S.F.'s emergency responses fail to meet goal

[VentMedic]

A lengthy front page story in the SF Chronicle today. The public comments are probably the most interesting.

S.F.'s emergency responses fail to meet goal

http://www.sfgate.com/cgi-bin/article.cgi?...3/MNR0VTB9I.DTL

http://www.sfgate.com/

"Where in the hell are They?"

Jim Doyle, Chronicle Staff Writer

Sunday, April 13, 2008

Gustave Grialou was one of at least 439 people who have died in San Francisco since February 2004 while waiting for a late ambulance or after delayed medical help arrived, according to a Chronicle analysis of dispatch logs for about 200,000 high-priority medical calls.

In 27 percent of those calls, first responders failed to meet the city's standard for getting help to the scene of high-priority medical calls. In some areas of the city, such as the Ingleside and Excelsior districts, the odds of an ambulance being late are almost 40 percent.

While it is impossible to know how many of the 439 people who died would have survived had

medical help arrived earlier, studies show a direct relationship between ambulance delays and the survival rates of patients in need of immediate resuscitation.

"A 30-second delay can mean everything to a patient who's waiting for life-support systems," said Mike Williams, president of the Abaris Group, a Walnut Creek consulting firm that helped create emergency medical standards for the state of California.

Many reasons

In an investigation that included dozens of interviews with city officials, front-line workers and experts as well as a review of hundreds of documents including dispatch logs and 911 audiotapes, The Chronicle found that delayed emergency medical responses are the result of numerous causes, from chronic understaffing, language barriers and botched dispatches at the city's 911 call center to traffic congestion and unavailable nearby ambulances.

In San Francisco, the most serious emergency medical calls fall into two categories - Echo and Code 3. Echo-priority calls require immediate resuscitation, such as cases of stopped breathing, choking, drowning, severe allergic reaction and cardiac arrest. Code 3-priority medical calls, such as severe hemorrhage and difficulty breathing, are also presumed to be life-threatening.

In the past decade, San Francisco has gradually lowered its response times on high-priority medical calls - improving its overall performance by about 2 minutes. In 2001, more than 10 percent of its responses to such calls exceeded 10 minutes.

But dispatchers and rescue crews in San Francisco have been unable to meet the upgraded, 6 1/2-minute standard that city health officials adopted on Feb. 1, 2004, even though that goal is less stringent than a 5-minute goal in urban areas recommended in 1998 by the EMS (emergency medical services) Medical Directors Association of California.

The city's objectives also are less rigorous than standards set by the National Fire Protection Association, which call for arrival on the scene within 6 minutes after a 911 medical call is answered.

Dual mission

Ten years after the Fire Department took over the city's ambulance fleet, the agency is still adjusting to its dual mission of putting out fires and sending help quickly to 911 medical incidents.

The number of fires in the city has decreased in recent decades. Medical calls currently make up more than two-thirds of the emergencies to which the department's engines and ambulances respond.

According to paramedics and other 911 medical experts, the Fire Department has been slow to reorganize itself to provide state-of-the-art ambulance services.

"The Fire Department's commitment to EMS isn't as great as they'd like you to believe," said paramedic David Anderson, a former quality improvement expert for San Francisco's ambulance service. He was hired last year by the Austin-Travis County EMS Department in Austin, Texas, which is not run by a fire agency.

Anderson said the management of the San Francisco Fire Department "has no idea how to run an EMS operation. And with state budget cuts, the money just isn't there to work on it."

The Chronicle's analysis found that 15 percent of the time, the city's ambulances and fire engines fail to meet the city's goal of arriving at the scene of an urgent medical call within 4 1/2 minutes after being dispatched - which contributes to the city's overall response delays of 27 percent. That 4 1/2-minute standard does not include dispatching or the time allotted for medics to climb stairs or ride an elevator to reach a patient's side.

The city is divided into 11 emergency districts that each consists of several neighborhoods. Although steps have been taken in the past two years to redeploy ambulances, fire officials are not providing equal response times to all neighborhoods.

More at

http://www.sfgate.com/cgi-bin/article.cgi?...3/MNR0VTB9I.DTL

[JPINFV]

According to paramedics and other 911 medical experts, the Fire Department has been slow to reorganize itself to provide state-of-the-art ambulance services.

"The Fire Department's commitment to EMS isn't as great as they'd like you to believe," said paramedic David Anderson, a former quality improvement expert for San Francisco's ambulance service. He was hired last year by the Austin-Travis County EMS Department in Austin, Texas, which is not run by a fire agency.

Anderson said the management of the San Francisco Fire Department "has no idea how to run an EMS operation. And with state budget cuts, the money just isn't there to work on it."

[AnthonyM83]

Anderson said the management of the San Francisco Fire Department "has no idea how to run an EMS operation. And with state budget cuts' date=' the money just isn't there to work on it." [/quote']

Ouch!!!

[Dustdevil]

Ever notice that, wherever VentMedic goes, EMS goes to hell?

[JPINFV]

Naw, it's a fire based system in California. She's just the messenger this time.

[Doug]

God forbid we lay any blame on those that overuse the 911 system and take trucks out of service in an area....

[Dustdevil]

God forbid we lay any blame on those that overuse the 911 system and take trucks out of service in an area....

Our mission is not to place blame. Our mission is to meet demand. FAILURE to meet that demand is not something that can be righteously blamed on the citizens we serve.

[spenac]

Our mission is not to place blame. Our mission is to meet demand. FAILURE to meet that demand is not something that can be righteously blamed on the citizens we serve.

The taxpayers pay our check so they feel they have the right to call an ambulance to be used as a taxi. As such we need to raise taxes and cut waste in other ares of government and increase available units. That and get medical directors with enough balls to authorize the crew to say no to people that can safely get to the hospital another way.

[Dustdevil]

You can always do things to help compensate for abuse. You can improve the education of your providers, enabling them to more accurately assess a patient's need for transportation. You change transportation policy, allowing no-rides. You can educate the public. You can establish alternate transportation resources, like handi-vans and taxi vouchers for trips to the hospital, both of which are one hell of a lot cheaper than EMS.

If your system does not either undertake the above measures or increase resources to meet current demand, your system FAILS. Simply blaming systemic FAILURE on the citizens you serve does not mitigate it.

[p3medic]

Bet their response time to "structure fire" is way better than cardiac arrest....just a guess.