San Francisco doesn't always have enough ambulances for medical calls, with a backlog of up to six calls at times. That means an ambulance has been requested but isn't immediately available.
Though paramedics are already at the scene delivering potentially life-saving care, and each delayed request may be resolved in minutes or even seconds, it can delay transport to a hospital in situations where each minute could matter.
While medical calls have grown nearly 16% since 2015, the number of ambulance personnel has remained at 200, according to a Fire Department memo. The impacts of more calls can be increased wait times for patients to get ambulances in outlying areas and reliance on overtime to meet staffing needs, the memo said.
Both Mayor London Breed and San Francisco supervisors are proposing bumping up the department's budget to help fill gaps, though their proposals differ. While the department and Breed said more analysis was needed to determine whether to increase staff in the future, Supervisors Matt Haney, Ahsha Safaí and Shamann Walton announced Wednesday that they are using budget savings to add 10 more paramedics for ambulances now.
"It is absolutely critical that paramedics are available to respond immediately in an emergency," Haney said in a statement. "Adding new paramedics will reduce response times, improve health and safety, and save lives."
In San Francisco, where elected officials are fighting over the police budget and staffing, there's near unanimous support for the Fire Department and particularly its community paramedics. The city has increasingly relied on them to respond to homelessness, mental health crises and drug overdoses, tackling some of the medical calls that may not always need an ambulance.
There are an additional estimated 57 paramedics on the department's community paramedicine and new Street Crisis Response Teams, and the department has been approved to backfill those positions on ambulances.
The city also added eight paramedics and emergency medical technicians on smaller trucks that aim to put medical staff on scene as soon as possible, although they can't transport patients to the hospital.
The mayor's spending plan proposes increasing the department's current $412 million budget by 7% over the next two fiscal years. The increased funding will go toward equipment, training, salaries and 35 new paramedics to backfill those in the ambulance division moving to street teams.
"Our plan is to do everything we can to make sure we can make up for some of the challenges that we know exist," Breed said Wednesday while standing outside the city's newly renovated ambulance hub at Station 49 in the Bayview district.
While the Fire Department's memo to supervisors a couple weeks ago painted a picture of "ambulance staffing issues," Breed and the department said this week that it's unclear if more personnel are needed. The city plans to restart a staffing analysis that was halted because of the pandemic to guide hiring. The department said it would then come back to the Mayor's office in the middle of the fiscal year, which starts July 1, or next year with budget needs.
"To put our foot down and say yes, we need more or no, we don't need more — that would be speculative and an uneducated decision," said Lt. Jonathan Baxter, a Fire Department spokesman, pointing to the need for the analysis.
But the Board of Supervisors — and the firefighters' union — want even more paramedics and funding now. The proposal Wednesday commits to using $1.9 million in budget savings to pay for 10 new paramedics — with possibly more to come. The total cost of a full-time paramedic for salary and benefits is just over $200,000. Ambulances need either two paramedics or one along with an emergency medical technician to run a 12-hour shift.
The debate is not new. Over the past 15 years, Fire Department service calls have steadily risen, largely attributed to calls for emergency medical services, the mayor's budget said. When a city report revealed that the city didn't have enough ambulances or paramedics in 2014, the city raised the number of ambulance personnel from 177 to 200 in 2015. The current number remains at 203.
Last year, with fewer people living and working in the city, calls overall decreased. Now that the city is emerging from the pandemic, the need is rising again.
Since most ambulance requests are downtown and in the Mission, the impact of the increased call volume is felt the most in the city's outlying districts, the Fire Department's memo said. Data shared with Supervisor Gordon Mar shows that average yearly response times for medical transport calls in the Great Highway area on the city's western edge increased 1% last year, and 10% this year, to nearly 10 minutes.
"Do increased response times concern me? Yes," Fire Chief Jeanine Nicholson told Mar during a budget hearing last week. "It concerns me, absolutely — not just the ambulances but all of our units."
The target response time for an ambulance medical transport is under 10 minutes. The department meets that goal 89% of the time. Another first responder arrives within four minutes 91% of the time. That responder can provide care, but not transport a patient to the hospital.
Baxter said the reason for sometimes longer call response times could be attributed to a number of factors — traffic, closed streets, construction — besides staffing.
"There are times when we have no ambulance to respond," Baxter said. "Why is that the case? Those are the things that we need to evaluate to see what our needs are."
The union believes the problem is staffing. Sam Gebler, director of Local 798 union representing nearly 1,700 Fire Department staff, said he's frequently the only paramedic on three fire engines in the Richmond District. He said that last week, while working overtime in the Sunset District, he responded to an older patient with a history of cancer who was sick with very severe symptoms. He had to wait 30 minutes stabilizing the patient for an ambulance to arrive, he said. In those cases, he's not able to respond to other calls if they come up.
With an increase in calls over the years, the department has been forced to rely more and more on overtime shifts, including mandatory overtime, and per diem employees to meet minimum staffing levels, the department's memo said. Gebler estimated that paramedics work mandatory overtime at least five times a month.
"We are doing our best to meet the needs for the safety of the citizens," said Shon Buford, a fire captain and union president. "But it's having a major impact on the mental health of our paramedics, and it's not sustainable."
Mallory Moench is a San Francisco Chronicle staff writer. Email: [email protected] Twitter: @mallorymoench
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