By Shelah Moody
The San Francisco Chronicle
Copyright 2007 San Francisco Chronicle
All Rights Reserved
As a paramedic captain for the San Francisco Fire Department, Niels Tangherlini is dedicated to saving lives and improving the quality of life for people in underserved communities.
In October 2004, Tangherlini created the Homeless Outreach and Medical Emergency Team, which delivers comprehensive social services and medical treatment to high-frequency users of 911, including the poor, homeless, mentally ill, elderly, disabled, and alcoholics and drug abusers.
When he started the HOME Team — a collaboration between the San Francisco Fire Department, the Department of Public Health, and the Department of Health and Human Services — Tangherlini had two goals: improve the services for the high-risk population and improve the working environment for paramedic firefighters.
“Over the years, I could see people’s incredible frustration,” said Tangherlini, 37. “I saw people whose careers ended because of the stress of repeatedly going to the same patient and watching the person slowly decline, while they couldn’t do anything about it.”
The HOME Team’s model has been adopted by the fire department in Memphis. Hospitals in Denver and Washington, D.C., have sent paramedics to ride along with Tangherlini on calls.
“Gina,” a heroin addict who was profiled by The Chronicle in 2005, is one of the team’s success stories. She had sores on her legs that had become infested with maggots.
“Not long after the article came out, we got a call from someone on the mayor’s staff who had seen somebody huddled in a bus shelter with blood dripping out of her wheelchair,” Tangherlini said.
“I went over there with a social worker from Homeless Outreach. (Gina) kind of broke down crying, saying, ‘I knew you would find me.’ I got her an ambulance. She voluntarily accepted placement at Laguna Honda Hospital and is doing really well. I saw her about six months ago; her legs had healed and she was happy, healthy, warm and thankful.”
Tangherlini, who grew up in Auburn, Mass., said he always knew he wanted to be a paramedic. He remembers being fascinated by the paramedics portrayed on the 1970s TV show “Emergency!” and was motivated by the desire to help people. He worked with the Red Cross in high school, and worked for an ambulance company in Worcester, Mass., during his senior year. After he graduated, Tangherlini went to paramedic school.
“When I worked for the Red Cross, we would go to a lot of places to help people after fires,” he said. “A lot of these people were living in poverty. They would lose everything in the fire, and we’d come and give them vouchers for new clothing at stores and bring them to a hotel. Often there were children, and what struck me was that these kids had never stayed in a hotel. Even though they had just lost everything and they were scared from the fire, they would get all excited. Many of them had never eaten in a restaurant, had never gotten new clothing. Out of this emergency, out of this loss, came a new experience.”
Tangherlini moved to the Bay Area in 1990. After working as a paramedic for seven years, he realized that he wanted to expand services to high-risk populations, so he went back to school, earning a bachelor’s degree in social welfare from UC Berkeley in 1999.
Part of his job is policy planning. Through the mayor’s office, he has strongly advocated a program for neighborhoods areas heavily affected by alcohol abuse.
“The model I’m looking at is out of Tacoma, Wash.,” he said. “Within a geographic area, they limited the types of alcohol and the hours of sales for the liquor stores. By doing that, they dramatically decreased police and EMS calls in those areas.
“When you go into areas like the Tenderloin or South of Market, the Mission and Bayview-Hunters Point, you see a lot of working poor families, struggling. A lot of children live in those areas. It’s tragic to see them exposed to public inebriation, having to step over a passed-out alcoholic, being exposed to somebody urinating in public.’'
Tangherlini is also focused on disease and injury prevention. In 2003, he and a group of paramedics started the Asthma Outreach Program in conjunction with the American Lung Association’s Open Airways for Schools program. For six weeks, paramedics visit elementary schools in San Francisco and teach children how to deal with the effects of asthma. At the end of the course, the fire chief presents the students with certificates.
“The city had had a spate of tragic, and probably avoidable, deaths of children from asthma,” said Tangherlini. “I found out that (San Francisco) had one of the state’s highest hospitalization rates among children for asthma. There was a real epidemic going on. I contacted the Department of Public Health’s Children Environmental Health section and the American Lung Association. A respiratory therapist from St. Luke’s Hospital joined our group. We worked with the mayor’s Asthma Task Force. We created the first EMS-based asthma outreach program in the nation.”
Tangherlini lives in the East Bay with his wife, Miriam, an emergency medical technician, and their sons, who are 2 and 11 months. Tangherlini works out of an office at the San Francisco Department of Public Health building at 1380 Howard St. Although he officially works 10 hours a day four days a week, he often goes beyond the call of duty. His cell phone is a 24-hour resource, he said.
“We joke that it is the most-known cell phone number in the city,” he said. “Every firefighter, paramedic, police officer, social worker has that number. Adult Protective Services has me do a lot of their well-being checks. We’ve created a resource that is filling an unmet need throughout the city. Even on my days off, I’m frequently checking messages and do a lot of calling.”