911 help arriving sooner in San Francisco

By Jim Doyle
The San Francisco Chronicle (California)

SAN FRANCISCO — Following a new protocol, San Francisco's 911 Call Center has reduced the time it takes dispatchers to process emergency medical calls and send help.

First responders in the city are showing up late for 1 of every 5 urgent medical calls, according to The Chronicle's analysis of dispatch logs, an improvement over the previous four years, when delays occurred in about 1 of 4 cases.

The call center's progress has been instrumental in reducing the overall response times of the Fire Department's ambulances and fire engines, whose paramedics and emergency medical technicians are most often the first to arrive at medical emergencies.

In November 2007, the center at 1011 Turk St. began instructing its call-takers to immediately dispatch help to callers reporting priority symptoms. A previous policy required dispatchers to spend additional time gathering more information on the patient's symptoms before sending help.

"Every day, we are seeking improvement," said Lisa Hoffmann, who runs the 911 Call Center. "Our staff is doing an incredible job under almost impossible conditions."

Nathan Ballard, press secretary for Mayor Gavin Newsom, said: "When you call 911, you deserve a quick response. We're pleased with the progress we've made."

The improvement follows a Chronicle investigation of dispatch logs for more than 200,000 high-priority medical calls, along with an examination of documents and audio recordings related to the performance of dispatchers and medics in cases involving delayed responses and fatalities.

6 1/2-minute goal
San Francisco's objective is to get professional help to the scene of high-priority medical emergencies within 6 1/2 minutes of receiving a 911 call, 90 percent of the time. That standard, adopted in 2004 by the San Francisco Emergency Medical Services Agency, was less stringent than a five-minute goal for urban areas recommended in 1998 by the EMS Emergency Medical Directors Association of California.

The Chronicle found that at least 439 people died in San Francisco from February 2004 through December 2007 while waiting for a late ambulance or after delayed medical help arrived. While it is impossible to know how many of those people 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.

From November 2003 through the end of 2007, emergency medical help arrived late 27 percent of the time on the most serious medical calls, termed Echo and Code 3. But during the first 11 months of this year, help arrived late 20 percent of the time.

The 6 1/2-minute goal includes two minutes for dispatch, plus 4 1/2 minutes for the fire engine or ambulance to arrive at the curb.

From January through November, the call center's call-takers and dispatchers met the city's goal of sending medical help within two minutes of receiving a 911 medical call about 64 percent of the time. A previous Chronicle analysis found that the call center met the city's two-minute goal only 44 percent of the time from November 2003 through the end of 2007 - making it the weakest link in San Francisco's emergency medical response system.

The 911 Call Center "has a rigorous program for quality assurance," said Hoffmann, adding that specialists listen in on some 911 calls to gauge a call-taker's performance. "Every single employee is monitored every month," she said.

Reasons for delays
Dispatch delays are often unavoidable, Hoffman said, because English is not the primary language of many of San Francisco's 911 callers, and the use of translators can slow the process. Other delays occur because of difficulty identifying a caller's address when a cell phone is used, and because some 911 callers are distraught.

While dispatchers are sending help more quickly, ambulances and fire engines are taking longer to arrive at the scene of high-priority medical calls. From January through November, these first responders failed about 18 percent of the time to meet the city's goal of arriving on scene within 4 1/2 minutes of being dispatched. By contrast, ambulances and fire engines were late 15 percent of the time from November 2003 through 2007.

Assistant Deputy Fire Chief Pete Howes attributed the delays to an increase in calls and adjustments being made by paramedics using new electronic patient charts that demand more time at hospitals than paper records.

Some medics complain there are not enough ambulances on duty, which increases the delays for the first units. Fire Chief Joanne Hayes-White disagreed and added: "Particularly with this economy, I don't see us expanding."

For the first 11 months of the year, the city's first responders arrived on the scene of urgent medical calls within seven minutes and 35 seconds 90 percent of the time. That's an improvement from the previous four years, when the city's 90th percentile for the first units on scene was eight minutes.

Service remains the worst in the Ingleside and Excelsior districts and nearby areas, with delays 29 percent of the time. The city's best response times are recorded in the Haight-Ashbury, Cole Valley and nearby neighborhoods, with a delay rate of 14 percent.

Copyright 2008 San Francisco Chronicle
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