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Home > Topics > EMS Management
March 03, 2014

Report: S.F. falls short on EMS goals, revenue

A lack of investment in ambulances and medics has left them short of the 80 percent response rate and could be putting patients' safety at risk

San Francisco Chronicle

SAN FRANCISCO, Calif. — The San Francisco Fire Department responds to only 72 percent of 911 calls seeking medical assistance, leaving the rest to private companies. It also leaves millions of dollars in potential revenue on the table each year, according to a recent report and interviews with city officials.

A lack of investment in ambulances and medics has left the city far short of the 80 percent response rate required by the state and could be putting patients' safety at risk, according to the report by the Board of Supervisors budget and legislative analyst.

It found that last year alone, nearly 2,500 people had to wait to be transported to a hospital because an ambulance wasn't immediately available — a fourfold increase since 2008. In those situations, firefighters and paramedics did respond on a fire engine to administer medical care within three to five minutes of the 911 call, but the patients couldn't be immediately taken away because an ambulance wasn't available.

"This is happening every single day — in fact, on average, it's happening eight times each day," said Supervisor London Breed, who has called for another audit to examine what the Fire Department needs to do to improve its medical service. "If this happens on an average day, what will happen when there's an earthquake or any other big event?" she asked.

Fire chief testimony
Residents shouldn't be concerned for their safety, insisted Fire Chief Joanne Hayes-White, who noted that the department responds to all 911 calls within five minutes. But she added the city should invest more money in medics and in ambulance maintenance. On Thursday, she told a supervisors' committee led by Breed that the department will request an additional $10 million next fiscal year for additional medical staff and new ambulances and other equipment.

That investment could pay off: The department believes it would bring in an additional $3 million to $5 million a year if it increases the response rate to 80 percent. The budget analyst also estimates the agency has left an additional $2 million to $3 million on the table in recent years because it hasn't had the staff to submit the proper paperwork for some federal reimbursements.

"There's always room for improvement, but I am not sounding the alarm that people shouldn't feel safe," Hayes-White said. "We could use more ambulances in the system, but on any given call, outside a major catastrophe in the city, a paramedic will be on scene, sometimes two or more, within a three- to five-minute period of time."

Response problems have grown since 2008, when the city lost its exclusive rights to oversee ambulance service in San Francisco after the state agency overseeing ambulance response, the Emergency Medical Services Authority, determined there was no longer a basis for that exclusivity. Hayes-White said the decision, which opened up San Francisco to private ambulance companies, was based on an erroneous analysis by state officials. It was reversed in 2012. Now, only two private companies are allowed to respond to calls in the city, and only to calls that the Fire Department cannot respond to. Those companies work closely with fire officials to coordinate training and 911 responses, Hayes-White said.

But by 2012, the city was seeing a large increase in 911 calls — about a 20 percent jump since 2008 — and had failed to properly invest in medic services, Hayes-White said.

"During that four-year period we experienced an increase in call volume, and because of the uncertainty (over the city's exclusive right to respond to calls), staffing and budget requests were challenged (at City Hall)," she said.

80% response rate
If the city cannot meet the 80 percent response rate — required to ensure that one public agency takes the bulk of responsibility for medic calls — it could lose its exclusivity again and lose millions of dollars in revenue. Hayes-White also has concerns about whether private companies would adequately serve the city.

The report noted that currently, while 76 percent of calls to the Fire Department are for emergency medical services, 77 percent of department staff are firefighters and just 23 percent are emergency medical support. The report raised questions about this inequity and stated that by "allocating staff and resource properly between EMS and suppression, the department can ensure the generation — or reimbursement — of revenue."

The city is reimbursed by private and public insurers and hospitals for transporting patients.

"This opportunity to collect revenue is critical for a department that otherwise relies almost entirely on the (city's) general fund," the report states.

Breed, a former fire commissioner, said staffing on both sides of the Fire Department is suffering. She said firefighters for several years have been forced to work overtime because of an employee shortage. She blamed department leaders for both problems.

"The equipment is falling apart, there's insufficient staffing — there are real problems and they are problems foreseen years ago," she said. "They should do a more effective job articulating what they need in the department. ... That's what department leadership is there to do."

Hayes-White defended the staffing allocations, noting that many firefighters are also trained as paramedics and that fire engines almost always respond to medical calls along with ambulances. Thirty-two of the department's 43 fire engines have medics on them, she said.

"They felt we put more eggs in one basket as it relates to the fire side compared to emergency medical services, but we disagree. It's not as simple as EMS and fire," she said. "When we run a medical call, it's not just an ambulance showing up. Typically it takes four, six or eight firefighters to assist on scene ... so over 70 percent of calls are medical, but that doesn't mean it's only an ambulance responding."

Best use of resources?
The report, however, questioned whether sending an engine and ambulance to every 911 call is the best use of resources. In the 2012-13 fiscal year, the budget analyst showed, there were 120,536 911 calls and 266,918 responses by the Fire Department, because multiple vehicles — fire engines and ambulances— responded to each call.

Breed said these sorts of debates illustrate why the city is undertaking an audit specifically looking at emergency response issues, including how much money the city makes responding to medic calls and how much it needs to invest to get to an 80 percent or higher response rate. That audit will be completed before the Board of Supervisors' budget process that begins in May, she said.

"We need to look at real data, real information, so we can decide what we really need," she said.

Copyright 2014 San Francisco Chronicle

McClatchy-Tribune News Service


All Rights Reserved

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