San Francisco fire chief warns EMS system strained as city growth drives medical calls

Fire Chief Joanna Hayes White told the San Francisco Board of Supervisors’ Budget & Finance Committee on April 20 that population growth and a sharp rise in medical calls have put "strain on the EMS system" and on fire suppression resources.

White said medical calls have driven most of the increase in overall call volume and projected an increase "of more than 12% over the past two years" in medical calls. "What this has meant ... is that there's a strain on the EMS system both on the ambulance side as well as on the suppression side," she said.

The department described several existing and planned responses. White said the Fire Department has reimplemented a program with two dedicated rescue captain-paramedics who work with the Department of Public Health to redirect 911 callers to more appropriate services when possible. The department has also added ambulances and created a per-diem paramedic classification, patterned on surge staffing models, to provide capacity during spikes in demand.

White highlighted improvements on performance metrics provided by the Controller's Office, saying the department is meeting its goal of getting advanced-life-support paramedics on scene within seven minutes more consistently than during earlier struggles. Still, she said, continued investments in staffing and equipment are needed to sustain those gains.

On recruitment and staffing, White said the department and the mayor's office are pursuing a multi-year hiring plan. She told supervisors the department anticipates hiring "approximately 270 members to counter the projected retirements through 2020," and that a recruitment coordinator (Firefighter Keith Baracca, appointed late 2015) is helping expand outreach.

White also described deferred maintenance across the department's roughly 50 facilities and noted prior general-obligation bond funding has helped; she told the committee that if a then-upcoming health bond passed, the Fire Department would be the department-level recipient of funds the chief presented (she cited roughly $58 million for an EMS division facility and about $14 million for ongoing station upgrades) while a comprehensive facilities assessment with the Department of Public Works is underway to quantify remaining backlog.

Apparatus replacement was a central theme. White said fire engines cost about $500,000 and aerial trucks about $900,000. Citing National Fire Protection Association guidance, she said frontline engines typically should be retired after about 10 years and trucks after about 15 years, but acknowledged several San Francisco front-line vehicles exceed those guidelines because of heavy use and hilly terrain. "We are really due to replace" aging apparatus, she said, and the department is working with the mayor's office to develop specifications and a replacement plan better suited to San Francisco's streets.

Two San Francisco firefighters who spoke during public comment reinforced the department's case. Jeff Colombini, a 26-year department member, said the NFPA recommends frontline apparatus not remain in regular service past 10–15 years, that "over 50% of our frontline fleet is over 15 years old," and that the department is spending roughly $500,000 per month in maintenance on the aging fleet—amounts he said rival the cost of a new engine. Another firefighter urged reinstating a special-operations battalion chief, more training positions, and a dedicated marine rescue unit following recent drownings at Ocean Beach.

The committee voted to continue item 2 to the call of the chair for further budget review. The department will return later in the budget season with additional detail and requested funds as the Mayor's Office and Controller's Office finish their analyses.