Ambulance response times in San Francisco have spiked over the past four months leaving first responders in a challenging position and possibly putting patients’ lives at risk, according to firefighters who spoke to 2 Investigates.
According to a June audit of the San Francisco Fire Department, performed by the city’s Budget and Legislative Analyst, the city’s population growth over the last 13 years has contributed to an increase in 911 calls. San Francisco’s population has grown by nearly 8 percent - from 776,733 residents in 2000 to 837,442 in 2013, according to the report.
An increase in San Francisco’s homeless population is also cited as “one of the reasons for the increased demand in emergency medical services.”
The audit shows that emergency services handled nearly 93,000 medical calls in 2013 alone.
Concern within the Department
Firefighters tell 2 Investigates that they’re feeling the impact in the field, especially when they arrive at a medical emergency and call for a “medic to follow,” meaning an ambulance is needed at the scene to treat or transport the patient.
According to internal memos and minute-by-minute dispatch reports obtained by 2 Investigates, there is concern brewing among the ranks in SFFD about the length of time firefighters are left waiting for a “medic to follow.” Firefighters say the problem has become dire in the last four months.
San Francisco Fire Chief Joanne Hayes-White told 2 Investigates that the goal response time for ambulances being dispatched to emergency or Code 3 calls is 10 ten minutes. That goes up to 20 minutes for Code 2 calls, or non-emergency responses.
But 2 Investigates found many recent incidents where sick or injured patients were left waiting much longer than the goal time of 10 minutes, after a fire crew had requested a “medic to follow.”
Records show that on June 14, a person with a finger chopped off waited 25 minutes for an ambulance to arrive at Pier 33.
On May 23, a driver who slammed into a Muni pole and was pinned inside their vehicle near San Jose Avenue and Tingley Street was removed from the wreckage by first responders and ready for transport to the hospital before an ambulance was even dispatched, according to records. The patient was a “Criteria 1 Trauma patient,” who waited 28 minutes for help to arrive.
On May 12, firefighters responded to a medical call for a 91-year-old woman with breathing trouble on Capp Street in the Mission District. The call was upgraded to a Code 3 emergency. Dispatch records show that it took an ambulance one hour and 20 minutes to arrive.
The situation has gotten so critical that Assistant Chief Tom Siragusa was prompted to write a memo to Hayes-White calling the long wait times “unacceptable.”
“I am concerned that a serious negative outcome will be the result of a lack of medic units available,” Siragusa wrote in an internal memo obtained by 2 Investigates.
He specifically addressed the Capp Street incident where firefighters and the patient were left waiting for more than an hour, saying that he “was informed that there were 8 calls with medic to follow” also in need of ambulances.
The memo outlines concerns about a pattern of “medic to follow” calls increasing between 5 a.m. and 8 a.m. in San Francisco.
“This current medic situation is unacceptable and needs to be addressed as soon as possible,” the memo concluded.
An aging ambulance fleet
Chief Hayes-White told 2 Investigates that she is aware of the trend and taking steps to alleviate the problem, which she partially attributed to population growth, staffing shortages, and aging equipment.
Just over half of the department’s operating ambulance fleet has exceeded the expected 10-year lifespan, according to the audit report.
The County Board of Supervisors appropriated millions of dollars in funds, starting in 2012, for SFFD to replace aging ambulances with 16 new vehicles over three fiscal years. But as of today, none of those ambulances have arrived.
Supervisor London Breed told 2 Investigates that the process shouldn’t have taken two to three years before firefighters and the public could see ambulances operating on the streets.
“The big part of my job is to make sure the money is there and when the money is there and it's not used, my question is ‘Why?’” explained Breed.
Minutes from meetings of the San Francisco Fire Commission show that by June 2013, five ambulances had been ordered for firefighters to test and several adjustments were made to the design.
Specifications for the next order, a batch of ten, were finally sent to the Office of Contract Administration by October 2013, with an anticipated arrival time of April 2014.
But during the Fire Commission’s May 8, 2014 meeting, the department was “still waiting for the ambulances and the pre-bid is scheduled for May 13.”
Hayes-White told 2 Investigates that the delays are partially due to a redesign of some ambulance specifications, as well as a lengthy purchasing and bidding process.
“The Office of Contract Administration, aka ‘purchasing,’ we've worked very closely with them to put together our specifications, which did take nine to 11 months. We wanted to get it right,” Hayes-White said. “They go through their process of making sure they're in full compliance, the vendors that are bidding are in full compliance. So it does take some time.”
She says an order for more ambulances was recently placed in the last few weeks since the audit’s release. She expects 14 new ambulances will be on the streets by the end of the year.
But most of those vehicles will only replace aging ambulances that are worn out.
“I think part of it is excuses, excuses, excuses, when you go to the chief you'll get excuses," said Breed. “Some of the excuses that we had gotten were that they were testing out new ambulances in order to decide which ones to purchase.”
Breed also says the department has no excuse for not planning ahead for the retirements and promotions that are contributing to staffing shortages.
“We should have prepared for the fact that we were going to move some of the paramedics into firefighter positions,” Breed said.
According to audit, SFFD needs to increase the number of ambulance shifts in order to meet the state’s requirement that it respond to 80 percent of emergency calls. The report shows that in 2012 the Fire Department only responded to 69 percent, and in 2013 that number only reached 73 percent.
The audit’s authors make a series of recommendations to alleviate the staffing crunch and reach the state’s requirements, among them, hiring 16 new EMS employees. Hayes-White says those hires were made on July 7, but this staffing increase is still short of the 42 employees she requested from the city.
“As the Chief of the Fire Department my feeling is that our analysis was very sound. Having been in this role for over 10 years, I understand the difficult decisions that are needed to be made over at City Hall,” Hayes-White said. ”I think it was a good faith effort to give us the 16. Would I have preferred the 42? Absolutely.”
But Breed says the responsibility for public safety ultimately falls on the department.
“The buck stops with the leadership.”
Stuck in the middle
In the meantime, San Francisco firefighters tell 2 Investigates that they can’t wait for months for new ambulances and staffing changes to provide relief.
“One of my firefighters said it felt like, to him, it was Halloween or New Year’s Eve every day,” said Shon Buford of San Francisco Firefighters Local 798. “Those days we are really short staffed, and we expect to have delays. But that’s been happening on a daily basis.”
Many firefighters also expressed concerns to 2 Investigates that being forced to wait half an hour or more for an ambulance puts them in a tough position, where they want to help a patient in urgent need of care or transport to a hospital. Firefighters aren’t allowed to transport patients on trucks or engines, and if they do, it could cost them their job.
“It’s got to be difficult sitting there with family members waiting and it’s hard to explain,” said Siragusa. “It’s hard to explain to the family why you are waiting that amount of time.”