HomeMy WebLinkAboutFD Grand Jury Response re 911 First Responder Referral ProgramCITY OF
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Agenda Item No: 4L.
Meeting Date: August 15, 2016
SAN RAFAEL CITY COUNCIL AGENDA REPORT
Department: Fire
Prepared by: Christopher Gray, Fire Chief City Manager Approval:
TOPIC: Response to the Grand Jury Report on the 911 First Responder Referral Program
SUBJECT: CONSIDERATION OF A RESOLUTION OF THE CITY COUNCIL OF THE CITY OF
SAN RAFAEL APPROVING AND AUTHORIZING THE MAYOR TO EXECUTE THE
CITY OF SAN RAFAEL RESPONSE TO THE 2015-2016 MARIN COUNTY CIVIL
GRAND JURY REPORT ENTITLED "THE 911 FIRST RESPONDER REFERRAL
PROGRAM: MORE THAN A BAND-AID FOR SENIORS"
RECOMMENDATION:
Staff Recommends that City Council of the City of San Rafael adopt the attached Resolution approving the
proposed response to the Grand Jury report and authorizing the Mayor to execute the response.
BACKGROUND:
The 2015-2016 Marin County Civil Grand Jury has issued its report dated June 9, 2016 entitled "The First
Responder Referral Program: More than a Band Aid for Seniors." (See Attachment B) The Grand Jury has
requested a response from all of the cities and towns in Marin, their respective Fire/EMS service providers, and
Central Marin Police Authority. The City of San Rafael has been asked to respond to recommendations Rl-R3.
The Grand Jury's Findings are set out on page ten (10) of the fifteen (15) page report.
The Grand Jury recommends that all Fire/EMS Agencies in Marin County do the following:
• Implement the 911 First Responder Referral Program County -wide.
• Coordinate with agencies throughout the County to create an outreach campaign for the 911 First
Responder Referral Program.
• Expand training for the First Responder referral program to include all Marin County Police and Sheriff
Patrol personnel, all Marin County paramedic personnel, and all private ambulance personnel operating
within the County.
Staff agrees with Grand Jury Findings F1 -F3, and as more fully set forth in the proposed response to the Grand
Jury (see Exhibit to attached Resolution) Staff is in the process of implementing Recommendations R1 -R3.
ANALYSIS:
FOR CITY CLERK ONLY
File No.: 269
Council Meeting: 08/15/2016
Disposition: Resolution 14180
SAN RAFAEL CITY COUNCIL AGENDA REPORT / Page: 2
In 2015, a partnership formed between San Rafael Fire Department and County's Aging and Adult Services
Information and Assistance (I & A) unit. Through multi -agency collaboration this program provides a streamlined
process to get persons connected with ongoing community resources and support. After a first responder makes
the referral, staff of I & A contact the resident or family member to assess the need for such things as
transportation, caregiver support, food and shopping, and social activities. Through a collaborative relationship
with the County I & A team, the San Rafael Fire Department is able to provide a wider range of services to
residents and business owners in San Rafael.
The Civil Grand Jury report findings emphasize that effective regional partnerships have been fundamental to the
success of the 911 First Responder Referral Program. The report recommendations encourage expansion of these
regional partnerships in order to support the provision of improved health care and social services County -wide.
The San Rafael Fire Department fully agrees with the findings of the report and looks forward to implementing
the report recommendations in collaboration with the Marin County Fire Chief s association.
FISCAL IMPACT:
There is no direct fiscal impact from the recommended action in this report.
ACTION REQUIRED:
The City is required to respond to the Grand Jury Report. Penal Code section 933(c) states in part:
"No later than 90 days after the Grand Jury submits a final report ... the governing body of the public
agency shall comment to the presiding Judge of the Superior Court on the findings and
recommendations ... (contained in the report)."
To comply with this statute, the City's response to the Grand Jury report is required to be approved by Resolution
of the City Council and submitted to the Presiding Judge of the Marin County Superior Court and the Foreperson
of the Grand Jury on or before September 7, 2016. A proposed Resolution is included that would approve staffs
recommendation for the City's response (Exhibit A)
OPTIONS:
The City is required to respond, however, the City Council has the following options to consider on this matter:
Adopt Resolution approving the proposed response;
Adopt Resolution with modifications to the proposed response;
Direct staff to return with more information.
RECOMMENDATION:
Staff recommends that City Council adopt the attached Resolution approving the proposed response to the Grand
Jury report and authorizing the Mayor to execute the response.
ATTACHMENTS:
A. Resolution with attached proposed response
B. Grand Jury report dated June 9, 2016
RESOLUTION NO. 14180
A RESOLUTION TO THE CITY COUNCIL OF THE CITY OF SAN RAFAEL
APPROVING AND AUTHORIZING THE MAYOR TO EXECUTE THE CITY OF SAN
RAFAEL'S RESPONSE TO THE 2015-2016 MARIN COUNTY CIVIL GRAND JURY
REPORT ENTITLED "THE 911 FIRST RESPONDER REFERRAL PROGRAM: MORE
THAN A BAND-AID FOR SENIORS: '
WHEREAS, pursuant to Penal Code section 933, a public agency which receives a Grand Jury
Report, addressing aspects of the public agency's operations, must comment on the Report's
findings and recommendations contained in the Report in writing within ninety (90) days to the
Presiding Judge of the Superior Court with a copy to the foreperson of the Grand jury; and
WHEREAS, Penal Code section 933 specifically requires the "governing body" of the public
agency to provide said response and, in order to lawfully comply, the governing body must
consider and adopt the response at a noticed public meeting pursuant to the Brown Act; and
WHEREAS, the City Council of the City of San Rafael has received and reviewed the 2015-
2016 Marin County Civil Grand Jury Report, dated June 9, 2016, entitled "The 911 First
Responder Referral Program: More Than a Band-Aid for Seniors."
NOW, THEREFORE, BE IT RESPOLVED that the City Council of the City of San Rafael
hereby:
1 Approves and authorizes the Mayor to execute the City of San Rafael's response,
attached hereto and incorporated herein by reference, to the 2015-2016 Marin County Civil
Grand jury Report, entitled "The 911 First Responder Referral Program: More Than a Band-Aid
for Seniors."
2. Directs the City Clerk to forward the City's Grand Jury Report response to the
Presiding Judge of the Marin County Civil Grand Jury.
I, ESTHER C. BEIRNE, Clerk of the City of San Rafael, hereby certify that the foregoing
Resolution was duly and regularly introduced and adopted at a regular meeting of the City
Council of said City held on Monday, the fifteenth day of August 2016, by the following vote, to
wit:
AYES:
Councilmembers:
Bushey, Colin, Gamblin, McCullough & Mayor Phillips
NOES:
Councilmembers:
None
ABSENT:
Councilmembers:
None
ESTHER C. BEIRNE, City Clerk
2015/2016 MARI/Y COUNTY CIVIL GRA/YD JURY
The 911 First Responder Referral Program
More Than a band -did° Forfeniors
Report Date: June 9, 2016
Public Release Date: June 16, 2016
a
-9 •
COUNTY OF MARIN
i
Marin County Civil Grand Jury
The 911 First Responder
More Than a Band-Aic"�'
SUMMARY
Referral Program
For Seniors
9-1-1: ... Okay, tell me exactly what's happened. [actual call]
Caller: My mother, who's 81, has fallen and kind of collapsed.
9-1-1: Are you with her now?
Caller: She's laying on the floor now and I'm walking towards her now.
9-1-1: Is she awake and breathing?
Caller: Yes, she's awake and breathing.
9-1-1: And when did this happen?
Caller: Moments ago. Maybe five minutes.
9-1-1: And do you know what caused the fall?
Caller: We don't. She was leaning against the wall when my father walked in the room.
Imagine you are a frail senior citizen living alone and finding it difficult to manage your daily
chores and stay independent. Suddenly, you find yourself on the floor, a little banged up and
unable to get up. What would you do? You would likely call 9-1-1 for help.
Most Marin County citizens have probably never needed to call 9-1-1 to report a medical
emergency. But if they did, within a few minutes they would likely see a fire engine and
ambulance arriving at their location and know that they would be in good hands.
When an emergency first responder (paramedic, firefighter, or police officer) arrives on scene,
after they treat the patient, there are two alternatives: 1) transport the patient to a nearby hospital
or 2) leave the patient at the scene. With an aging senior population, responders frequently find
themselves returning to the same patients. While they are eager to address the immediate problem,
they are unable to address the underlvin2 issue: poor balance, poor diet, dementia, Alzheimer's or
other memory -related disease, etc.
The 911 First Responder Referral Program was launched by the San Rafael Fire Department in
2014 to empower emergency first responders to provide a referral, with the patient's consent, to
Aging and Adult Services Information and Assistance Program (part of Marin County's Health &
Human Services). If the patient doesn't want the referral at that time, the responder leaves
information behind so the patient and caregivers can learn more about available programs and
contact Information and Assistance when he or she is ready.
This report describes how the 911 First Responder Referral Program can be a win -win-win for
Marin County:
■ Senior citizens' quality of life may improve by obtaining assistance in helping to manage
their long-term issues.
■ Marin County's Health & Human Services has an opportunity to intervene earlier to
improve the client's health and wellness.
■ Emergency first responders receive fewer 9-1-1 calls.
BACKGROUND
The percentage of Marin County residents who are at least 65 years old (senior citizens) has been
growing steadily for decades and is estimated to continue to grow for at least another decade':
30.00%
22 50%
m
a,
m
vGi 15 00%
U
7.50%
0 00%
Percentage of Population 55 Years and Older
1970 1980 1990 2000 2010 2020 2030 2040
Year
Many chronic health issues afflict senior citizens 2: heart disease, hypertension, stroke,
emphysema, asthma, chronic bronchitis, cancer, diabetes and arthritis. Having one or more of
these health problems increases the chances of falling3. According to the U.S. Centers for Disease
Control and Prevention4:
■ One-third of Americans aged 65+ fall each year.
■ Every 13 seconds, an older adult is treated in the emergency room for a fall; every 20
minutes an older adult dies from a fall.
■ Falls are the leading cause of fatal injury and the most common cause of nonfatal trauma-
related hospital admissions among older adults.
■ Falls result in more than 2.5 million injuries treated in emergency departments annually,
including over 734,000 hospitalizations and more than 21,700 deaths.
■ In 2013, the total cost of fall injuries was $34 billion.
■ The financial toll for older adult falls is expected to increase as the population ages and
may reach $67.7 billion by 2020.
' htto://www.bavareacensus.ca.2ov/counties/MarinCountv.htm and California Department of Finance: Report P-1
(Age): State and County Population Projections by Major Age Groups, 2010-2060 (by decade)
(http://www.dof.ca.2ov/research/demographic/reports/nroi ections/P-1 /1
2 Federal Interagency Forum on Aging -Related Statistics, Older Americans 2012: Key Indicators of Well -Being
httD://aginastats.gov/aiiingstatsdotnet/Main Site/Data/2012 Documents/Docs/EntireChartbook.pdf
3 htto://www.healthina2ing.or-2/aging-and-health-a-to-z/tonic:falls/info:causes-and-svmDtoms/
4 http://www.cdc.2ov/homeandrecreationalsafetv/falls/adultfalls.html and httDs://www.ncoa.or2/resources/falls-
prevention-fact-sheet/
June 9, 2016 Marin County Civil Grand Jury Page 2 of 15
Besides the previously mentioned chronic health issues, senior citizens are increasingly affected
by Alzheimer's diseases:
■ One in nine people age 65 and older has Alzheimer's disease.
■ It is the fifth leading cause of death for those age 65 and older.
■ In 2015, approximately 473,000 people age 65 or older will develop Alzheimer's disease
in the United States.
■ Between 2000 and 2013, deaths attributed to Alzheimer's disease increased 71 percent.
With the growth of the elderly population emergency medical providers throughout the United
States have developed a number of programs that address their common health challenges:
■ In 2002, the City of Berkeley (California) launched The Senior Injury Prevention
Program6, a collaboration between Berkeley's Fire Department, Health & Human
Services, and the Division of Aging. While Alameda County's Senior Injury Prevention
Project actively educates people in senior centers, the City of Berkeley wanted to support
their fire departments, who could do more with frequent "elderly lift assist" calls. With
over 13,000 senior citizens, emergency first responders currently refer 4-5 seniors/month
to the Aging Services Division for follow-up case management services.
■ In 2003, Hawaii's State Department of Health, Injury Prevention and Control Section
started working with community partners to prevent falls among senior citizens and
developed a Hawaii Falls Prevention State Plan9. Concerned that the increasing volume of
fall -related injuries being treated by emergency healthcare providers will threaten Hawaii's
healthcare system, they have convened a number of Hawaii Fall Prevention Conferences.
■ In 2007, Satellite Beach10 (Florida) started offering fall -prevention fairs and providing 90 -
minute free in-home risk assessments. After conducting approximately 100 home
inspections, emergency first responders have seen a 7% drop in falls with injuries and hip
fracture -related incidents were reduced by 37%11
■ In 2010, San Diego 12 (California) implemented an electronic system for paramedics to
provide medical case manager referrals for "vulnerable patients". Using a combination of
9-1-1 and 2-1-1, these patients are able to access (free or low cost) community services to
obtain help for finding food, housing and other senior services. As a result, connecting
seniors to services within the community reduced the 9-1-1 system call volume. 2-1-1 San
5 httos://www.alz.ory/facts/downloads/facts figures 2015.ndf
6 htto://www.ci.berkeley.ca.us/Health Human Services/Division on Aging/
Senior Companion Caregiver and Iniury Prevention Proarams.aspx
7 htto://stoDfalls.orL,/advocacv/success-stories/alameda-countv-senior-iniury-prevention-Droiect/
8 htto:Hhealth.hawaii.aov/iniurvorevention/files/2013/09/HIPP-2012-2017-Falls-Prevention-671KB.Odf
9 httos://www.hawaiiadre.orL,/Portals/ AgencvSite/2013Falls.pdf
10 htto://www.satellitebeachfire.com/#!fall-i)revention/cl lm6
11 Statistics provided by Satellite Beach Fire Rescue (Florida)
12 httn://www.iems.com/articles/print/volume-41/issue-2/features/
how-san-die go-ems-inte grated-system-wide-conditional-social-referrals-in-epers.html
June 9, 2016 Marin County Civil Grand Jury Page 3 of 15
Diego 13 also offers a free Are You OK? automated daily phone call as a senior safety
check.
■ In 2013, Delaware County (Ohio) launched the First in Response To Seniors14 (FIRST)
program. Their initial challenge was establishing clear internal communication among the
various team members: first responders, service coordinators, directors and legal
representatives. A grant from local Area Agency on Aging 15 covers 85% of the cost of the
program. Of the 477 referrals in 2015, eight individuals were enrolled in a Community
Support Program, and 26 individuals had new services added to their established care
plans. Thus, the FIRST program accelerated the establishment and/or addition of much
needed services.
■ In 2014, Central Mason Fire & EMS 16,17 (Washington State) joined with the Mason
County EMS Council to create a Falls Prevention Program, which has since expanded to
five surrounding Washington counties. Their baseline data showed that senior citizens
comprised 2/3 of hospital admissions for falls, and their initial EMS referral program
reduced falls by about 10%. They are hoping to reduce falls to a total of 30% using the
Otago Exercise Programme18.
■ In 2015, police, fire and EMS agencies in Hamburg (New York) 19 began offering free fall
prevention safety checks.
The public might not be aware, but most fire departments and fire protection districts in Marin
County offer free home safety inspections upon request. In addition to offering inspections to look
at all home hazards (structure, vegetation, fall -prevention, etc.), the Novato Fire Protection District
offers a Fall Prevention Program that addresses several concerns that contribute to elderly falls20.
Their first responders will soon be distributing a Tips to Prevent Falls handout.
Less well known than the emergency 9-1-1 service, the 2-1-1 service offered throughout the
United States "connects callers with hundreds of programs to help people find food, housing,
health care, senior services, child care, legal aid, volunteer opportunities and much more."21
Accredited by the Alliance of Information and Referral Systems (AIRS)22, the United Way of the
Bay Area operates the Bay Area 211 free helpline for five counties 23. The 2-1-1 service provides
resource information from local agencies and it is up to the caller to make contact with any service
or agency.
13 httD://www.21Isandieeo.ore/
14 httD:Hfirehouse-servcoord.orp/_)ae_ es/16
15 httD://www.n4a.or2/
16 Emergency Medical Services (EMS)
17 htto://www.kitsansun.com/news/local/mason/
first-responders-take-new-approach-with-seniors-Drone-to-falls-eD-693 524697-3 5 5196461.html
18 htto://www.acc.co.nz/PRD EXT CSMP/erouDs/external providers/
documents/DublicationsDromotion/Drd ctrb118334.Ddf
19 httD://www.twcnews.com/nvs/buffalo/news/2015/12/15/
fire--Dolice-and-ems-personnel-volunteer-to-offer-fall-prevention-services-to-the-elderlv.html
20 Developed in partnership with Dominican University of California's Department of Occupational Therapy
21 httDs://uwba.ore/211
22 htto://www.airs.ore/i4a/Da2es/index.Cfm?Da2elD=3376
23 Service also available at httD://21 lbavarea.ore/
June 9, 2016 Marin County Civil Grand Jury Page 4 of 15
METHODOLOGY
In researching this topic, the Grand Jury:
■ Investigated similar programs in other states.
■ Interviewed Marin fire chiefs to learn how emergency medical services and the 911 First
Responder Referral Program are deployed in their service area.
■ Interviewed staff in Marin County Health & Human Services to understand how the
County handles these referrals.
■ Interviewed United Way of the Bay Area staff who oversee 2-1-1 implementation.
DISCUSSION
In June 2014, the San Rafael Fire Department launched the 911 First Responder Referral
Program. Although emergency first responders observed recurring senior -related issues, they were
limited to treating the immediate problem, but could do nothing to prevent its recurrence. The 911
First Responder Referral Program developed a simple form that is sent to a referral team. The
form is provided to the referral team only if the senior citizen or adult agrees that such additional
aid or assistance is necessary and desired. However, in the early months they were challenged by
the limited capacity of the referral team.
In January 2015, Marin County's Aging and Adult Services24 established the Information and
Assistance Program (I&A), to provide customized client -centered referral support. Before I&A
was launched, people wanting information on County programs would have to navigate a
complicated automated phone system. The new program was to provide a higher level of service, a
single contact point, and a system for follow through.
Early in 2015, San Rafael Fire Department started working with the Information and Assistance
Program to streamline the referral process and ensure referral tracking. The resulting collaboration
allows first responders to initiate a referral and know that help would be available much sooner.
The 911 First Responder Referral Program does not change what responders do or how they do
it—they simply are given "another tool for their toolbox" to help their patients. The program
simplifies the responder's job by using a standardized form and relying on Aging and Adult
Services Information and Assistance Program's expertise to find the best solutions for the patient.
Since Marin County Aging and Adult Services helps both seniors and adults, the 911 First
Responder Referral Program can also refer adults for help, although the majority of medical 9-1-1
callers are senior citizens.
To date, the Fire Department has trained 60 San Rafael Fire Department first responders and 40
San Rafael Police Department patrol officers to recognize elderly patients with age-related
problems and connect them with community resources these patients might not be aware of.
24 httn://a2in2.livelonelivewellmarin.or2/
June 9, 2016 Marin County Civil Grand Jury Page 5 of 15
The Process
When someone in San Rafael calls 9-1-1 with a medical emergency:
1. 9-1-1 dispatches appropriate emergency medical services.
2. Emergency first responders (usually a fire engine and ambulance) arrive and begin
appropriate treatment.
The 911 First Responder Referral Program can begin after the patient is stable. While
treating the patient, first responders are also trained to be aware of their surroundings,
looking for obvious indications 25 that the patient has some underlying problems, such as:
their home in disarray; they are heating their home with an oven; they are at risk for
medication interaction complications; they do not have a local support network; they have
insufficient or inedible food; their memory is impaired. While a person may appear fine in
public, in private it may be clear to the responder that they are at risk.
4. If the responder determines that their patient already has a social worker assigned to them
(in conversation, looking at their Vial of L.I.F.E.26, or from a relative), which is the case
for approximately 10% of the 9-1-1 medical callers, the responder contacts the patient's
social worker and shares their observations.
Based on the indications, the responder may offer to complete a Request to Phone Me With
Help Form for services (see Appendices A and B). The fear that many patients express is
the possibility of a loss of independence and being forced to leave their home. The
responder explains that Request to Phone Me With Help simply allows a social worker to
contact them with help and refer them to appropriate services. If the patient agrees to the
referral, the patient signs the form.
6. The responder faxes the signed form to the Information and Assistance Program and also
logs their referral into a first responder referral database. Health Insurance Portability and
Accountability Act (HIPPA) regulations 27 are followed to ensure that the patient's health
information is handled in confidence. If they do not wish to fill out the form, an
information sheet (see Appendices C and D) is left behind to educate the patient and their
caregivers about County resources.
7. Marin County's Aging and Adult Services Information and Assistance Program receives
the referral. They are mandated by the Older American's Act 28 to respond and follow-up
on 100% of all assistance referrals. Sharing the programs and resources that might be a
good match for the client's 29 needs ("resource counseling") and contacting the client's
25 In response to a 9-1-1 call, first responders are allowed to enter a dwelling without a warrant to render emergency
aid and assistance to a person whom they reasonably believe to be in distress and in need of that assistance. Once
inside on that basis, rendering that assistance could include checking for medications, but also might include looking
for other health and welfare hazards that are in plain view.
26 A small plastic vial containing an overview of a patient's medical history stored in the refrigerator. It is available
for free from any fire station in Marin County. htto://vialoflife.com/
27 htto://www.cros.gov/Reeulations-and-Guidance/HIPAA-Administrative-Simplification/
HIPAAGenInfo/downloads/hipaalaw.pdf
28 htto://www.aoa.Rov/AoA_Pro2rams/OAA/Index.aspx
29 Health and Human Services staff refer to first responder patients as clients.
June 9, 2016 Marin County Civil Grand Jury Page 6 of 15
family caregiver or nearby aide, as appropriate, the social worker helps these people
become aware of the client's situation. The social worker can also facilitate program
enrollment, including "a soft handoff'— to personally introduce them to an appropriate
program representative. At any point the client has the choice to decline service help.
8. First responders follow up with the Information and Assistance Program to ensure that
patient referrals were contacted, and update the patient's status in the first responder
database.
Funding
The San Rafael Fire Department's direct cost to implement the 911 First Responder Referral
Program is under $5,000/year, which the San Rafael Fire Department considers an investment in
their strategy to slow the growth rate of their 9-1-1 call volume.
Program Results
The San Rafael Fire Department's first responders enthusiastically endorse the program 30:
"It's an incredible tool to use."
"We're hungry to solve problems that have aggravated us and eager to use our skills."
"It feels good to do this."
Marin County's Aging and Adult Services Information and Assistance Program (I&A) now has
social workers answering calls, doing program intakes and personally helping callers understand
available resources to Live Long Live Well31. Compared to local 2-1-1 service, I&A provides a
much more personalized, comprehensive and up-to-date free service, by phone, email, and
website. 32 They shared a typical success story:
"A year ago, I reached out to an elderly couple referred by the 911 First Responder
Referral Program, who were confused and disoriented. After speaking to the wife for a
while, she gave me the number for her daughter in Sonoma, and I called her to find out
more about her parents' situation. The daughter stated that she visits her parents every
weekend and prepares food for them. After assessing the parents' situation, I gave the
daughter resources for home caregiver agencies, linked her to telephone equipment for the
hard of hearing, and gave her information for home -delivered meals. The daughter was
very pleased with our outreach in Aging and Adult Services."
In 2015 there were 41 Aging and Adult Services referrals from the San Rafael Fire Department.
That might not sound like many referrals for a service area with an estimated senior population 33
of 10,038 and 5,936 medical 9-1-1 calls. However, in previous years, these 41 people had been
30 Interviews conducted with the San Rafael Fire Department
31 http:Haging.livelonglivewellmarin.org/#projects
32 httos://www.marinhhs.orL,/aging-adult-services
33 htto://factfinder.census.2ovibkmk/cf/1.0/en/nlace/San Rafael city. California/POPULATION/PEP EST
June 9, 2016 Marin County Civil Grand Jury Page 7 of 15
responsible for over 375 calls, 90% of which were fall -related, with some people making up to
three fall -related calls a day.34
Next Steps
The Marin County Fire Chiefs Association, inspired by the results of the San Rafael Fire
Department program, is working on identifying next steps towards a County -wide emergency first
responder program and protocol. They feel that they have "hit a homerun" for fire prevention and
response, and now want to "hit a homerun" for healthcare. Many Association members have
already been implementing components of the 911 First Responder Referral Program. The goal
now is to create a better referral tracking database, offer trainings, and to develop a consistent
community outreach for the program.
Conclusion
Since the publication of the 2014 Grand Jury Report Aging in Marin: What's the Plan ?35, the
County of Marin's Aging and Adult Services has streamlined a senior citizen referral strategy with
emergency first responders. While the 911 First Responder Referral Program is still very much in
its infancy, the Grand Jury applauds the initiative of the San Rafael Fire Department and Marin
County's Aging and Adult Services Information and Assistance Program. Based on similar
programs in the United States, the Grand Jury expects that this program, when rolled out County-
wide, will not only make a significant difference in the lives of senior citizens, it will make better
use of existing local social services, and will likely reduce many preventable 9-1-1 medical calls.
34 Statistics provided by San Rafael Fire Department
35 httn://www.marincountv.ora/—/media/files/departments/ei/reports-responses/2013/aLinL in marin.pdf
June 9, 2016 Marin County Civil Grand Jury Page 8 of 15
FINDINGS
F1. Marin County's Aging and Adult Services Information and Assistance Program is a highly
proactive team of caring professionals who have a strong desire to provide personalized
assistance for improving lives of adults in the County.
F2. The San Rafael Fire Department has done an effective job implementing the 911 First
Responder Referral Program and fostering an efficient relationship with the Aging and
Adult Services Information and Assistance Program.
F3. The Marin County Fire Chiefs Association has a strong desire to roll out a consistent 911
First Responder Referral Program, which could be successful in every fire department
throughout Marin County.
RECOMMENDATIONS
R1. Marin County fire chiefs should implement the 911 First Responder Referral Program
County -wide.
R2. Marin County fire chiefs should create a community outreach campaign for the 911 First
Responder Referral Program.
R3. Marin County police chiefs and Sheriff should have their patrol officers/deputies attend the
911 First Responder Referral Program training.
R4. Marin County paramedic agencies should have their emergency first responders attend the
911 First Responder Referral Program training.
R5. Private ambulance companies serving Marin County should have their emergency first
responders attend the 911 First Responder Referral Program training.
Note: At the time this report was prepared, information was available at the websites listed.
Reports issued by the Civil Grand Jury do not identify individuals interviewed. Penal Code Section 929 requires that reports of
the Grand Jury not contain the name of any person or facts leading to the identity of any person who provides information to
the Civil Grand Jury. The California State Legislature has stated that it intends the provisions of Penal Code Section 929
prohibiting disclosure of witness identities to encourage full candor in testimony in Grand Jury investigations by protecting the
privacy and confidentiality of those who participate in any Civil Grand Jury investigation.
June 9, 2016 Marin County Civil Grand Jury Page 9 of 15
REQUEST FOR RESPONSES
Pursuant to Penal code section 93 3.05, the grand jury requests responses as follows:
From the following governing bodies:
■ Bolinas Fire Protection District (R1, R2)
■ Central Marin Police Authority (R3)
■ City of Belvedere (R3)
■ City of Larkspur (R1, R2)
■ City of Mill Valley (R1, R2, R3)
■ City of Novato (R3)
■ City of San Rafael (R1, R2, R3)
■ City of Sausalito (R3)
■ CSA #28 (West Marin Paramedic) (R4)
■ CSA #31 (County Fire) (R1, R2)
■ Kentfield Fire Protection District (R1, R2)
■ Marinwood Community Service District (R1, R2)
■ Novato Fire Protection District (R1, R2)
■ Ross Valley Fire Department (R1, R2)
■ Southern Marin Emergency Medical -Paramedic System (R4)
■ Southern Marin Fire Protection District (R1, R2)
■ Stinson Beach Fire Protection District (R1, R2)
■ Tiburon Fire Protection District (R1, R2)
■ Town of Corte Madera (R1, R2)
■ Town of Fairfax (R3)
■ Town of Ross (R3)
■ Town of Tiburon (R3)
The governing bodies indicated above should be aware that the comment or response of the
governing body must be conducted in accordance with Penal Code section 933 (c) and subject to
the notice, agenda and open meeting requirements of the Brown Act.
From the following individuals:
■ The Marin County Sheriff (R3)
The following individuals are invited to respond:
■ Police Chief, Belvedere Police Department (R3)
■ Police Chief, Central Marin Police (R3)
■ Fire Chief, Corte Madera Fire Department (R1, R2)
■ Police Chief, Fairfax Police Department (R3)
■ President, Falcon Critical Care Transport (R5)
■ President, Falck/verihealth, Inc. (R5)
June 9, 2016 Marin County Civil Grand Jury Page 10 of 15
Fire Chief, Larkspur Fire Department (R1, R2)
President, Marin County Fire Chiefs Association (R1, R2)
Fire Chief, Marin County Fire Department (R1, R2)
President, Marin County Police Chiefs Association (R3)
Fire Chief, Mill Valley Fire Department (R1, R2)
Police Chief, Mill Valley Police Department (R3)
Chief Executive Officer, NORCAL Ambulance (R5)
Police Chief, Novato Police Department (R3)
Police Chief, Ross Police Department (R3)
Fire Chief, San Rafael Fire Department (R1, R2)
Police Chief, San Rafael Police Department (R3)
Police Chief, Sausalito Police Department (R3)
President, St. Joseph's Ambulance Service (R5)
Police Chief, Tiburon Police Department (R3)
June 9, 2016 Marin County Civil Grand Jury Page 11 of 15
APPENDIX A: Request to Phone Me with Help Form (English)
Request to Phone Me with Help
First Responder Referral Project
Information and Assistance to Keep You Safe and At Home
Name Phone (415)
Address
Family Caregiver? No ❑ Yes ❑
Name Phone
Any other help, such as a neighbor?
Name & relationship Phone
Describe Situation
By signing below, I invite you to ask Marin County Aging and Adult Services to phone me about ml
situation, and allow them to contact other help organizations as needed.
I would like help with:
Transportation to medical appointments. Taking care of my spouse or partner.
House cleaning and organizing. _ Food shopping and meals. _ Reducing trip hazards.
Having more social activities. Other
Signature of Patient or Caregiver Date
First Responder Name Station/ Shift Station Phone or Personal Cell
-If this person was transported to Emergency: KP ❑ MGH ❑ NCH ❑
First Responder — please fax this completed form to both:
1. Marin County Arc ing_& Adult Services: (415) 473-7042 or (415) 473-6465
phone (415) 457-4636, M -F 8:30-5 www.mainhhs.orglaging-adult-services
2. San Rafael Fire Department, Station 51— (415) 453-1627
The 911 First Responder Referral Project is a cooperative initiative of Senior Access, the City of San Rafael Fire Department
and the Marin County Fire Chief's Association.
June 9, 2016 Marin County Civil Grand Jury Page 12 of 15
APPENDIX B: Request to Phone Me with Help Form (Spanish)
Solicitud para Ilamarme con Ayuda
Proyecto de Referencia del Departamento de Bomberos
Informacion y Asistencia para mantenerse seguro en casa
Nombre Telefono (415)
Direccion
Tiene cuidado familiar? No ❑ Si ❑
Nombre Telefono
Recibe otro tipo de ayuda; como de un vecino?
Nombre y Relacion Telefono
Describa su Situacion
Al firmar a continuaci6n, les permito pedir a el Servicios para Adultos del Condado de Marin que me
(lame por mi situaci6n, y les permito ponerse en contacto con otras organizaciones de ayuda, segun sea
necesario.
Me gustaria ayudar con:
Transporte a las citas medicas. _ Cuidado de mi c6nyuge o pareja.
Limpieza y organizaci6n de la Casa. La compra de alimentos. La reducci6n de riesgos de tropiezos.
Tener mas actividades sociales. Otros
Firma del Paciente o Cuidador Fecha
Nombre del Respondedor Estacionlgrupo Tel de la estacion o personal
Si Esta persona fue trasladada a Emergencias: KP ❑ MGH ❑ NCH ❑
Respondedor por favor envie por fax este formulario completo a ambos:
1. Marin County Aging & Adult Services: (415) 473-7042 o (415) 473-6465
Telefono (415) 457-4636, L -V 8:30-5 www.mainhhs.org/aging-adult-services
2. Departmento de Bomberos de San Rafael, Estacion 51 — (415) 453-1627
EI F'royecto de Acceso para Adultos es una iniciativa de cooperaci6n del 411, Uepartannento de Bomberos de la Ciudad de San Rafael, y la
Asaciaci& de Jefes de Bomberos del [ondado de Marin.
June 9, 2016 Marin County Civil Grand Jury Page 13 of 15
APPENDIX C: Marin County Aging and Adult Services Info Sheet (English)
Marin County Aging and Adult Services
Information & Assistance,
(415) -457 -INFO, (415) 457-4636
457-info@marincounty.org
Monday— Friday, 8:30am — 5pm
Community Resource Guide
MarinHHS.org/Resources
MarinHHS.orglAginq
Do you need equipment or supplies?
ReCARES, provides free gently used health care
equipment, such as walkers, wheelchairs, canes and
commodes, and unused medical supplies, such as wound
dressings and adult diapers, Wednesdays 11 am-2pm,
3100 Kerner Blvd, San Rafael, (415) 388-8198
LIVE Lavin LIVE We.LL
www.LivelongIivewellmarin.org
June 9, 2016 Marin County Civil Grand Jury Page 14 of 15
APPENDIX D: Marin County Aging and Adult Services Info Sheet (Spanish)
Servicio para Adultos y Envejecimiemto del
Condado de Marin
Informacion y Asistencia
(415) -457 -INFO, (415) 457-4636
457 -info @,,marincounty.orq
Lunes — Viernes, 8:30am — 5pm
Guia de Recursos y Servicios
MarinHHS.org/Resources
MarinHHS.orglAging
INecesita equipos o suministros?
ReCARES, proporciona equipos de atenci6n gratuitos de salud con
poco uso, como andadoras, sillas de ruedas, bastones y c6modas.
Suministros medicos no usados, tales como vendajes para heridas y
panales para adultos. Los mi6rcoles de 11 a.m.-2 p.m
3100 Kerner Blvd, San Rafael, (415) 388-8198
V(/v& M alk vim& B 6&n/
www.LivelongIivewelImarin.org
June 9, 2016 Marin County Civil Grand Jury Page 15 of 15
August 30, 2016
The Honorable Judge Kelly V
Marin County Superior Court
P.O. Box 4988
San Rafael, CA 94913-4988
Honorable Judge Simmons:
Mr. Mann:
MAYOR GARY O. PHILLIPS
VICE MAYOR KATE COLIN
COUNCILMENIBER MARIBE'nl BUSIIE•Y
COUNCILMEMBER JOHN GANIBLIN
COUNCIL. EMBER ANDREW CUYUGAN MCCULLOUGH
Simmons John Mann, Foreperson
Marin County Civil Grand Jury 2015/2016
3501 Civic Center Drive, Room #275
San Rafael, CA 94903
CITY CLERK
415-485-3065
RE: 2015/2016 Marin County Civil Grand Jury Report: "The 911 First Responder Referral Program —
More Than a Band-Aid for Seniors"
We are forwarding to you the following documents:
• A certified copy of Resolution No. 14180 adopted by the San Rafael City Council on
August 15, 2016, approving and authorizing the Mayor to execute the City's response;
• Original of the "Response to Grand Jury Report Form," executed by Mayor Phillips on August
24, 2016;
• Copy of the City Council Staff Report dated August 15, 2016
Should you need further assistance, please contact me at (415) 485-3065.
Sincerely,
ESTHER C. BEIRNE
City Clerk
cc: Gary O. Phillips, Mayor of the City of San Rafael
Jim Schutz, City Manager
Robert Epstein, City Attorney
Christopher Gray, Fire Chief
1400 Mrm AVENUE • PO Box 151560 - SAN RAFAEL. CA 94915-1560
Www.CITYOFSANRAFAEL.ORG
RESOLUTION NO. 14180
A RESOLUTION TO THE CITY COUNCIL OF THE CITY OF SAN RAFAEL
APPROVING AND AUTHORIZING THE MAYOR TO EXECUTE THE CITY OF SAN
RAFAEL'S RESPONSE TO THE 2015-2016 MARIN COUNTY CIVIL GRAND JURY
REPORT ENTITLED "THE 911 FIRST RESPONDER REFERRAL PROGRAM: MORE
THAN A BAND-AID FOR SENIORS: '
WHEREAS, pursuant to Penal Code section 933, a public agency which receives a Grand Jury
Report, addressing aspects of the public agency's operations, must comment on the Report's
findings and recommendations contained in the Report in writing within ninety (90) days to the
Presiding Judge of the Superior Court with a copy to the foreperson of the Grand jury; and
WHEREAS, Penal Code section 933 specifically requires the "governing body" of the public
agency to provide said response and, in order to lawfully comply, the governing body must
consider and adopt the response at a noticed public meeting pursuant to the Brown Act; and
WHEREAS, the City Council of the City of San Rafael has received and reviewed the 2015-
2016 Marin County Civil Grand Jury Report, dated June 9, 2016, entitled "The 911 First
Responder Referral Program: More Than a Band-Aid for Seniors."
NOW, THEREFORE, BE IT RESPOLVED that the City Council of the City of San Rafael
hereby:
1 Approves and authorizes the Mayor to execute the City of San Rafael's response,
attached hereto and incorporated herein by reference, to the 2015-2016 Marin County Civil
Grand jury Report, entitled "The 911 First Responder Referral Program: More Than a Band-Aid
for Seniors."
2. Directs the City Clerk to forward the City's Grand Jury Report response to the
Presiding Judge of the Marin County Civil Grand Jury.
I, ESTHER C. BEIRNE, Clerk of the City of San Rafael, hereby certify that the foregoing
Resolution was duly and regularly introduced and adopted at a regular meeting of the City
Council of said City held on Monday, the fifteenth day of August 2016, by the following vote, to
wit:
AYES:
Councilmembers:
Bushey, Colin, Gamblin, McCullough & Mayor Phillips
NOES:
Councilmembers:
None
ABSENT:
Councilmembers:
None
ESTHER C. BEIRNE, City Clerk
RESPONSE TO GRAND JURY REPORT FORM
Report Title: The 911 First Responder Referral Program: More than a Band-Aid for Seniors
Report Date: June 9, 2016
Public Release Date: June 16, 2016
Response By: Mayor Gary Phillips and San Rafael City Council
RECOMMENDATIONS:
• Recommendation number R1 has not yet but will be implemented.
(See Attachment "A")
• Recommendation number R2 has not yet but will be implemented.
(See Attachment "A")
• Recommendation number R3 has not yet but will be implemented.
(See Attachment "A")
Date: '� C, Signed: .�
G O. P i ips, Mayor
Attest: .i�?_S .�.c 2�
Esther Beirne, City Clerk
Number of Pages Attached: 2
ATTACHMENT "A"
RESPONSE OF THE CITY OF SAN RAFAEL TO GRAND JURY REPORT
THE 911 FIRST RESPONDER REFERRAL PROGRAM: MORE THAN A BAND-AID
FOR SENIORS
Recommendations:
Rl. Marin County fire chiefs should implement the 911 First Responder Referral
Program County -Wide.
Response: Has not yet but will be implemented
The Marin County Fire Chiefs Association is planning for the implementation of this program in
all of Marin's fire agencies by January 1, 2017. The Marin County Fire Chiefs Association is
comprised of Fire Chiefs representing each of Marin's fire agencies. Marin's fire agencies
provide 911 first responder and transport ambulance emergency medical response throughout
Marin County. The Marin County Fire Chiefs Association is working in collaboration with the
Marin County Department of Health and Human Services and the Marin County Police Chiefs
Association to coordinate the implementation of the program across all of Marin's first responder
agencies.
San Rafael Fire Department Staff have already provided Train the Trainer classes to fire service
personnel Countywide. San Rafael Fire staff has also hosted trainings for San Rafael Police
Officers. Additional Train the Trainer classes are being scheduled for a countywide
implementation. The San Rafael Fire Department will continue to provide support for the Marin
County Fire Chiefs Association's January 1, 2017, implementation of the program.
R2. Marin County fire chiefs should create a community outreach campaign for the 911
First Responder Referral Program.
Response: Has not yet but will be implemented
The Marin County Fire Chiefs Association and the Marin County Department of Health and
Human Services will be working in collaboration to develop a community outreach and
education video public service announcement to introduce the program to Marin's residents.
R3. Marin County fire chiefs and Sheriffs should have their patrol officers/deputies
attend the 911 First Responder Referral Training.
Response: Has not yet but will be implemented
The San Rafael Fire Department is working with the Marin County Sheriff's office to conduct
911 First Responder Referral Program trainings during the last two weeks of August. There will
be a video conference set up to connect staff at all of the County's stations to the training.
CITY OF
, �alf 1�
Agenda Item No: 44.
Meeting Date: August 15, 2016
SAN RAFAEL CITY COUNCIL AGENDA REPORT
Department: Fire
Prepared by: Christopher Gray, Fire Chief City Manager Approval:
TOPIC: Response to the Grand Jury Report on the 911 First Responder Referral Program
SUBJECT: CONSIDERATION OF A RESOLUTION OF THE CITY COUNCIL OF THE CITY OF
SAN RAFAEL APPROVING AND AUTHORIZING THE MAYOR TO EXECUTE THE
CITY OF SAN RAFAEL RESPONSE TO THE 2015-2016 MARIN COUNTY CIVIL
GRAND JURY REPORT ENTITLED "THE 911 FIRST RESPONDER REFERRAL
PROGRAM: MORE THAN A BAND-AID FOR SENIORS"
RECOMMENDATION:
Staff Recommends that City Council of the City of San Rafael adopt the attached Resolution approving the
proposed response to the Grand Jury report and authorizing the Mayor to execute the response.
BACKGROUND:
The 2015-2016 Marin County Civil Grand Jury has issued its report dated June 9, 2016 entitled "The First
Responder Referral Program: More than a Band Aid for Seniors." (See Attachment B) The Grand Jury has
requested a response from all of the cities and towns in Marin, their respective Fire/EMS service providers, and
Central Marin Police Authority. The City of San Rafael has been asked to respond to recommendations Rl-R3.
The Grand Jury's Findings are set out on page ten (10) of the fifteen (15) page report.
The Grand Jury recommends that all Fire/EMS Agencies in Marin County do the following:
• Implement the 911 First Responder Referral Program County -wide.
• Coordinate with agencies throughout the County to create an outreach campaign for the 911 First
Responder Referral Program.
• Expand training for the First Responder referral program to include all Marin County Police and Sheriff
Patrol personnel, all Marin County paramedic personnel, and all private ambulance personnel operating
within the County.
Staff agrees with Grand Jury Findings 171-173, and as more fully set forth in the proposed response to the Grand
Jury (see Exhibit to attached Resolution) Staff is in the process of implementing Recommendations R1 -R3.
ANALYSIS:
49y..193 W&14"._124191 ki LW7
File No.:
Council Meeting:
Disposition:
SAN RAFAEL CITY COUNCIL AGENDA REPORT / Paae: 2
In 2015, a partnership formed between San Rafael Fire Department and County's Aging and Adult Services
Information and Assistance (I & A) unit. Through multi -agency collaboration this program provides a streamlined
process to get persons connected with ongoing community resources and support. After a first responder makes
the referral, staff of I & A contact the resident or family member to assess the need for such things as
transportation, caregiver support, food and shopping, and social activities. Through a collaborative relationship
with the County I & A team, the San Rafael Fire Department is able to provide a wider range of services to
residents and business owners in San Rafael.
The Civil Grand Jury report findings emphasize that effective regional partnerships have been fundamental to the
success of the 911 First Responder Referral Program. The report recommendations encourage expansion of these
regional partnerships in order to support the provision of improved health care and social services County -wide.
The San Rafael Fire Department fully agrees with the findings of the report and looks forward to implementing
the report recommendations in collaboration with the Marin County Fire Chief's association.
FISCAL IMPACT:
There is no direct fiscal impact from the recommended action in this report.
ACTION REQUIRED:
The City is required to respond to the Grand Jury Report. Penal Code section 933(c) states in part:
"No later than 90 days after the Grand Jury submits a final report ... the governing body of the public
agency shall comment to the presiding Judge of the Superior Court on the findings and
recommendations ... (contained in the report)."
To comply with this statute, the City's response to the Grand Jury report is required to be approved by Resolution
of the City Council and submitted to the Presiding Judge of the Marin County Superior Court and the Foreperson
of the Grand Jury on or before September 7, 2016. A proposed Resolution is included that would approve staff's
recommendation for the City's response (Exhibit A)
OPTIONS:
The City is required to respond, however, the City Council has the following options to consider on this matter:
1. Adopt Resolution approving the proposed response;
2. Adopt Resolution with modifications to the proposed response;
3. Direct staff to return with more information.
RECOMMENDATION:
Staff recommends that City Council adopt the attached Resolution approving the proposed response to the Grand
Jury report and authorizing the Mayor to execute the response.
ATTACHMENTS:
A. Resolution with attached proposed response
B. Grand Jury report dated June 9, 2016
