By Greta Kaul and Marisa Lagos
San Francisco Chronicle
SAN FRANCISCO, Calif. — San Francisco ambulance response times have come down since they peaked in August, but progress has stalled and ambulances still aren’t getting to medical emergencies as quickly as San Francisco Fire Department standards call for, according to a new report from the mayor’s office.
The Dec. 18 memo indicates the city has made significant progress tackling the problem since a September Chronicle investigation highlighted the scope of delays, which were felt most severely in neighborhoods such as the Sunset and Bayview districts.
City leaders hope a variety of new initiatives, including an influx of new paramedics, better coordination with private ambulances and efforts to reduce the number of 911 calls — in part by stationing public health officials in high-need areas — will reduce response times in the new year.
When firefighters get a call for a life-threatening emergency, the department’s goal is to have an ambulance on-scene within 10 minutes 90 percent of the time.
The department is still more than two minutes shy of that mark. In November, ambulances arrived at 90 percent of incidents within 12.7 minutes — down from 14.6 minutes in August, according to the new report.
The report is “a progress update, and there’s definite progress being made,” said Mindy Talmadge, a Fire Department spokeswoman.
When San Franciscans call 911 for a medical emergency, firefighters arrive on the scene first, providing aid until an ambulance arrives. But with an overburdened ambulance fleet, more than 400 people — and possibly more — in a yearlong period starting in June 2013 were left waiting more than 10 minutes for transport to a hospital, according to a Chronicle investigation.
Seeking solutions
The city has tried a number of ways to help bring down those response times, including hiring more medics in August and convening a working group in September to develop more long-term solutions.
Fire Chief Joanne Hayes-White attributes some of the progress outlined in the report to that working group, and said city leaders must continue to work on solutions because the city’s population keeps growing, placing strain on the system.
“This work group has done its work in sort of illuminating what the real issues are, and one of the biggest issues was staffing,” Hayes-White said. “We’re still not quite there. I think we’ve made a lot of progress to date.”
At the end of August, 35 new paramedics started work, helping to lower ambulance response times from their peak in August into the 12-minute range in September, where they have hovered since. But many of the new medics only replaced others who had been promoted.
Talmadge hopes that 20 more new hires, who will begin work mid-2015, will bring response times down more. In the meantime, the department will improve coordination with the private ambulance companies that jump in to transport patients when the city’s system is maxed out. As part of that coordination, the city is looking into installing GPS technology into private ambulances, something those companies have been requesting for years.
In the past, delays have been compounded by ambulances breaking down, but with the delivery of nine new vehicles since August — and with two more coming every other week through February — those problems have eased, the memo states.
“We have the equipment, it’s the staffing, really,” Talmadge said.
In addition to the new hires, the department is looking at managing sick leave better so there aren’t unexpected staffing shortages, and studying call data to decide if they should change how shifts are scheduled.
In months past, firefighters have questioned the city’s commitment to solving the ambulance problem: Last year, the Fire Department got less than a third of the money it requested for staffing and equipment.
Tom O’Connor, president of the union that represents firefighters, said he is heartened by the improvements but warned that the city still has a long way to go.
‘The right direction’
“We finally see we are moving in the right direction,” he said. “The working group realizes this can only be solved with more people and more ambulances, and I applaud the mayor for his effort.”
Off the record, several firefighters said that while things have improved, they are still seeing “medic to follow” calls, in which a fire truck responds but it takes longer than the prescribed time for an ambulance to get there. Early mornings and afternoons seem to be the times of day with the worst delays, they said.
Another problem the working group hopes to tackle is the overwhelming volume of calls from people with chronic health concerns and drug and alcohol problems who regularly call 911, funneling ambulances toward the city’s center. Many of them dial 911 so frequently firefighters know them by name.
During the past fiscal year, 444 “frequent fliers” were transported to a hospital or sobering center more than four times in at least one month, according to the city’s Department of Public Health.
To reduce that number, the city is hiring a nurse to be stationed at a homeless shelter that accounted for more of those calls than any other location last year and will propose reinstating something like the Home Team.
That team was a partnership between the Fire Department, the Department of Public Health and the city’s Human Services Agency that ran from 2004 to 2009. Under that program, a paramedic drove around the city with a rotating cast of social and health workers, connecting homeless people with services.
Data suggest the program was effective: In its first year, eight of the 10 most frequent 911 callers stopped using ambulances for at least six months, according to a 2005 story in The Chronicle.
By bringing back a Home Team-like program, “That’s a large volume of calls that probably won’t even come to the 911 system,” Talmadge said.
©2014 the San Francisco Chronicle