Ambulances & Vehicle Ops, Communications & Dispatch, Major Incidents, News

Dangerous delays; UPDATE: CODE3 Progress Report

SAN FRANCISCO — San Francisco emergency officials have been unable to make significant improvements in responding to 911 medical calls despite their pledges to reduce the city’s ambulance delays.

Mayor Gavin Newsom promised in April to improve response times after a special report by The Chronicle found that the city’s first responders were failing 27 percent of the time to meet the city’s goal of getting help to the scene of urgent medical calls within 6 1/2 minutes.

At least 439 people have died in the city since 2004 while waiting for a late ambulance or after delayed medical help arrived, the paper found.

New statistics from the city show little improvement has been made in response times. In May and June, none of San Francisco’s 11 emergency response districts was able to meet the city’s standard of responding to 90 percent of potentially life-threatening medical calls – most of which are known as Code 3 – within 6 1/2 minutes.

In addition, 40 percent of urgent calls in the two-month period took longer to dispatch than the city’s goal of two minutes, the city report said.

City officials have hired a new contractor to help translate 911 calls from non-English speakers, and they have begun re-evaluating dispatch protocols for how and when to send help on high-priority calls. They also plan to begin testing this fall a computer system capable of more precisely tracking and deploying the city’s ambulances and fire engines.

But paramedics said that they are constantly running short of ambulances for life-threatening medical calls and that these units are forced to respond to urgent 911 calls at greater distances across the city, despite the mayor’s acknowledgment that more ambulances might be needed.

Paramedic salso complained of insufficient medical equipment and personnel to staff more fire engines with paramedics.

“We are critically short of ambulances,” said veteran paramedic Jeff Rusteen. “Every day we descend to zero ambulances or very low levels. … The bottom line is that it impacts patient response times and survivability.”

Evaluation consulting

At a news conference after The Chronicle’s report in April, the mayor said that he would hire national consultants to help evaluate the Fire Department’s emergency medical services, but those plans appear to be on hold. The mayor also said he would consider purchasing more ambulances.

“We need more ambulances. We need more personnel,” said Paramedic Capt. Mike Whooley. “What we’re being told is, ‘It’s not going to happen.’ … We never seem to run out of fire engines.”

Since April, veteran paramedics have pointed out numerous delays on high-priority calls, including Echo calls, which require immediate resuscitation. Ambulances stationed in Hunters Point have been deployed to emergencies as far away as Seal Rock; units stationed in the Richmond District are often deployed to the Tenderloin.

Medics said handling frequent calls at such great distances puts a serious strain on them.

“We have no surge capacity whatsoever in our ambulances,” Whooley said. “If we can’t handle day-to-day, routine operations, it’s going to get ugly if something like an earthquake happens and more ambulances are needed.”

City officials attribute most of the dispatch delays to factors such as language barriers, agitated and non responsive callers and callers who do not know their location.

A report by emergency officials attributed dispatch delays to “the lack of dependable translation services” provided by a state vendor. On April 18, four days after The Chronicle reported that problem, the city changed its vendor to another firm, Language Line Services.

Emergency officials also said they are focusing on recruitment and retention strategies, but the 911 Call Center still has dozens of vacant positions for dispatchers.

Next month, the call center plans to field-test the first phase of a vehicle locator system that will provide a map showing gaps in ambulance coverage. The project, which includes installation of transmitters in fire engines and ambulances to provide increased accuracy of location to dispatchers, is expected to be completed by June.

In addition, a recently published study by MGT of America Inc., a consulting firm retained by the city’s Department of Emergency Management, found that the call center is hampered by poor training, nonstandard policies and procedures, poor internal communications and insufficient accountability.

“Staff interviews revealed concerns over poor management at every level of the department,” said the report. “These failures include a lack of oversight and enforcement of departmental policies. … These problems diminish the sense of accountability staff have in their own actions.”

The study also noted that the amount of overtime used by the Department of Emergency Management has more than doubled in the past four years – rising to about $2.3 million in 2006-07.

The fire chief, emergency management director and public health director have met at least twice in recent months to review the ambulance delays. In a recent memo, they said the 911 dispatchers are showing signs of improvement, especially in instructing callers on what to do while waiting for medics to arrive.

Paramedics impatient

But the brass is not moving fast enough for some paramedics.

“They’re moving deck chairs around on the Titanic,” paramedic Rusteen said. “They need to ask what’s best for patient care, is this the best we can do with tax dollars, and is this good for employees?”

Outside consultants also have weighed in.

“The mayor’s plan is a start but feels more like shots in the dark,” said Mike Williams, president of the Abaris Group, a Walnut Creek consulting firm that helped create California’s emergency medical standards. “They need to do a comprehensive study.”

Reducing 911 delays San Francisco officials are taking or plan to take these steps to reduce response times to 911 medical calls:– Recruit, hire and retain additional dispatchers.– Send ambulances sooner to life-threatening emergencies.– Use private ambulance firms on some high-priority calls.– Reduce paramedics’ time transferring patients at hospitals.– Resolve tensions between Fire Department and dispatchers.– Refine the 911 Call Center’s dispatch criteria.–

“Every day we descend to zero ambulances or very low levels. … It impacts patient response times and survivability.”