911 calls in San Francisco surge, leaving ambulance service at 'level zero' on a daily basis

Homelessness is a growing problem in the Bay Area. So is drug addiction and those suffering from mental health issues. As a result, 911 calls are surging throughout San Francisco, putting a massive strain on paramedics and reigniting a cry for more emergency crews, in a department that hasn't hired any new paramedics since 2015. 

2 Investigates has learned that the emergency system is so taxed that is reaches a  "Level Zero" status every day, even if just for a few minutes at a time. That means there is such extreme demand for service, the regulatory agency called Emergency Medical Services Agency, requests additional private ambulance companies working in other cites come to San Francisco to help. 

One of these situations occurred on Aug. 25, when several ambulances were unstaffed with calls waiting and no crews were available, 2 Investigates learned. The city had to rely on mutual aid for ambulance coverage. 

On 25 times that day, the city's ambulance coverage dropped below "level zero," meaning at least one call for help was waiting.  The Emergency Medical Services Agency issued an urgent request for additional ambulances. Crews in two private ambulances answered the call.

The city can't point to any deaths because of this low level of service, but union leaders say every second counts when you're waiting for paramedics to arrive.          

"The risk is a person's health," said Tom Fogle with the San Francisco Firefighters Union Local 798.     "If you're having a heart attack or a stroke or you've been in a car wreck and you need to be in an operating room right away, the longer you wait, the less likely you're going to have a positive outcome." 

Fogle said this demand is pretty common.

"It's fairly regular that we're not able to staff up to five scheduled ambulances on a daily basis," he said.

During a heat wave in June, as another example, the city couldn't meet demand and once again fell below that critical "level zero." Five ambulances drove across the bridge from Solano County to help respond to emergencies in San Francisco, 2 Investigates has learned. 

What happened this summer is just another warning sign that the city's ambulance service faces its own emergency, Fogle said. He added that staffing hasn't kept pace with the increasing number of 911 calls. In fact, as another example, Fogle said that it's common for an average of five ambulances to sit dormant each day because no paramedics are available to fill them.

A recent analysis, paid for by the union, shows the system is stretched thin. It cites a 7% jump in calls from 106,079 in 2016 to 113,633 in 2018.  At the same time, no additional paramedics have been hired. The survey concludes the department is unable to staff all scheduled ambulances due to a lack of available personnel.   

The matter has some city leaders alarmed.

"How equipped are we to handle a city-wide emergency?" asked Supervisor Catherine Stefani during a budget committee hearing in June following the heat wave. 

She raised concerns about the difficult challenge to keep up with the high volume of calls. 

Fire Chief Jeanine Nicholson, just two weeks into her tenure, acknowledged the problem and admitted the need for additional staffing. 

Back in her office, Nicholson is preparing for the next negotiations, taking a closer look at the numbers to see what's needed to meet the growing demand. "This is why I need to really drill down on the data," she said. "That's what I need to do before I can definitively say 'Oh, we're 10 short or this short.' " 

During the last round of budget talks, the fire department requested funding for 12 paramedics but was denied. She's hoping that will change.   

"It's been a huge challenge for us,"  Nicholson told the supervisors.  "It's been a huge challenge for us.  We run at level zero on a daily basis and level zero is when there are no ambulances available to respond to an incident. That speaks volumes to me."