he does. I think the most important reason is the rank we brought that. You cannot have someone telling people who are essentially disenfranchised on the street to move on the youre a Law Enforcement officer or youre for d. P. W. Or you dont have credibility with the consumer. I think that having a Fire Department captain there has really been the form of success in this case. Okay, i want to talk about challenges that weve been facing quickly before i go on to the street crisis Response Team. I recognized that the situation with conservatorship is of interest to many of the commissioners. So we do have a lack of placement options. Essentially the situation as i know it is first of all, i want to say im reluctant to talk about this because except for an explanation of the difficulties we face trying to get peel off people off the streets, i feel i dont have a solution to this problem and i dont want to point to any agency for the reason we got into this situation. [inaudible] for people that are gravely disabled and need to be under a conservato conservatorsh conservatorship, covid happened and court dates got rolled back. People that were in line to be conserved were kept in place, as patients in hospitals. Being inpatient in a hospital is an extremely expensive thing. Hospitals dont want People Living there on months on end. In addition to that because of covid again, hospitals needed to maintain a certain number of beds available for surge capability. So the result of this is that someone that may be recognized by doctors and administrators as being greatly disabled fit the criteria for conservatorship but who are not acutely at risk are left in the community. This is what weve seen. We have we can see people that are completely reliant on the medical system. Without us, they would die. There is nowhere to take these individuals. Were left in an quandary because we provide such wrap around care and support for these people that doctors and administrators think that the person is doing just fine. If theyre doing just fine, whats the problem . We might be saying look, this person really cant be on the street. They cant be themselves. Theyre not showing up at the door because were doing somersau somersaults, trying to keep somebody safe and alive. This is what were doing. We want to express its very difficult and frustrating at times. From my end, i do not know what the solution is. That is one challenge that we face and im sure that you all have questions, which i will be happy to attempt to answer, perhaps dr. Yeh. Another challenge that i see is managing the expectation of the public. The street crisis Response Team was scheduled to begin in just a few weeks, but you know, there is a lot of expectation in the community for social change and you know, we are starting off with just one unit, 12 hours a day, 7 days a week. There is no possible way you can cover all the behavioral crises in the city. The police will be playing a prominent role. So we want to make sure that the public understands that. So there we go. So there are 17 trained Community Paramedics in the Fire Department, 12 of them are currently active. We embarked in this project. We have said no to a few things but generally if someone asks if we can do something, we generally say yes, we can. We did have a covid outbreak amongst or team, 4 out of 12, thats 33 sick rate, not very good. 2 of the members had to be hospitalized. Everybody is now out of the hospital and we have only one member that has still not returned to work. We are stretched thin. Its the problem, chief nicholson and the entire command staff has been extremely supportive. Im just wanting to make sure im just talking about it as a challenge we face. Thats the challenge. Okay. Now moving on to street crisis Response Team. This is a slide that we have been using for presentations over the last few weeks. Its not a deck that i put together so im a little uncomfortable with it, but i certainly know the material so i will get through it. So, the goal of the street crisis Response Team is to respond to nonvie lent behavioral crisis in public spaces. We intend on connecting people through the care they need, reducing Law Enforcement response and reducing unnecessary e. R. Transport. So its been identified as a problem back in 2019, even before the pandemic. There had been many meetings hosted by the Mayors Office for ideas on how to improve the delivery of care to people having crises in the street. It is a focus of Mental Health reform. So Law Enforcement has traditionally been the primary agency that responds to these calls. I think i mean it started because theres been no one else to send. Police officers are by far the most ubiquitous agency on the street. There had been no other apparatus to send to people that meet wellbeing checks or reportedly have the mental disturbance. Its what the police had traditionally done. Its been a system thats difficult to change. What we propose is to have a very thoughtful change and send Healthcare Professionals and behavioral clinicians to these calls and hopefully well get a much better response. When the police go to these calls, the way the traditional system we have now by far and away, the majority are gone on arial arrival, or unable t locate, or no merit. The police are maxed out as is. If they go on the call, report of a person that may be mentally disturbed, it could take them 30 to 90 minutes to arrive. By that time, the person has left. The reporting party has already left. So we hope to get there in a timely manner and have a more rigorous approach to the engagement and the follow up care for these individuals. All right. I have just been notified that we are running short on time and i need to wrap up. Let me talk to you about what we plan on doing here. We plan on staffing were going to model this on the program, which has been in existence for about three decades. The Cahoots Program has an e. M. T. Or paramedic and behavioral clinician on a vehicle that goes out into the street. We decide to improve on that by adding a peer support specialist. That is someone who is going to be provided by ram, richmond area Multiservice Agency and Peer Support Service is someone with lived experience that may be in recovery, may have been formally homeless, that has some credibility and training to help reach the people that we will be seeing. Again, were going to focus on a Geographic Area that has known high call volume for behavioral crisis. Thinking of equity, we want to focus on other gentlemen grap c graphic gentlemen Geographic Area that may have a population thats traditionally not wanting to call 911 because they really dont want the police showing up. So during our phase one, our implementation period, were going to start in limited Geographic Areas but once we have full implementation, which will be tentative march 2021, we anticipate going. By the end of november, just a few weeks from now, we want to get our first unit on the road by end of january, 2021. Well have our second unit on the road and by end of marbch, e hope to have six total units to uncompass this work. Were going to shoot to do 15,000 to 17,000 call as year with those six units. We have a very, very large group of performance that we are envisioning, we employed a company to help us with the evaluation piece and we want to plan, study, and act. We want to see what were doing well, what we can do to improve and use data to perhaps advocate for more resources to cover more places. Okay, i just wrapped it up very quickly because i think the most important part is the question and answer. I apologize that were going so long. Any questions . Chief, thank you very much for the presentation. Can you hear me . Yes. Thank you very much to everyone who presented. This is a wealth of information. I am sure you have a lot of questions from all of the commissioners. Let me just check in with the commission secretary. Madam secretary how are we doing on time . We need to wrap up by 12 15 and there is no one on the Public Comment line. Okay, thank you. I think that we can go through some questions but it behooves us to have a follow up because there was so much information today. Well talk about how to do a follow up. How are my fellow commissioners doing . Just fine. Okay, great. So lets start with commissioner rodriguez, do you have any questions . Real quick, because i know time is limited here. We had an incident with my motherinlaw, she had dementia. Same thing, the caseworker would show up and everything was clean and in order because my wife would constantly go over there and make sure everything was okay. She would go outside, lock herself out and didnt know where she lived. The neighbors would call us and we would go and help her. We couldnt afford to put her in a home and she wouldnt agree to do it any way. So the caseworker said basically you have to, when she calls you for help, you dont answer. Then they would call the emergency, they would pick her up, take her to the hospital. When she was in the hospital, if we didnt answer, they would knowing whats going on, the caseworker would let the hospital know and they would put her in the psych ward. I mean it was really hard to do all this. Then she went in to the psych ward and from there they determined that they had to take over the conservatorship of her. That was the only way that it was going to happen. Otherwise, she would have been out on the street. To a lot of the people that are homeless right now, a lot of people were going through that. I know you said the hospitals right now for that reason arent dealing with it because theyre overworked or they dont have the room. Have you found that thats the best way to deal with this, that when you take a person in and then you just basically let the hospital know that theyre repeat offenders and stuff and for saving lives and just their regular health. There have been some of our action plans. Some of our action plans specifically indicate that the right course of action is to have someone transported to the hospital, to the e. R. We worked really hard to limit unnecessary transport service to the e. R. , but for executive reasons you just mentioned that is the thing to do. Okay. Thank you. Thank you for your report. It was really informative, whatever the word im looking for. Informative. It wasnt formal. [laughter] all right. Well thank you very much commissioner rodriguez. Lets see, commissioner feinstein excuse me, Vice President feinstein. Thank you. I have to say a few things here. Your presentation, all of you, really brought tears to my eyes. The compassion youre showing for those who may label or view differently than you do. You make us proud as a city doing all that youre doing. I cant thank you enough because it is a real issue, it is a real challenge and i know it isnt easy. So you have to be proud of yourself. Please be proud of yourselves because we are. One issue, im not sure if its a Fire Department issue, but you probably now know more about this than i do. I recall when i was still on the bench. We played hell trying to get someone conserved. It was whether someone could provide food, shelter and clothing themselves to justify the conservatorship. The city was taking the city, im saying that broadly, that if you could eat out of a garbage can, you provided food for yourself. If you could wrap yourself in black garbage bags, you were providing shelter or clothing for yourself and if you could sleep under a cardboard box, you were providing shelter. We went round and round on that and these people stayed on the streets because of the attitude that city officials were taking. Thats just a fact. Getting someone conserved is way easier to send them to prison than it was to get them conserved and to get them the help they needed and deserved and were humane. I am wondering if you have seen that change and my second question thats related is, i have a reasonable background with foster children and transitional aged combroyouth. Theres been a decrease in the number of available foster homes and were Getting Better on transitional housing, but its not great. Were Getting Better. Foster homes have moved out of San Francisco because of the cost of housing and real estate. So my second part of my question i guess my only question, the second part of my question is are you seeing that there are board and care homes that are still in existence, that are of sufficient quality and provide, you know, a level of care that we would be proud of for those few who are conserved and i love to know the number. The city doesnt want to pay for it. So however many years i have left, its going to continue to drive me crazy. I appreciate any information you can provide on that. Vice president feinstein, thank you so much for your support. I want to quickly say that we have had fantastic support from chief nicholson and her staff, dr. Yeh, the Fire Commissioners have been supportive since day one, five years ago and we wouldnt have gotten there without you guys. The idea of the difficulty of getting someone conserved, that has not changed Vice President. In fact, i think its probably only worse. We have one of the psychiatrists that worked for street medicine, dr. Anita. Shes passionate about what she does and she knows what shes talking about. She said when she was a new psychiatrist, that you get all the people on the street [inaudible] to harm themselves, because theyre eating. I think their doctors are good doctors and administrators have to make pragmatic decisions because of a lack of supply. There is no place to put people. You know, third question, board and care. Well, we feel that the supply is diminishing in the city and because of it, a lot of people are placed out of county. Did i answer everything . Yes, you did. I really appreciate it and maybe we can have a conversation offline or at some point. I would like to volunteer to try to be a help on this topic because its just yeah, its just too heartbreaking. To see what you all go through everyday and to know that it could be solved. I understand what the issues are, but to know or my perception is that youre not getting the help you need and this is not this is outside the Fire Department. I mean what the Fire Department is doing is just amazing. Everything that youre planning, everything that you done, your presentation just, you know, really through me back and to not have other City Partners stepping up to the plate and acknowledging whats going on is really troubling and disturbing to me. You know, im willing to take on a battle if there is one to be had. You know, i just i just cant speak highly enough of what youre so much braver at and courage and skill and dedication. I wish i had your guts and your talent. I really, really want to commend you on this work. Youre making me cry. Thank you. Thank you. Thank you very much. Lets see, excuse me. Commissioner nakajo. Thank you madam president. Due to the limitation of time im just going to make some comments rather than pose some questions because the material in the presentation was very comprehensive. As you all know, its overwhelming in terms of information and in terms of data. I just want to say to you that captain sloan, captain mason, dr. Yeh, chief pang, with the acknowledgment of its been five years when you started the ems6, that it has continued with chief nicholson and this commission. To the comprehensive nature of the program today and its simply overwhelming and the materials and the concept and the plans and the strategy that you provide definitely has an impact in terms of the members of our city that are part of the client case load. The words that setand out is passionate care. It came out of captain sloan, chief pang, dr. Yeh, in the form of ems6 and how it has evolved to this point is simply amazing. The kinds of indicators that concern me are the challenging sections, in terms of lack of resources, in terms of where to house these individuals or the understanding of change of policies from the Police Department in response to the homeless and even in terms of my community, how we have homeless members now that are preparing one of our hotels in japan town and yet there is a situation by which now there has to be ady simulation out of these hotels because of cost in terms of trying to find housing or some kind of relief in terms of where he is a real leader that listens and knows how to bring people together. Brought this department together like never before. I am so excited to be swearing in the next chief of the San Francisco Fire Department, ladies and gentlemen, lets welcome, Jeanine Nicholson. applause . I grew up total tomboy, athlete. I loved a good crisis, a good challenge. I grew up across the street from the fire station. My dad used to take me there to vote. I never saw any female firefighters because there werent any in the 1970s. I didnt know i could be a fire fighter. When i moved to San Francisco in 1990, some things opened up. I saw women doing things they hadnt been doing when i was growing up. One thing was firefighting. A woman recruited me at the gaypride parade in 1991. It was a perfect fit. I liked using my brain, body, working as a team, figuring things out, troubleshooting and coming up with different ways to solve a problem. In terms of coming in after another female chief, i dont think anybody says that about men. You are coming in after another man, chief, what is that like. I understand why it is asked. It is unusual to have a woman in this position. I think San Francisco is a trailblazer in that way in terms of showing the world what can happen and what other people who may not look like what you think the fire chief should look like how they can be successful. Be asked me about being the first lbgq i have an understands because there are little queer kids that see me. I worked my way up. I came in january of 1994. I built relationships over the years, and i spent 24 years in the field, as we call it. Working out of firehouses. The Fire Department is a family. We live together, eat together, sleep in the same dorm together, go to crazy calls together, dangerous calls and we have to look out for one another. When i was burned in a fire years ago and i felt responsible, i felt awful. I didnt want to talk to any of my civilian friends. They couldnt understand what i was going through. The firefighters knew, they understood. They had been there. It is a different relationship. We have to rely on one another. In terms of me being the chief of the department, i am really trying to maintain an open relationship with all of our members in the field so myself and my deputy chiefs, one of the priorities i had was for each of us to go around to different fire stations to make sure we hit all within the first three or four months to start a conversation. That hasnt been there for a while. Part of the reason that i am getting along well with the field now is because i was there. I worked there. People know me and because i know what we need. I know what they need to be successful. I have known Jeanine Nicholson since we worked together at station 15. I have always held her in the highest regard. Since she is the chief she has infused the department with optimism. She is easy to approach and is concerned with the firefighters and paramedics. I appreciate that she is concerned with the issues relevant to the Fire Department today. There is a retired captain who started the Cancer Prevention foundation 10 years ago because he had cancer and he noticed fellow firefighters were getting cancer. He started looking into it. In 2012 i was diagnosed with breast canner, and some of my fellow firefighters noticed there are a lot of women in the San Francisco Fire Department, premenopausal in their 40s getting breast cancer. It was a higher rate than the general population. We were working with workers comp to make it flow more easily for our members so they didnt have to worry about the paper work when they go through chemo. The turnout gear was covered with suit. It was a badge to have that all over your coat and face and helmet. The dirtier you were the harder you worked. That is a cancer causeser. It casser. It is not cancer causer. There islassic everywhere. We had to reduce our exposure. We washed our gear more often, we didnt take gear where we were eating or sleeping. We started decontaminating ourselves at the fire scene after the fire was out. Going back to the fire station and then taking a shower. I have taught, worked on the decontamination policy to be sure that gets through. It is not if or when. It is who is the next person. It is like a cancer sniper out there. Who is going to get it next. One of the things i love about the Fire Department. It is always a team effort. You are my family. I love the city and department and i love being of service. I vow to work hard to work hard to carry out the vision of the San Francisco Fire Department and to move us forward in a positive way. If i were to give a little advice to women and queer kids, find people to support you. Keep putting one foot in front of the other and keep trying. You never know what door is going to open next. You really dont. [cheers and