San Francisco FD medical director wins award for innovative program

The program pairs paramedics with the Public Health Department Homeless Outreach Team to reduce 911 calls from the city's homeless people


By Heather Knight
San Francisco Chronicle

SAN FRANCISCO — We've all seen them — the very sick homeless people who dot San Francisco's sidewalks. They may be drunk, strung out on drugs, passed out, having a mental breakdown, or suffering from the terrible symptoms of untreated diabetes or asthma.

Many of them don't have a primary care doctor, so it's either get sicker on the streets or call 911. Those "high users" of the city's emergency rooms costs taxpayers an average of $87,480 a year each, according to the Department of Public Health. That means treating the sickest homeless people for a year costs about the same as renting a one-bedroom apartment in San Francisco — the most expensive rental market in the nation — for two years. (It's true! The rental website Zumper says the average median rent for a one-bedroom in the city these days is $3,500 a month.)

Clearly, something isn't adding up. Dr. Clement Yeh is trying to help San Francisco get smarter about the way it treats its sickest citizens and is being honored Thursday by the San Francisco General Hospital Foundation at its annual Heroes & Hearts award luncheon for his work.

Yeh is the medical director for the Fire Department and the 911 dispatch system and is overseeing a new program called EMS-6, which pairs paramedic captains from the Fire Department with members of the Public Health Department's Homeless Outreach Team.

The program takes its name from emergency medical services and the six points on the Star of Life, the familiar emblem on ambulances. The EMS-6 team, which has been on call from noon to midnight seven days a week since Jan. 30, gets around in a Ford Expedition equipped with lights, sirens and first responder equipment. The staffing and equipment cost $765,000 a year. 

Trying to reduce 911 calls
The idea is that when an ambulance responds to a 911 call for one of those frequent users of the city's emergency rooms, it will call the EMS-6 team to join it.

Sometimes the person will be transported to an emergency room anyway, but sometimes the EMS-6 team will be able to address the problem on the spot and find social services or other help, as well. The idea is to get the patients healthier, reduce the number of 911 calls they make, and free up ambulances in a department already struggling with how to trim ambulance response times.

"The overall goal is to improve the health of people we see as vulnerable," said Yeh, 42. "If you're not sure where you're going to be sleeping and where your next meal is coming from, it's harder to think about managing your diabetes and making your doctor's appointments."

In a city of innovation, EMS-6 isn't exactly cutting-edge stuff. It's similar to the Fire Department's Homeless Outreach and Medical Emergency Team, which was developed by Niels Tangherlini, a paramedic captain. He treated sick homeless people on the streets along with a rotation of social workers, nurse practitioners and outreach workers.

The HOME Team program ran from 2004 to 2009. According to a 2005 story in The Chronicle, 8 out of 10 of the city's high users of the city's emergency rooms stopped using ambulances for at least six months within the first year of the program. Fire Chief Joanne Hayes-White praised the HOME Team program but said she had to end it during mandated budget cuts during the recession.

"We hated to get rid of it," she said. "This has a lot of similar goals." The idea to restart the program came from Mayor Ed Lee's working group on emergency medical services, which was convened after the Fire Department was found to have ambulance response times that were too long. In a statement, Lee said EMS-6 should lead to "a better, coordinated response on our streets and better results for people who need our help."

Hayes-White appointed Yeh to the mayor's working group, asked him to oversee EMS-6, and nominated him for the Heroes & Hearts award. "I'm proud of him," the chief said. "He's very passionate about what he does."

Providing best possible care
Running the EMS-6 program is one more job for the already busy Yeh. As the medical director for the 911 system and the Fire Department, he's in charge of ensuring San Francisco's citizens get the best possible care from emergency dispatchers and paramedics before they arrive at the hospital.

He oversees 1,500 paramedics and ambulance technicians who respond to 100,000 incidents every year. He also works one shift a week as a doctor in the emergency room at San Francisco General Hospital.

"It all aligns," he said. "I'm the doctor for the first couple of minutes to couple of hours." Yeh grew up in Norman, Okla., the middle of three children. His father was a professor of architecture at the University of Oklahoma, and his mother was an art teacher.

Yeh moved west to attend Stanford University, where he stuck around to earn a master's degree in bio-mechanical engineering and attend medical school.

He lives in Berkeley with his wife, Elizabeth Fair, a tuberculosis researcher at UCSF, and their daughters, Elsa, 7, and Thea, 4. Yeh had considered going into the medical device field but realized the emergency room was for him during his residency at S.F. General.

"I fell in love with the place," he said. "It's really about the camaraderie and the teamwork there."

Response to Asiana crash 
One of Yeh's most memorable days was being the only doctor in the SFO triage area after the Asiana plane crash in 2013. He said the five or six hours after the crash were "exhausting" but that the scores of paramedics and emergency medical technicians working with him did an "amazing job." Of the Heroes & Hearts award, Yeh said, "I'm totally honored and touched. It's very meaningful to be recognized by my colleagues and peers at S.F. General. Everyone else is so dedicated there."

(c)2016 the San Francisco Chronicle

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