In a surprise move, San Francisco Public Health Director Mitchell Katz, MD, announced in October that any and all private ALS ambulance services are welcome to join the city's 9-1-1 response system. The San Francisco Fire Department (SFFD) has been the city_s primary EMStransport provider since 1993, when paramedics employed by a third service run by the San Francisco Department of Public Health (SFDPH) petitioned to join SFFD. However, that marriage has been rocky from the start, and the department has struggled with staffing and response times.
In April, Mayor Gavin Newsom promised to improve SFFD response times, after theSan Francisco Chronicle reported it took dispatchers more than two minutes to send resources to 40% of the most urgent calls, and first responders met the goal of a 6.5-minute response time to such calls only 73% of the time. In August, however, theChronicle reported little had changed, despite the city's announced intention to recruit, hire and retain more dispatchers; refine dispatcher protocols; resolve tensions between dispatchers and SFFD personnel; send ambulances sooner to life-threatening emergencies; use private ambulances on some high-priority calls; and reduce ambulance turnaround times at hospitals.
Katz, SFFD Chief Joanne Hayes-White and Vicki Hennessy, executive director of the city's Department of Emergency Management, replied in a joint letter in theChronicle Sept. 11, citing recent advances and claiming dispatch times had improved to an average of one minute, 42 seconds, and first responders were reaching Code 3 patients in an average of five minutes, 20 seconds from when 9-1-1 received the call.
However, the day after that letter appeared, theChronicle went public with a letter from the California EMS Authority to the SFDPH rescinding the city's right to operate an "exclusive ambulance zone" and advising the city to start work on a competitive-bid process.
"My decision was whether to challenge the state_s determination," Katz said. "On review, there was evidence that our exclusive ambulance zone no longer existed because the geography of San Francisco has grown beyond the prior ambulance zone." That growth came from the acquisition of two islands and other former military property.
"My decision simply acknowledged what the state had said and added that we would welcome additional providers, as long as they followed our dispatch, quality and other procedures," he said. "The state's decision does not require that I put the service out to bid unless I want to recreate an exclusive operating area. Inviting other providers to join us increases capacity and improves our system."
Katz noted that two private services -- American Medical Response and King-American Ambulance Co. -- already provide backup to the SFFD and added, "Given that the existing two private providers could have increased their rigs at any time and have not done so, suggests that opening our system is not likely to result in major changes."
A week after Katz's announcement, Art Hsieh, MA, NREMT-P, chief executive officer of the San Francisco Paramedic Association, said the SFDPH had not communicated any details of the new plan. "We're unclear what this means to the system," he said. "We agree that anyone who is qualified and has the necessary checks and balances should be allowed to participate in the system. But what are the next steps? Will there be an examination of how things are done? The chance to succeed without plans and processes in place is low, no matter how well-intentioned you are."
The SFFD declined to comment.
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