The San Francisco Fire Department may stop shuttling patients to hospitals on the Peninsula as it struggles to provide prompt medical response across The City.
The Fire Department took 1,149 patients to Seton Medical Center in Daly City or Kaiser Permanente in South San Francisco in fiscal year 2008-09. About one-third of those calls were for non-emergency incidents in which the patient requested a ride to another hospital.
A majority of the calls were for Code 3 incidents — calls that mean a person needs immediate medical care. The Fire Department takes those patients to hospitals outside San Francisco mainly from southern parts of The City, saying it is faster because the routes are quicker than navigating city streets.
The practice of driving patients out of The City, especially for nonemergencies, has fallen into question while the Fire Department struggles to level out its response times in San Francisco.
In potentially deadly situations when every second counts, emergency responders show up to The City’s northeastern neighborhoods more than a minute earlier than those in southern areas, according to a recent report. The Fire Department study does show a significant improvement in response overall from recent years — a 2007 report showed that no city district met the overall 6½-minute standard.
Fire Commission President Victor Makras, however, is looking into whether the Fire Department should change its policy so that out-of-county transports only occur in an emergency and when a hospital outside of San Francisco is the quickest option.
"I will continue to put pressure on performance standards until all neighborhoods in San Francisco receive equal response times," Makras said.
Other Fire Department officials, however, say cutting out the out-of-town transports would result in worse response times.
Deputy Fire Chief Pat Gardner said returning from the Peninsula actually takes less time.
"As soon as the transport is over, the clock starts ticking," Gardner said. "There’s a turnaround time that’s actually quicker to go out of the county than to go to Kaiser on Geary."
In addition, making calls to the two major hospitals in San Mateo County keeps those hospitals together on San Francisco’s protocol, which is important if there is a regional disaster. Gardner also said that bringing a patient to their medical home makes it easier for doctors to pull files and determine treatment.
The major culprit of the response time problem, he said, is when there is a second incident in the same area. The time to go to that emergency lags because one ambulance is already on a call.
Counties and jurisdictions wrestle with the debate of transporting patients on a regular basis, according to Rob Dudgeon, director of the Division of Emergency Services at the Department of Emergency Management.
He calls it a balancing act between patient’s rights — many San Francisco residents get their primary care at San Mateo hospitals — and faster response times. Also, there are other consequences.
"If you make a decision not to take them across this imaginary line, hospitals in San Francisco will absorb the patient load, and you’ll probably see an increase in ER waiting times," Dudgeon said.
A spokesman for Kaiser Permanente declined to comment for this story, saying the hospital didn’t have enough information.
Transport to hospital
The number of patients SFFD drove to out-of-city hospitals in fiscal year 2008-09:
483 Kaiser Permanente, South San Francisco
666 Seton Medical Center, Daly City