The San Francisco Fire Department may stop shuttling patients to hospitals on the Peninsula, as it struggles to provide prompt medical response across The City.
The Fire Department took 1,149 patients to Seton Medical Center in Daly City or Kaiser Permanente in South San Francisco in fiscal year 2008-09. About one-third of those calls were for nonemergency incidents in which the patient requested a ride to another hospital.
A majority of the responses were for a person in need of immediate medical care. The Fire Department takes those patients to hospitals
outside San Francisco mainly from southern parts of The City, saying it’s faster because the routes are quicker than navigating city streets.
The practice of driving patients out of The City, especially for nonemergencies, has come into question while the Fire Department struggles to level out its response times in San Francisco.
In potentially deadly situations when every second counts, emergency responders show up to The City’s northeastern neighborhoods more than a minute earlier than those in southern areas, according to a recent report. The Fire Department study does show a significant improvement in response overall in recent years; a 2007 report showed that no district met the overall 6½-minute standard.
Fire Commission President Victor Makras, however, is looking into whether the Fire Department should change its policy so that out-of-county transports only occur in an emergency and when a hospital outside San Francisco is the quickest option.
“I will continue to put pressure on performance standards until all neighborhoods in San Francisco receive equal response times,” Makras said.
Other Fire Department officials, however, say cutting out the out-of-town transports would result in worse response times.
Deputy Chief Pat Gardner said returning from the Peninsula actually takes less time.
“As soon as the transport is over, the clock starts ticking,” he said. “There’s a turnaround time that’s actually quicker to go out of the county than to go to Kaiser on Geary.”
The major culprit of the response time problem, Gardner said, is when there’s a second incident in the same area.
Counties and jurisdictions wrestle with the debate of transporting patients on a regular basis, according to Rob Dudgeon, director of the Division of Emergency Services at the Department of Emergency Management.
He calls it a balancing act between a patient’s rights — many city residents get their primary care at San Mateo hospitals — and faster response times. Also, there are other consequences.
“If you make a decision not to take them across this imaginary line, hospitals in San Francisco will absorb the patient load, and you’ll probably see an increase in ER waiting times,” Dudgeon said.
First responders slow to reach goal
Response times in San Francisco during an emergency have improved in the past two years, but several obstacles to reaching the goal set by the Fire Department still exist.
A 2007 report showed that no fire district in San Francisco reached the 6½-minute standard for arriving to a patient in need. A September report by the Fire Department concluded that emergency responders have primarily reached their targets, but discrepancies and problems still exist.
When there’s an emergency, the first contact is usually with the Department of Emergency Management 911 call center.
If there is a high volume of calls coming into the center and low staffing levels, it could lead to calls that are either put on hold or dropped.
A call can also be delayed if it comes in from a cell phone, since those are often first routed through the California Highway Patrol
Once a call is answered, operators have to make quick decisions about whether to send immediate medical help. If the caller is speaking a foreign language, the call is routed to a third-party language service contracted by The City.
The ambulance should receive the call in less than two minutes. It then has 4½ minutes to respond to the scene.
The Fire Department has been the primary provider of 911 medical services in San Francisco since 1997. Private ambulance companies are rarely sent on an emergency call in The City.
Recently, the Fire Department changed its policies so ambulances are parked throughout San Francisco on a rotating basis, instead of at the same station all day. That has improved response times, according to fire officials, but if a second call in the same area comes in, that leads to more delays.
At any time on a call, traffic or driver error can also cause critical delays in the delivery of a patient.
Calls for emergency care
The SFFD shuttled patients to the Peninsula for non-emergency (Code 2) and immediate medical care (Code 3) in fiscal year 2008-09.
Month Code 2 Code 3 Total
July 21 71 92
August 31 57 88
September 34 73 107
October 35 68 103
November 29 68 97
December 26 49 75
January 22 63 85
February 22 55 77
March 29 76 105
April 28 74 102
May 38 70 108
June 32 78 110
Total 347 802 1,149
Transport to hospital
The number of patients SFFD drove to out-of-city hospitals in fiscal year 2008-09:
483 Kaiser Permanente, South San Francisco
666 Seton Medical Center, Daly City
Slow going during emergencies
Response times to emergencies have improved during the past two years, but there are still discrepancies.
District Response time* Engines in district
1 4 minutes, 20 seconds 4
2 4 minutes, 16 seconds 5
3 4 minutes, 44 seconds 4
4 4 minutes, 3 seconds 4
5 4 minutes, 24 seconds 0
6 4 minutes, 41 seconds 5
7 4 minutes, 50 seconds 5
8 5 minutes, 13 seconds 5
9 5 minutes, 30 seconds 4
10 5 minutes, 1 second 6
* Average times from June to August
** One engine is stationed on Treasure Island
Source: Fire Department