San Francisco in Desperate Need of Staff, Units, Equipment

Medics have worked up to 48 hours of mandatory overtime in a single week.


A man loses a finger near Pier 33 and waits 40 minutes for an ambulance to take him to the hospital.

Firefighters spend 20 minutes giving an unconscious man CPR on Market Street before medics drive him away.

A 91-year-old woman waits for an hour and 20 minutes to be transported to the hospital after calling 911 from her Mission District home.

These incidents point to what emergency workers say is a lack of investment in the people and equipment necessary to help respond quickly to those in need - and points to the bigger problem of whether San Francisco is equipped to deal with both everyday and large-scale emergencies.

Ambulances, emergency rooms and dispatch centers are perennially understaffed, workers say, which regularly leads to backlogs at the 911 center, forces noncritical patients to wait for transportation to hospitals, and leaves patients lingering for hours before they can receive care or a bed at San Francisco General Hospital, the city's only trauma center.

Fire Chief Joanne Hayes-White and other city leaders said they are making changes to help deal with the problems, such as an increase in 911 calls, which have jumped by nearly 22 percent between 2007 and 2013, according to a recent city report, likely because of an increasing population.

"The system is strained," Hayes-White said. "On an average day in the city ... we make it work. Should we have more resources? Yes. We are in a building mode. ... There's an additional strain I have noticed in the last six, nine, 18 months."

Disaster readiness

Hayes-White, Emergency Management Director Anne Kronenberg and Roland Pickens, who oversees patient care for the Health Department, all noted that the city's 2014-15 budget includes money to hire emergency workers and buy new ambulances. They insist San Francisco and the Bay Area have plans in place for bigger disasters and stress that critically ill or injured patients are never turned away or asked to wait for care.

But people who staff the city's ambulances, dispatch centers and hospitals painted a picture of overtaxed workers in already high-stress environments and say low morale has become the norm. They say dispatchers are struggling to pick up 911 calls, ambulances are taking more time to arrive at medical emergencies and patients are often waiting for care at the hospital.

Ambulance shortage

At the Fire Department, broken-down ambulances and short staffing have resulted in a drastic increase in "medic-to-follow" calls - that's when a fire engine responds to a medical call within five minutes, but an ambulance doesn't arrive to transport a patient until later.

Local 798 President Tom O'Connor, whose union represents firefighters and medics, said the division's staffing shortfall is putting patients at risk. He said medics have worked up to 48 hours of mandatory overtime in a single week.

"Our great concern right now is that we don't have enough people to staff all the ambulances necessary to respond to 911 calls," he said. "People are waiting for an ambulance for 20, 30, 40 minutes."

City records show that medic-to-follow calls occurred nearly 2,500 times in 2013, up from about 2,000 in 2012.

O'Connor said the city is falling short of state mandates that require it to respond to 80 percent of all calls for ambulances (two private companies respond to the rest). And a May 12 memo to Hayes-White from Deputy Chief Tom Siragusa raised concerns about what he called an "unusual" number of medic-to-follow calls in the preceding month and cited one day in particular with "unacceptable" wait times.

"I am concerned that a serious negative outcome will be the result of a lack of medical units available," he wrote. "The current medic situation is unacceptable and needs to be addressed as soon as possible."

Equipment issues also plague the department, officials say. On any given day, nine of the department's 45 ambulances are in the shop for repairs, said Assistant Deputy Chief Ken Lombardi, though only 16 are generally on the street at any given time.

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