Earlier I had commented that the problems San Francisco faced in its EMS system were too large and complex to be fixed by merely throwing money at them. A combination of population changes, declining healthcare finances and rigid government thinking contribute to a problem that has been ongoing for three decades.
I was taken to task by an EMS1 reader who felt that I offered no suggestions, which is true. There are folks who are far smarter than me who could weigh in on this issue.
But, I don’t have to; San Francisco itself has tried several innovative ways to manage its call volume:
- It had a successful diversion program that reduced the number of high frequency callers to the 911 system. Using a medic/social services worker team, chronic 911 callers were identified and matched to appropriate resources within the health department. As a result, many of these patients reduced or even stopped calling 911. Unfortunately this program was eliminated.
- A sobering center was established to divert those who were intoxicated, but not injured or ill, to a facility that could monitor them, freeing up precious emergency department beds.
- For a while, city paramedics treated, then release acute asthma patients after a more detailed evaluation. A similar program provided alternative transportation to a hospital or clinic for patients who did not require ambulance transport.
Given the rapidly evolving nature of community paramedicine, there are other ways to adapt to field patients, rather than simply adding more workers to the department. That’s real change that is permanent and meets the needs of the community.
Then there is the need to closely look at how the city views its EMS system. Is it the primary role its fire department, or is it subservient to fire suppression services? A review of the department’s budget shows that the vast majority of money is spent on the latter. It’s also likely that the turnover rate of its EMS division is much higher than that of its fire suppression. Perhaps the department needs to be restructured so that resources are spent in a way that better matches resources to needs.
There are plenty of options for a proactive agency to explore, evaluate and implement. It’ll be interesting to see if this department takes a chance and remakes itself during this time of crisis.
