Madame secretary spews next order businesses item 10 closed session. Theres no closed session items. Nextdoor business is item 11 adjournment i favorite item. Adjournment. So we are adjourning at 2 11 pm. [gavel] [adjournment] test. America and to the republic for which it stands, one nation under god, indivisible, with liberty and justice for all. This is a reminder to silence owl Electronic Devices the regularly wednesday, march 8, 2017, and the time is 902 roll call commissioner president Ken Cleaveland commissioner vicepresident Stephen Nakajo commissioner Michael Hardeman commissioner Francee Covington capitol hill of department chief joanne hayeswhite item 2 general Public Comment to the public that are within the subject matter jurisdiction of the commission except agenda items. With respect to agenda items, your opportunity to address the commission will be afforded when the item is reached in the meeting. Each member of the public may the lack of a response by the commissioners are Department Personnel doesnt constitute the statements during Public Comment. Is there any Public Comment anyone wish to address us okay Public Comment is closed. Approval of the minutes important Meeting Minutes of the regular meeting of wednesday, march 8, 2017. Any Public Comment on the minutes seeing none, Public Comment is closed. Commissioners what is your pleasure. So moved. Do i have a second. Second mr. President , as well as the special meeting on march 2 all in favor, say i. Opposed . Seeing none, minutes are approved thank you next item, please. Madam secretary. Item 4 update on ems 6 program to provide update on the ems 6 Program Since implementation of the program. Welcome doctor yeah. Good morning medical director forever the Department Im pleased to provide an update for the ems 6 program and ask folks to join me at podium to give a presentation id like to between the three of us give a 15 minute presentation to describe some of the activities of ems 6 program over the last 12 months and talk about the inception of the program and give examples of work up to in the last year and also both some of the successes and challenges of the program and hopefully also ideas of directions the program should be going in addition im lucky to have the presence of. H a few honored guests i want to recognize doctor john brown here on behalf of find the Public Health and jim wagner in the back row here on behalf of the permit Holder Department of homelessness and supportive of housing a couple of other members id like to point out jason one of our Wonderful Team members with the Homeless Outreach team in the back row and Michael Mason in the capacity for the ems 6 ill go ahead and get started with the presentation can i have the slides thank you the commission recalls the ems 6 program is a reenvisioning of a Prior Program within the Fire Department that looks to team up a unique pair of ems h33 captain where a Homeless Outreach working with an attempt to connect many of the vulnerable clients in the city with the City Services that help to stabilize the situation and the continual needs for nonemergency the origin of the name the ems 6 goes to the program that the some other significant meaning the ems star of life as designed by some consists of 6 different star points each represents a mission of the ems and the 6 star point is the controversy and connections wellness the repair that in many cases people rely rely on the Emergency Services it addresses the locations and then from an operational stand point as i mentioned functionally for us over the last year the ems as a paramedic captain that is paired with a Homeless Outreach team worker and who is connected with the department of Health Medicine and who are available for assistance 12 hours a day if noon to midnight for this purpose to address the frequent users of 9191 so youve met in the past some of the team members involved in the project and again paramedic captains are here as coperntsdz the Team Available in the system since the end of january 2016 through continuous operations weve been available 7 days a week and the team is dispatched to 911 and available as well as both addressing and outreaching to 911 clients for high users and performing outreach in a nonemergency fashion when i mention frequent users many people have ideas with the 911 frequency users i want to clarify the Overall Mission of the project not to prevent people from utilizing the services but were people that rely on 911 as safety net that we address these people by interaccepting them in the 911 and body camera them trying to find out who happens to require them to use the if i any system with the users have several case depictions from a fungal stand point we recognize the people that are calling 911 more than 4 time a month or 4 times a day and recognition those are the people we want to find out in their needs and recognize that in some of the literature about 911 super users people that use any any more than ten times a year are at risk the city has identified certain patients as the comes or high users of must not systems in addition to 911 services these are the top one to 5 percent of clients that use shelters or hospitalization or longterm care or using the Emergency Services those are the overall patient base were trying to gave me and find out why narrowing dndz 911 services and stabilize their situation with that in mind one thing that the observed this is a team effort to the best of my knowledge there is a good reason people with calling and it takes a huge effort with multiple agencies as youll see later on many, many people will address the needs of the individual okay so, now kind of get into the meat of what the activities have been as i mentioned in the 11 update 11 months ago from the time is ems was in the system it has been busy weve basically hit the ground running that monuments to 7 encurrent a watch that is the operational period i want to emphasis the encounters the el cap team have with the clients are complex this is very different than our usual the immediate recognition of a life threat with the transfer to the hospital many, many times it involves careful assessment of the detailed interviews a very extended building of trust and then a lot of coordination and communication with other entities that come up with a plan of care and conviction so this is an extended encounter and something that ems 6 is specifically adopted to do and allows our other 911 assets our engines and ambulance cruise to go back into certify and be very available for other Services Rather than performing this type of assessment we have a total of as i mentioned we average around 7 encounters per watch but ties about 13 in the busiest of days and a total of 6 r 4 hundred and 67 units you may notice the unique client list is smaller that might seem puzzling but youll see themselves 68 high users weve been maybe the best way to put 2 involved in the care of people that depend on 911 a lot this is the people we gave me in we encounter each individual is a high number of encounters and the number is those extended evaluations are involved when we engage the high users when we can prevent or find a different solution than arbitrating to the hospital that is different and in terms of the financial implication if you recall that a single transport every in our system is 1,700 charge that means there are around 60 avoided ambulance introverts to the new if any, that amounts to one hundred thousand dollars for the first charges and so certainly we have a lot to improve in the lives but this system is an indication of the type care as well workplace in mind, i will im going to turn it over to captain tang to give that a little bit more perspective on the cases. Welcome captain. Good morning, commissioners and my name is captain simon tang and case study one is a woman in her 40s a mother of grown children shes been living in the city homeless for several years in 20152016 shes a top one percent patient high user of multiple City Services it many means she used more than 99 percent of other folks she had a history of the alcohol abuse disorder and millennials and trauma we began graphing searching for her on the street to try to prevent the next 911 call one day one evening my colleague of the homelessness Outreach Team relocated her on a beverage with an empty bottle of red wipe she was passed out couldnt stand or talk that was getting discard it was very cold she was wearing a shit if we didnt locate her we would have had a medical emergency what it took to get her to stay in detox not easy then we got her into treatment there were many relawyers up and at this point, i want to point out the graph to you on that graph in the vertical access is a number of contact by 911 contacts or ems 6 outreach contact so the red line is a number of new any contacts that she had by two week integrals over 2016 so as you can see on this particular slide here that big red spike she called 9118 times if you look at carefully that ems 6 had 3 engagement with her on that sdwral and over time i think this graph shows we effectively drove down her 911 usage as our number of engagements increased one day in june after she was sober so for many weeks in a unit she her family back east or in the mid west had a family tragedy she told us she wanted to be with her family so on her own she called the doctor and bought a bus ticket and left we stay in contact with her shes got difficult moments relapsed but the last time we spoke she was sober and happy. Good morning commissioner im kathy and go over a case study two and three so case study 2 is a location of the collaboration with the sober to get a gentleman into supportive of housing this is a gentleman who had beat previous addictions but on the streets called the services and began to outreach him aggressively and into the sober center he went there and agreed to Case Management we coordinated a entry into medical detox he was disconnected from services we were able to find him a program he was discharged from detox and went into the streets and relapsed and sobering to secure the appointments we cooperated a resubway into the Treatment Program in the meantime the sobering case manager submitted the case he got the housing the supportive of housing daily contact with the case manager and keeps in touch with him and case study number 3, is a gentleman that we helped to re50i7b9 with his family the number was 69 in 2016 this gentleman had two lengthy stays where he was not generating calls and must not calls one day during an 8 hour period 4 contacts i realized there was a significant impairment problem we called the hospital and talked with the social workers and the nurse they reached cynthia pollock in transfer to the medical hospital with insurance and after a long lengthy process with insurance dph and patient we decided to transfer him to another Insurance Plan so the readmission he has mel deintoxicated and allowed to go home after the family at dph the decision to an assistant home a social working and ems accompanied him across the country where he is now. Let me say youre the one that k0i79d him to reunite with his family; correct . Correct. Id like to thank. clapping. i want to add that last thing that april described for the last 3 years were the top one hundred percent of the patients this slide shows not able examples where people lives have been changed and this colombia second from the left and red those are the number of new any calls forces 2016 prior to my attention and the column in blue its shared with so many others blue in these cases ems 6 has been influential in the outcome so i want to point out that if you add all the red numbers adds up to 6 hundred and 42911 calls in 2016 if you add up the blue numbers and x palate the blue numbers are 2016 and up to now if you extrapolate them for 4 quarters of 2017 it comes out to a fraction of what of those happening ill point out some examples case 3, 19, 911 calls this was a male in his 60s with schizophrenia and called 911 but never stayed they hospital long we asked we Budget Committee searched his assets for a higher degree of oversight they did and since then in july zero 911 calls case no. 1038, 911 calls a homeless meddle person he is mel frail we began to stir him to the center repeatedly until it become habit every night hell could go to the Sobering Center since december 3rd a 3 month period on there 3 times and extrapolate that is 12 far lower than 38 and finally example will be case 1248, 911 calls this is a person with seer alcohol had that is mentally illness and resistant to treatment we shepherded him through detox and treatment as of two weeks hes housed in the first 8 months of 2016 he called 91148 times and the previous 8 months 5 times now the finally case study well be remiss if we only shows certain case but we noticed it the case that gives you the most difficulty often involve people with severe mentally illness a male in his 50s schizophrenia and with a disorder formally housed but evicted from direct assess housing pr his case manager booked a hotel at the start of every month after a week goes by hes on the streets this individual calls 911 says hes hunger when i arrive on scene he says simon i want to sandwich if at the didnt get one he walks into traffic and uses the hospital for a shelter and leaving paramedics and outreach workers and nurses to clean up after him hes well known in pe s but police holds are listed one minutes and his suicidal so what do we do if you look at the graph as you can see were unable to manage his 911 usage we cant get on top of that curving next steps ill leave that to doctor yeah. So thank you both very much and i wanted to i hope this is illustrates some of the great work that paramedic captains tang and bassett and others our partners have been undertaking i think when i see that last case in particular that makes me release there are a lot of struggles and challenges i want to say that in terms of engaging our highest users within the system i feel like the design of ems 6 has shown that is an acceptable design in fact 90 percent of ems 6 have encountered people that saved that high user super user excuse me having more than 10 encounters with 911 in a 12 month period we look at the overall statistics we see there among other things we gave me less than half of them; right . There is a request why are people depending on 911 so much not having the services met whether this is a matter of deployment or circumstances that is difficult to say i have suspicions i think that that can drive the programs of the future but suffice is it to say in this system 101 to grow and that designs is very, very busy engaging the clients i think we need to engage from that stand point the design is successful i wanted to note that we had a lot of concerns initially and trying to decide and see the assets of vulnerable for that the clients 71 percent of the people that engaged were super users recorded homelessness in 2016 i think the housing and security is significant part of the challenge for the people that were trying to help so this slide may be difficult to see some of the numbers but the upper box illustrates what i think were all aware of the system is growing we are seeing annual growth rates in the overall 911 calls and relative increase in the super users that says that growth level is stable excuse me continuing the lower box, however, shows the number transports that each super user in 2016 we the actual number of transport was stable and decreased despite the number of users in the system grew and the other system grew it is difficult to conclude very much from an overall broad number ill point out that is one of the specific metrics this was designed to address the number of ambulance the amount of ambulance utilitytion what is been stable so with that are the contributing things to allow the stabilization as mentioned multiple times aulti departmental and complex source problem that are a lot of questions answered but in the gross of metrics we have the system impacts and finally one of the most existing things that developed over the last 12 months was ill say was the development of the california states Pilot Projects in the entry of the pilot progress announce with the San FranciscoSobering Center the Fire Department has become california Ems AuthorityPilot Project number 13 we join a number of projects throughout the state that are addressing novel ways to provide care i think well be able to better address the needs of the population so the specific projects involved are Community Paramedics and owl paramedics in the system improving patient care by instead of bringing patient to a hospital selects a number of patients who are stable and have evidence of alcohol intoxicate to bring them to the sober center instead thank you for the partners who were able to make that happen both the department of Emergency Management and department of health and the california Ems Authority and of note in january we as a department completed a paramedic core course and graduated 10 paramedics that joined in the first paramedics of sta