San Fransisco: Quality of pre-hospital 911 care questioned

[CBEMT]

While San Francisco has made progress this year in reducing ambulance delays, emergency medical experts have raised questions about the quality of pre-hospital care delivered to patients.

The city's 911 ambulance staff, experts say, is insufficiently trained and keeps patient charts that often fail to indicate the specific medical treatment provided.

Medical experts have also criticized a decision by San Francisco health officials earlier this year to postpone a program requiring city ambulances to transport severe heart attack victims to designated hospitals with specialty departments and personnel equipped to treat these patients.

Experts say the quality of the agency's medical care lags behind the pre-hospital services of leading U.S. cities such as Austin, Boston and Seattle, as well as other Bay Area cities and counties.

http://www.sfgate.com/cgi-bin/article.cgi?.../MN4M14R20R.DTL

Be sure to check out the comment left by "Horace." Sounds like he was on the inside when SF EMS went downhill.

[Arizonaffcep]

That's too bad. I had always heard they were really good.

[Dustdevil]

That's too bad. I had always heard they were really good.

Did you hear this about thirty years ago?

[Arizonaffcep]

No...had heard it from an RN that worked in that area a while ago...he was also a CEP.

[spenac]

I really never recall hearing anything good about SF EMS. Another place I do not visit.

[Arizonaffcep]

Well, if it's a tradtional FD thing...they probably cook well...

[Fox800]

If I remember correctly...they take STEMI patients to hospitals without interventional cath labs. Kickass.

[UMSTUDENT]

Did you hear this about thirty years ago?

Yeah, I heard they only recently adopted 12-Lead capabilities. Aren't they the same fire department that still carts around wooden ladders?

Whatever. Firemonkey problems. What I think is completely ridiculous is these hospitals who are unwilling or not capable of providing cardiac services (mainly 24/7 PCI) are worried about loosing STEMI patients because "their records won't be available." BS. They just want their revenue at the expense of someone else's life.

[Rettungsassistentin]

"While [insert any fire-based EMS department] has made progress this year in reducing ambulance delays, emergency medical experts have raised questions about the quality of pre-hospital care delivered to patients."

The news is that this is actually making news!

San Francisco needs to throw in the towel. Focus on your strengths: fire suppression, fire safety, and brainwashing the public that you were sent here from heaven as a gift to all of us mortals, ensuring our safety from ruthless fire demons!

[VentMedic]

SFFD has had troubled waters for many years and when it appears it might get better, they get another set back.

This is a description of how they are operating now with a few minor changes here and there.

http://www.sfgate.com/cgi-bin/article.cgi?...;type=printable

SAN FRANCISCO

Fire Dept. to be restructured

Firefighters and paramedics will cease to be merged

Jaxon Van Derbeken, Chronicle Staff Writer

Wednesday, September 22, 2004

San Francisco's troubled Fire Department will soon be restructured under a plan hailed by the mayor as both improving service and saving the city $3 million a year.

The new approach marks the end of a seven-year merger between the firefighter and paramedic ranks. The merger has been described as difficult by the department.

In June, the San Francisco grand jury, which reviews city operations, found that the department was dogged by on-duty drinking and unchecked harassment of paramedics by firefighters in the wake of the 1997 merger. Union officials dispute the claims of harassment.

Under the merger, paramedics said they endured a heavy workload and hostility from their firefighter colleagues at the firehouses where they both worked 24-hour shifts.

Firefighters, among other things, claimed they could not sleep because of the sound of sirens from the responding ambulances housed at stations.

Rather than continue with the merger, Mayor Gavin Newsom said Tuesday, he will create a three-tier system of paramedics, firefighters and firefighter paramedics. Once the system is in place in 18 months, he said, the city could save $3 million in salaries.

"This will bring better service, better, more consistent responses,'' Newsom said. "From the taxpayer perspective, we're going to same money.''

At the entry level will be 200 lower-paid civilian paramedics and emergency medical technicians to staff the city's ambulances. They will be hired at $65,000 or more a year, $20,000 less than fully trained firefighter paramedics.

The ambulance crews will be housed away from fire stations, and the crews will work 10- to 12- hour shifts, without the same benefits as their higher- paid colleagues.

The next rung will be firefighters, followed by the highest paid group, the firefighter paramedics created in the merger, who earn a starting wage of $85,000.

The firefighter paramedics will no longer staff ambulances on a regular basis. Instead, they will be stationed at the city's 42 firehouses, riding with fire crews to provide emergency life support until ambulance crews arrive.

Fire Chief Joanne Hayes-White said the plan was "the best use of our resources'' with a goal of a 4 1/2-minute response time within 18 months.

Critics say the plan simply abandons the costly merger of the department at the behest of the powerful firefighters' union, Local 798.

"The merger could have worked, but it didn't because of a lack of leadership,'' said Michael Creedon, a firefighter paramedic who is an outspoken critic of the current administration.

Creedon and others worry that the paramedics assigned to stations will not have the variety of experience needed to keep up their skills, a contention dismissed by Hayes-White, who said the department would compensate for the change by increased training.

The mayor's office and Fire Department tout the new plan as solving some long-running problems with the department, including fatigue. They point out that new ambulance crews will work only 10-12-hour shifts -- instead of 24- hour shifts -- to reduce fatigue.

"Because of the high call volume, the workload became essentially unbearable,'' Hayes-White said.

They say the new ambulance-crew spots will also provide an entry-level good avenue for minorities.

But Kevin Smith, head of the San Francisco Black Firefighters Association, said the new plan wouldn't necessarily help minorities, who have to finance their own training before applying. "They say you have to get the training on your own, where the department provided it before,'' Smith said.