Close Calls: When Emergency Help Comes Late

Close Calls: When Emergency Help Comes Late

Photo by Sam Hodgson

Family members of Rickquese McCoy share memories of him over a memorial in a canyon near their home. McCoy was shot and killed in June 2012. It took fire crews 12 minutes to arrive at his aid.

Rickquese McCoy decided the bonfire could wait.

It was after 10 p.m. on a Saturday last June, and teenagers along the 2600 block of 44th Street in City Heights had begun piling into cars for a bonfire at Mission Beach. McCoy, 18, stepped out of his friend’s Pontiac Grand Am to talk with a neighbor instead. McCoy had lent her his cigarette lighter and wanted it back. He didn’t mind being a little late.

McCoy and the neighbor chatted in a nearby apartment complex’s common area. She teased him about keeping the lighter, which was pink. About 10 feet away, McCoy’s friend Timothy Walker spoke with his uncle, Stephen McClendon, who also lived on the block.

As the friends talked, three men in dark clothing approached the complex. The neighbor whispered to McCoy, asking who they were. McCoy shrugged.

The men reached the group and opened fire.

They shot McClendon and Walker. Both fell to the ground. Two shots struck McCoy, in the buttocks and back. One bullet broke two ribs and ripped through his left lung. McCoy ran and collapsed in an alley behind the apartment complex, about a football field from where the shooting began.

Calls to 911 poured in. Police arrived, radioing to the Fire-Rescue Department for medical help. An ambulance came first, seven minutes after the department learned of the incident. A fire truck arrived a minute later. They both went to the front of the complex for Walker and McClendon. They didn’t know about McCoy in the alley, the department later told his family.

Firefighters at the scene eventually learned there was a third victim and sent a paramedic to McCoy. But rescuers couldn’t give McCoy the care he needed until another fire engine came, 12 minutes after the Fire-Rescue Department received the first 911 call.

When firefighters arrived, they found Lennece Chambers, whose apartment opens into the alley, holding McCoy’s hand. At first she had watched McCoy try to get up. Then, after a while, Chambers saw blood trickle out McCoy’s nose. She asked him if he knew Jesus.

“When he got in the ambulance, I already knew right then and there he wasn’t going to make it,” Chambers said. “You could see the life just going.”

McCoy lost his pulse when he arrived at Scripps Mercy Hospital in Hillcrest. Doctors began emergency surgery, but gave up within minutes. Rickquese McCoy had bled to death.

Help for McCoy should have been there sooner. He was shot less than a half-mile from Home Avenue, where the city’s newest fire station should have been built by now. City leaders pledged to put one there because first responders don’t get to emergencies fast enough.

Graphic by Amy Krone. Source: City of San Diego.

Graphic by Amy Krone. Source: City of San Diego

By their own standard, first responders have arrived late across the city more than 37,000 times to cardiac arrests, chokings, shootings and other highest-priority incidents during a 21-month period ending in March, a Voice of San Diego analysis of delayed responses found. That’s an average of more than two times an hour, every day. If you add lower-priority incidents to the list, the rate almost doubles.

Nowhere in San Diego has a greater chance for delays than five neighborhoods within 9 ½ square miles south and east of downtown, including some of the poorest and brownest parts of the city. A recent consultant study found that the neighborhood surrounding Home Avenue had the highest risk of a late response, followed by Paradise Hills, College Area, Skyline and Encanto.

Twenty months ago, city leaders committed to building fire stations in all five neighborhoods by the middle of 2017. They haven’t put a dime toward funding any of them.

When you dial 911 with a medical emergency in the city of San Diego, the Fire-Rescue Department responds. Medical incidents, not fires, make up 87 percent of the department’s more than 100,000 annual 911 dispatches.

First responders aim to arrive at medical emergencies within seven minutes and 30 seconds, nine times out of 10. They fall far short of that goal, even though the department relaxed its standards 20 months ago. Before then, first responders were supposed to arrive within six minutes, nine times out of 10, a nationally recommended target. The department couldn’t meet that goal even half the time. Fire officials argue they can’t possibly reach the newer target without more resources.

Time matters for gunshot wounds like McCoy’s, and for cardiac arrests, chokings and other emergencies. For every minute someone doesn’t receive emergency medical help after collapsing from cardiac arrest, that person’s chance of survival goes down 7 to 10 percent.

Triple shootings don’t happen often in San Diego. But other traumas do. In the neighborhoods most at risk for a long emergency response, the delays can provide a painful punctuation to horrifying incidents.

Last November, 28-year-old Cherish Lomeli was scrubbing the gas stove in her Encanto home when the cleaner she was using ignited. A fireball exploded in her face. Two and a half inches of her hairline burned off. So did her eyebrows and nose hair.

Her wife called 911, and Lomeli sat in the shower running cold water over her face.

“It pretty much felt like someone poured acid on my face and down my throat,” Lomeli said.

Lomeli waited more than 11 minutes for first responders to arrive. She ended up in the hospital for two days with burns to her face and lungs.

Photo by Sam Hodgson

Photo by Sam Hodgson

Cherish Lomeli

During the region-wide blackout in fall 2011, 81-year-old Rosemary Womack awoke from a nap to find her oxygen machine not working. Womack, who lives alone in her Skyline home, suffers from chronic pulmonary disease and needs extra oxygen all the time. She called 911. She waited more than 15 minutes for someone to get there and give her the oxygen she needed.

Womack, who also has glaucoma, estimated she dialed 911 about a half dozen times over the past 18 months.

“I just thank God they come when they do,” Womack said. “And I worry about the time when they might take too long.”

In March 2012, two roommates of 51-year-old Mark Ledesma found him passed out in his room in their Paradise Hills home and dialed 911. Ledesma had likely died of a methamphetamine overdose and cardiac arrest before the 911 call, but the roommates didn’t know that.

In an excruciating 11-minute 911 recording, a dispatcher instructs the roommates to give Ledesma CPR and tells them help is on the way.

“They’re coming with lights and sirens,” the dispatcher says.

After five minutes on the phone, a roommate says, “Fucking hurry up please.”

After seven minutes she screams, “Where the fuck is the ambulance at?” between sobs.

After nine minutes, she screams, “Where the fuck is the ambulance at?” again.

Photo by Sam Hodgson

Photo by Sam Hodgson

Rosemary Womack

More 911 calls resemble Ledesma’s than true life-and-death situations, said Jim Dunford, a physician and the city’s emergency medical director. In Ledesma’s case, the response time likely wouldn’t have affected whether he lived or died. But it did matter to those in the room with him.

Any practical investment in getting paramedics to medical emergencies faster likely will only save a small number of lives each year, Dunford said.

“We try to meet the collective needs of the community, realizing there is no such thing as an ambulance or fire engine arriving too soon,” Dunford said.

But any investment also would help people cope with the dread of being alone when disaster strikes.

“What we’re really buying here is a psychological insurance plan,” he said. “That if something bad happens, someone will be in the room.”

Click on this interactive map to see how long first responders took to arrive to major medical incidents on your block during a 21-month period ending in March. Also included are the locations of the city’s existing fire stations and the top five highest-priority, not-yet-built stations. Click here for more info.

 

By now, the chance of a long emergency response in high-risk neighborhoods should be lower. It isn’t.

After the response time study came out, the City Council unanimously passed a plan to build all five top-priority stations within five years. They estimated the price tag would be $49 million, including the cost of the firefighters to work there. Twenty months later, no money has gone toward any of the stations.

Mayor Bob Filner has broken a promise on the new fire facilities, too.

In Filner’s first press conference after his November election, he said he would spend more than $10 million immediately to help build the Home Avenue and Paradise Hills stations. He didn’t.

Money has been tight in San Diego for years. And the city has thrown some cash the Fire-Rescue Department’s way since the response time study was released. It restored idled fire engines that had been browned out during the nadir of the city’s financial crisis and funded a fire station in Mission Valley to replace a trailer-turned-makeshift-station currently in Qualcomm Stadium’s parking lot.

But city leaders have prioritized other things as well. The city is spending tens of millions of dollars this year on new programs and initiatives. It also borrowed $35 million to build and rehab city facilities. A new library in Skyline is on the list, but a new fire station there, or in any of the other most at-risk neighborhoods, didn’t make the cut.

Photo by Sam Hodgson

Photo by Sam Hodgson

Ricky and Patricia McCoy, grandparents of Rickquese McCoy, were held back from going to the hospital while police officers worked the crime scene. Rickquese died soon after he arrived at the hospital.

Patricia McCoy was showering when she heard the gunshots. The mariachi music from outside her neighbor’s house stopped. There was silence, then screams.

Her nephew banged on the bathroom door. Rickquese, her grandson, was down. She threw on her clothes and, sopping wet and barefoot, ran as fast as she could across the street and down the block to the alley. She saw Rickquese lying in his own blood, talking and scared.

Photo by Sam Hodgson

Photo by Sam Hodgson

Ricky and Patricia McCoy keep memories of their slain grandson Rickquese around the house.

Patricia McCoy, who usually needs a cane, hurried back to her house to get her grandson’s insurance card for the hospital. But police officers held her and her husband at their house while cops worked the crime scene. She didn’t make it to the hospital, and found out on the phone that Rickquese had died.

Patricia McCoy had raised Rickquese like he was her own son. All his life, Rickquese had struggled in school and had minor skirmishes with the law, but he had just made the honor roll for the first time and was a few credits short of graduating high school.

“He didn’t deserve to die like a dog in the alley,” Patricia McCoy said. “We didn’t deserve to have to watch him.”

Later that night, Patricia McCoy started having trouble breathing. She suffers from high blood pressure. Worried family members dialed 911.

It took first responders almost nine and a half minutes to show up to her house. They were late for her, too.

Voice of San Diego is a nonprofit that depends on you, our readers. Please donateto keep the service strong. Click here to find out more about our supporters and how we operate independently.

Voice of San Diego is a nonprofit that depends on you, our readers. Please donate to keep the service strong. Click here to find out more about our supporters and how we operate independently.


Liam Dillon

Liam Dillon

Liam Dillon is senior reporter and assistant editor for Voice of San Diego. He leads VOSD’s investigations and writes about how regular people interact with local government. What should he write about next? Please contact him directly at liam.dillon@voiceofsandiego.org or 619.550.5663.

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63 comments
j p
j p

The real issue in most of these calls is where is the transport unit?

Barry Pollard
Barry Pollard

i am surprised all of the comments included nothing about the fact the top 5 areas that have the poorest response times are areas that have historically been underserved. In fact this issue redefines the word "underserved". It is true we need better processes and more manpower and resources but this imbalance was glaring..... obviously only to me! I am not paranoid, nor am I the first one to bring up "race" as an issue but come on folks. Do we really think it is a coincidence that underserved communities are the TOP 5 areas with the poorest response times? Not prepared to "blame" anyone because my sense is that blaming folks typically creates defensiveness and crazy responses. So I am just asking the question. "...why is this so?..." Are we THAT unaware? Has anyone heard the term "Institutional Racism?" "...Institutional racism is the differential access to the goods, services, and opportunities of society. When the differential access becomes integral to institutions, it becomes common practice, making it difficult to rectify. Eventually, this racism dominates public bodies, private corporations, and public and private universities, and is reinforced by the actions of conformists and newcomers. Another difficulty in reducing institutionalized racism is that there is no sole, true identifiable perpetrator. When racism is built into the institution, it appears as the collective action of the population..."

Barry Pollard
Barry Pollard subscriber

i am surprised all of the comments included nothing about the fact the top 5 areas that have the poorest response times are areas that have historically been underserved. In fact this issue redefines the word "underserved". It is true we need better processes and more manpower and resources but this imbalance was glaring..... obviously only to me! I am not paranoid, nor am I the first one to bring up "race" as an issue but come on folks. Do we really think it is a coincidence that underserved communities are the TOP 5 areas with the poorest response times? Not prepared to "blame" anyone because my sense is that blaming folks typically creates defensiveness and crazy responses. So I am just asking the question. "...why is this so?..." Are we THAT unaware? Has anyone heard the term "Institutional Racism?" "...Institutional racism is the differential access to the goods, services, and opportunities of society. When the differential access becomes integral to institutions, it becomes common practice, making it difficult to rectify. Eventually, this racism dominates public bodies, private corporations, and public and private universities, and is reinforced by the actions of conformists and newcomers. Another difficulty in reducing institutionalized racism is that there is no sole, true identifiable perpetrator. When racism is built into the institution, it appears as the collective action of the population..."

Omar Passons
Omar Passons

All I can really say is wow...and thank you for covering this. Dr. Dunsford is an incredibly smart, nationally renowned guy and we should be giving his department resources to do more. Our collective inability to bring real political will to bear on this issue is an embarrassment. This is a great example of why it is so frustrating to hear people talk about building new major projects while we ignore glaring holes that affect people's lives. This is why infrastructure can't just be about potholes and slurry seals and parks. It must be about all municipal infrastructure, including fire stations and police stations.

Omar Passons
Omar Passons subscribermember

All I can really say is wow...and thank you for covering this. Dr. Dunsford is an incredibly smart, nationally renowned guy and we should be giving his department resources to do more. Our collective inability to bring real political will to bear on this issue is an embarrassment. This is a great example of why it is so frustrating to hear people talk about building new major projects while we ignore glaring holes that affect people's lives. This is why infrastructure can't just be about potholes and slurry seals and parks. It must be about all municipal infrastructure, including fire stations and police stations.

Liam Dillon
Liam Dillon memberadministrator

Hello- Thanks for the note. You are correct that the police department often orders EMS personnel to stand back prior to entering a potentially violent scene. However, in this case according to the information the fire department provided the McCoy family, EMS personnel were given clearance to enter the scene prior to the first unit arriving.

SDN8tive
SDN8tive

You should point out that when there is a medical aid when a violent crime is involved such as a shooting, stabbing, or assault etc... That Fire/EMS personal is not allowed to enter until the scene has been deemed safe/clear by Law Enforcement for EMS to enter and provide care. Its something you should clarify when your main story is about a delayed response to a shooting. That being said the city does need more fire stations, compared to other large fire departments such as Orange & Riverside County, LA City and San Francisco, a city of this size should have more than 47 stations.

Liam Dillon
Liam Dillon memberadministrator

Hi Joe- We did speak with the fire department extensively and went through our findings with them. Their comments helped make this an accurate and complete story, but we didn't feel the need to include any of their comments aside from paraphrasing. In short, they agree that help would have arrived more quickly to the McCoy shooting had there been a fire station a half-mile away and the fire crews were in house. They also say they cannot meet the seven minute, 30 second response time goal without more resources. The incidents on the map are where the first response arrived after 7:30. They might occur very near fire stations because fire crews could be out of the station responding to other incidents when calls come in.

Derek Hofmann
Derek Hofmann

What do the colors on the map mean? They don't seem to be related to response times. It would be interesting to see a heat map of response times according to location.

Derek Hofmann
Derek Hofmann subscribermember

What do the colors on the map mean? They don't seem to be related to response times. It would be interesting to see a heat map of response times according to location.

j opp
j opp

excellent article, but there was no response from police/fire departments I LIVE IN PALACCIO DEL MAR, WHICH IS ON THE SOUTH SIDE OF 56 AT CARMEL COUNTRY. THERE IS A FIRES STATION AT + MINUTES TO MAKE THIS TRIP? (I GOT THE TIME BY PUSHING THE CARMEL COUNTRY RIGHT OFF VIA VALLE. WHY SHOULD IT TAKE 7-TO 9 MINUES TO GO THIS SHORT DISTANCE ?) (I GOT THE TIMES BY USING THE INTERACTIVE BUTTONS IN TH MAP YOU SENT WITH THE ARTICLE) GOOD WORK, BUT YOUR JOB IS NOT COMPLETE. --JOE

Bill Bradshaw
Bill Bradshaw

Residents are well advised to learn CPR because you can't always rely on first responders to get there quickly, as well trained and dedicated as they are. My father might have lived ten years longer had my mother known a little CPR. He passed out as a result of dehydration, and stopped breathing. She called 911 but it was about 10 minutes before the paramedics arrived. They put him on a ventilator immediately and restored his heart and lung functions, but his brain had been deprived of oxygen too long and he never came out of the coma. Two weeks later my mother and I instructed the hospital to "pull the plug". Fortunately, my dad had an "advance directive" stating clearly he didn't want to be kept alive by artificial means. That's the other suggestion, get one of those.

Bill Bradshaw
Bill Bradshaw subscribermember

Residents are well advised to learn CPR because you can't always rely on first responders to get there quickly, as well trained and dedicated as they are. My father might have lived ten years longer had my mother known a little CPR. He passed out as a result of dehydration, and stopped breathing. She called 911 but it was about 10 minutes before the paramedics arrived. They put him on a ventilator immediately and restored his heart and lung functions, but his brain had been deprived of oxygen too long and he never came out of the coma. Two weeks later my mother and I instructed the hospital to "pull the plug". Fortunately, my dad had an "advance directive" stating clearly he didn't want to be kept alive by artificial means. That's the other suggestion, get one of those.

Kevin Swanson
Kevin Swanson

Question: Is the response time impacted by the address system that is in place within the San Diego area? In other words, do the first responders have any problem receiving or finding the address? What are the major variables contributing to the slow response? Is it that they are receiving multiple calls and do not have the resources to answer them? How are the variables determined and measured? What are the variables that, when resources are applied to them, will show the highest level of improvement in the response time equation?

Kevin Swanson
Kevin Swanson subscriber

Question: Is the response time impacted by the address system that is in place within the San Diego area? In other words, do the first responders have any problem receiving or finding the address? What are the major variables contributing to the slow response? Is it that they are receiving multiple calls and do not have the resources to answer them? How are the variables determined and measured? What are the variables that, when resources are applied to them, will show the highest level of improvement in the response time equation?

Chris Brewster
Chris Brewster

Mr. Dillon: This is an important story, but I am confused by an aspect of your reporting. My understanding is that Fire Rescue reports their response time not as the time between when the call comes in and the paramedic/fire unit arrives, but as the time between when the paramedic/fire unit “rolls” (leaves the station) and when the personnel report that they have arrived on scene. The implication of your story is that the time being reported is the time between when the call comes in to 911 and the responders arrive on scene. This is a big difference that may add several (unreported) minutes. Obviously, there is time involved in the call screening. There is also time involved between when firefighters/paramedics are dispatched to respond and when they actually leave the station. It is my understanding that this so-called “chute time” is not reported. If, for example, firefighters/paramedics are on a workout when the call comes in, that may add several (unreported) minutes to the time between dispatch and response. Obviously, for the person calling 911, the clock starts when they call in, but I am not sure if that is what Fire Rescue reports.

Chris Brewster
Chris Brewster subscribermember

Mr. Dillon: This is an important story, but I am confused by an aspect of your reporting. My understanding is that Fire Rescue reports their response time not as the time between when the call comes in and the paramedic/fire unit arrives, but as the time between when the paramedic/fire unit “rolls” (leaves the station) and when the personnel report that they have arrived on scene. The implication of your story is that the time being reported is the time between when the call comes in to 911 and the responders arrive on scene. This is a big difference that may add several (unreported) minutes. Obviously, there is time involved in the call screening. There is also time involved between when firefighters/paramedics are dispatched to respond and when they actually leave the station. It is my understanding that this so-called “chute time” is not reported. If, for example, firefighters/paramedics are on a workout when the call comes in, that may add several (unreported) minutes to the time between dispatch and response. Obviously, for the person calling 911, the clock starts when they call in, but I am not sure if that is what Fire Rescue reports.

Liam Dillon
Liam Dillon

Hello- Thanks for the note. You are correct that the police department often orders EMS personnel to stand back prior to entering a potentially violent scene. However, in this case according to the information the fire department provided the McCoy family, EMS personnel were given clearance to enter the scene prior to the first unit arriving.

Liam Dillon
Liam Dillon

You're right. I just fixed it. Thanks

Liam Dillon
Liam Dillon

Hi Derek- It's a little hard to find, but we included this description in the link to the Google Fusion table map: San Diego first responders arrived after their seven-minute, 30-second goal to high-priority emergency medical calls more than 37,000 times during a 21-month period ending in March. We've mapped the location of the calls and color-coded them so you can see how long first responders took to arrive to cardiac arrests, chokings and other major medical incidents on your block during that time. Incidents taking the Fire-Rescue Department between seven minutes, 30 seconds and nine minutes to arrive are green, between nine minutes and 11 minutes are yellow, and longer than 11 minutes are purple. We've also added the location of the city's existing fire stations (red) and the top five highest-priority, not-yet-built stations needed to reduce the risk of long response times (blue), as recommended by a 2011 consultant report. All five top-priority stations fit within 9 ½ square miles south and east of downtown, including some of the poorest and brownest parts of the city. Some disclaimers about the map: • Federal health privacy rules prohibited the Fire-Rescue Department from releasing the actual addresses of medical emergencies. Instead, we've mapped the nearest intersection to the incident. • About 7 percent of the incidents couldn't be mapped because the addresses provided by the Fire-Rescue Department didn't translate to Google's mapping tool. Many of these incidents were traffic accidents and/or occurred on freeways. • No actual locations have been chosen for the five not-yet-built fire stations yet. The Fire-Rescue Department provided us an intersection in the neighborhood where the station is supposed to go. We placed a "0" or "1" in the Response Time field to allow Google to indicate existing and planned stations. • If you see any incidents showing up in the wrong place, email liam@vosd.org.

Liam Dillon
Liam Dillon memberadministrator

You're right. I just fixed it. Thanks

Liam Dillon
Liam Dillon memberadministrator

Hi Derek- It's a little hard to find, but we included this description in the link to the Google Fusion table map: San Diego first responders arrived after their seven-minute, 30-second goal to high-priority emergency medical calls more than 37,000 times during a 21-month period ending in March. We've mapped the location of the calls and color-coded them so you can see how long first responders took to arrive to cardiac arrests, chokings and other major medical incidents on your block during that time. Incidents taking the Fire-Rescue Department between seven minutes, 30 seconds and nine minutes to arrive are green, between nine minutes and 11 minutes are yellow, and longer than 11 minutes are purple. We've also added the location of the city's existing fire stations (red) and the top five highest-priority, not-yet-built stations needed to reduce the risk of long response times (blue), as recommended by a 2011 consultant report. All five top-priority stations fit within 9 ½ square miles south and east of downtown, including some of the poorest and brownest parts of the city. Some disclaimers about the map: • Federal health privacy rules prohibited the Fire-Rescue Department from releasing the actual addresses of medical emergencies. Instead, we've mapped the nearest intersection to the incident. • About 7 percent of the incidents couldn't be mapped because the addresses provided by the Fire-Rescue Department didn't translate to Google's mapping tool. Many of these incidents were traffic accidents and/or occurred on freeways. • No actual locations have been chosen for the five not-yet-built fire stations yet. The Fire-Rescue Department provided us an intersection in the neighborhood where the station is supposed to go. We placed a "0" or "1" in the Response Time field to allow Google to indicate existing and planned stations. • If you see any incidents showing up in the wrong place, email liam@vosd.org.

Liam Dillon
Liam Dillon

Hi Joe- We did speak with the fire department extensively and went through our findings with them. Their comments helped make this an accurate and complete story, but we didn't feel the need to include any of their comments aside from paraphrasing. In short, they agree that help would have arrived more quickly to the McCoy shooting had there been a fire station a half-mile away and the fire crews were in house. They also say they cannot meet the seven minute, 30 second response time goal without more resources. The incidents on the map are where the first response arrived after 7:30. They might occur very near fire stations because fire crews could be out of the station responding to other incidents when calls come in.

Bit-watcher
Bit-watcher

Is there any information on the call load to the various areas? One thing that's missing from this article is how frequently the responders are out on calls. I'd guess that in poorer areas, there might be a higher level of service calls.

As far as the 911 service centers, how many calls to them are non-emergency related, and how does that clog up the system? There's more to this story than what you've written. Inclining the story towards color (race/ethnicity) gets folks attention, but you could probably more accurately slice and dice it by poverty level.

It's unfortunate that there's no legend for the map. That's a primary failure of that otherwise useful graphic.

Liam Dillon
Liam Dillon

You raise a good point, Bill. It's a double whammy that those communities with the greatest risk for a long emergency response time in San Diego also have some of the lowest rates of people who know CPR. You're also right about the importance of CPR. Dr. Dunford did a study in 2005 on cardiac arrest survival rates in San Diego. For emergency responses longer than four minutes to cardiac arrests, CPR gave people a chance to survive. No one who waited longer than four minutes and didn't receive CPR survived. http://voiceofsandiego.org/wp-content/uploads/2013/07/Dunford-Study.pdf

Bit-watcher
Bit-watcher subscriber

Is there any information on the call load to the various areas? One thing that's missing from this article is how frequently the responders are out on calls. I'd guess that in poorer areas, there might be a higher level of service calls.

As far as the 911 service centers, how many calls to them are non-emergency related, and how does that clog up the system? There's more to this story than what you've written. Inclining the story towards color (race/ethnicity) gets folks attention, but you could probably more accurately slice and dice it by poverty level.

It's unfortunate that there's no legend for the map. That's a primary failure of that otherwise useful graphic.

Liam Dillon
Liam Dillon memberadministrator

You raise a good point, Bill. It's a double whammy that those communities with the greatest risk for a long emergency response time in San Diego also have some of the lowest rates of people who know CPR. You're also right about the importance of CPR. Dr. Dunford did a study in 2005 on cardiac arrest survival rates in San Diego. For emergency responses longer than four minutes to cardiac arrests, CPR gave people a chance to survive. No one who waited longer than four minutes and didn't receive CPR survived. http://voiceofsandiego.org/wp-content/uploads/2013/07/Dunford-Study.pdf

j opp
j opp

EXCELLENT QUESTION(S)

Liam Dillon
Liam Dillon

Hi Kevin- Lots of good questions here, let me try to address some of them. The consultant hired to measure response-time risk across the city made its conclusions based on four factors: 1. Current fire station areas where the most incidents happened simultaneously 2. Individual fire engines that had the highest workload rates, i.e. the busiest 3. Current fire station areas where fire crews had to go outside their areas most frequently 4. Distance between existing stations. The consultant concluded that building the top-five priority stations would improve service to almost 60,000 residents. The city decided it would build more fire stations to fix the response time problem. As the story points out, this is expensive. Like $10m each. There are other ways to address this issue, however, and I hope to explore them in more detail. The city, for instance, recently started sending a fire engine to medical calls immediately instead of waiting for the 911 operator to triage the call. If the dispatcher determines the engine isn't warranted, then the crew is cancelled. This change came after a city auditor recommendation. It's projected to shave as much as one minute off response times. http://www.sandiego.gov/auditor/pdf/report/audit/2012/120229dispatch.pdf

Liam Dillon
Liam Dillon memberadministrator

Hi Kevin- Lots of good questions here, let me try to address some of them. The consultant hired to measure response-time risk across the city made its conclusions based on four factors: 1. Current fire station areas where the most incidents happened simultaneously 2. Individual fire engines that had the highest workload rates, i.e. the busiest 3. Current fire station areas where fire crews had to go outside their areas most frequently 4. Distance between existing stations. The consultant concluded that building the top-five priority stations would improve service to almost 60,000 residents. The city decided it would build more fire stations to fix the response time problem. As the story points out, this is expensive. Like $10m each. There are other ways to address this issue, however, and I hope to explore them in more detail. The city, for instance, recently started sending a fire engine to medical calls immediately instead of waiting for the 911 operator to triage the call. If the dispatcher determines the engine isn't warranted, then the crew is cancelled. This change came after a city auditor recommendation. It's projected to shave as much as one minute off response times. http://www.sandiego.gov/auditor/pdf/report/audit/2012/120229dispatch.pdf

SDN8tive
SDN8tive

LA County runs Squads that have Paramedics on them, You get a Squad dispatched to the call, a Fire engine and an Ambulance transport unit staffed by two EMT's. When you have a squad dispatched to a call in LA County, if that patient needs continued ALS care to the hospital then that squad is now out of service, due to one of the medics being required to go along with the patient in the ambulance. Squads are fine for cutting down on response times but doesn't change the fact that some medical aids require more than 2 paramedics to handle the call. When you have a full cardiac arrest in progress, you need one person doing CPR, one person to tube the patient, and someone who is going to watch the 12 lead along with administer drug therapy. SDFD already will cancel and engine if the medic unit arrives first and they are not needed and works the other way if the engine arrives first and no transport is needed due to a patient singing an AMA waiver. SDFD also has floating ambulances who will cover an area when an ambulance is transporting to the hospital. Just a comparison the city of Phoenix has 1.4 million people and has 57 fire stations, the city of San Diego has 1.3 million people and 46 fire stations, City of Los Angeles has 3.8 million people and 106 fire stations.

Chris Brewster
Chris Brewster

I think it is important to separate out the need to have a fire station and the need to have responders in an area. A station is just that, a station. The real cost is the staffing. Fire responses are down in San Diego, as in most parts of the US, due to better building codes and other issues. When firefighter advocacy organizations in San Diego and across the US observed this happening, they converted to becoming medical responders, as medical responses are not going to decline. Smart move on their part, but fire engines are incredibly inefficient and costly conveyances for medical responses. As well, firefighters cost more in salary and training than do paramedics. Firefighter advocacy organizations will likely fight the concept of fast response squads, but that is precisely what is needed. As well, they don’t necessarily need to have fire stations to operate out of. A prior paramedic contractor in San Diego used an algorithm that repositioned paramedic units dynamically, based on units out of service (due to calls). If you live next door to a paramedic staffed station, it does you no good if that paramedic unit is on a call when you need them. In fact, you may have a greatly delayed response. Conversely, if several paramedic units are on a call in the same part of the city and other units can be repositioned, it smooths out the response time drag.

Joshua Brant
Joshua Brant

Regarding the fact that nearly 90% of the calls that Firefighters respond to are medical calls, are they responding to these medical calls in the big fire engines? Would it be more efficient in terms of speed, gasoline use, parking ease, and access (alleys, etc.) to use a properly equiped SUV, or an ambulance instead of a fire engine?

Joshua Brant
Joshua Brant

I just checked the map and the closest half dozen responses near my house did not meet the seven minute goal. I was surprised because I feel like I am right between the 25th St. station in Golden Hill and the station at Oceanview Blvd @ I-15. Both stations seem relatively close.

Katherine Lopez
Katherine Lopez

Good dig at Filner. Now tell us about Sanders' record, pls.

Liam Dillon
Liam Dillon

Hi Chris- Good question. The Fire-Rescue Department recently changed their response time reporting so that the clock starts from when the department receives the 911 call. So the 911 dispatch processing time now is included. This change came after the 2011 response time study and a couple city audits recommended the change. That said, the response time stats are not perfect. As the graphic linked in my story shows, SDPD receives 911 calls first and they then get transferred to the Fire Rescue Department. The time for the police department to transfer the call to the fire department is NOT included in the response time stats. In the McCoy situation, for instance, the police department knew about the triple shooting for about three minutes before the fire department was notified. For consistency's sake, the figures I use in my story all refer to the fire department's response time. Another issue with response time stats is that they measure when emergency medical personnel arrive at the scene, not when they start treating a patient. In large apartment complexes, for instance, it can take a long time for paramedics to get to someone who needs help after they get there. Hope this helps answer your questions.

Chris Brewster
Chris Brewster subscribermember

I think it is important to separate out the need to have a fire station and the need to have responders in an area. A station is just that, a station. The real cost is the staffing. Fire responses are down in San Diego, as in most parts of the US, due to better building codes and other issues. When firefighter advocacy organizations in San Diego and across the US observed this happening, they converted to becoming medical responders, as medical responses are not going to decline. Smart move on their part, but fire engines are incredibly inefficient and costly conveyances for medical responses. As well, firefighters cost more in salary and training than do paramedics. Firefighter advocacy organizations will likely fight the concept of fast response squads, but that is precisely what is needed. As well, they don’t necessarily need to have fire stations to operate out of. A prior paramedic contractor in San Diego used an algorithm that repositioned paramedic units dynamically, based on units out of service (due to calls). If you live next door to a paramedic staffed station, it does you no good if that paramedic unit is on a call when you need them. In fact, you may have a greatly delayed response. Conversely, if several paramedic units are on a call in the same part of the city and other units can be repositioned, it smooths out the response time drag.

Joshua Brant
Joshua Brant subscriber

Regarding the fact that nearly 90% of the calls that Firefighters respond to are medical calls, are they responding to these medical calls in the big fire engines? Would it be more efficient in terms of speed, gasoline use, parking ease, and access (alleys, etc.) to use a properly equiped SUV, or an ambulance instead of a fire engine?

Joshua Brant
Joshua Brant subscriber

I just checked the map and the closest half dozen responses near my house did not meet the seven minute goal. I was surprised because I feel like I am right between the 25th St. station in Golden Hill and the station at Oceanview Blvd @ I-15. Both stations seem relatively close.

Katherine Lopez
Katherine Lopez subscriber

Good dig at Filner. Now tell us about Sanders' record, pls.

Liam Dillon
Liam Dillon memberadministrator

Hi Chris- Good question. The Fire-Rescue Department recently changed their response time reporting so that the clock starts from when the department receives the 911 call. So the 911 dispatch processing time now is included. This change came after the 2011 response time study and a couple city audits recommended the change. That said, the response time stats are not perfect. As the graphic linked in my story shows, SDPD receives 911 calls first and they then get transferred to the Fire Rescue Department. The time for the police department to transfer the call to the fire department is NOT included in the response time stats. In the McCoy situation, for instance, the police department knew about the triple shooting for about three minutes before the fire department was notified. For consistency's sake, the figures I use in my story all refer to the fire department's response time. Another issue with response time stats is that they measure when emergency medical personnel arrive at the scene, not when they start treating a patient. In large apartment complexes, for instance, it can take a long time for paramedics to get to someone who needs help after they get there. Hope this helps answer your questions.

Derek Hofmann
Derek Hofmann

No, the colors are wrong. See the yellow dot right next to the fire station marker on Imperial Avenue just west of Euclid? The response time is 8.6 minutes, so it should be green. Below that is another yellow dot (8.05 minutes), which should also be green. Below that is a green dot (9.02 minutes), which should be yellow.

Derek Hofmann
Derek Hofmann subscribermember

No, the colors are wrong. See the yellow dot right next to the fire station marker on Imperial Avenue just west of Euclid? The response time is 8.6 minutes, so it should be green. Below that is another yellow dot (8.05 minutes), which should also be green. Below that is a green dot (9.02 minutes), which should be yellow.

Joshua Brant
Joshua Brant

Interesting Liam. I wonder if the fire union is on board because they negotiated a plan that limits their personnel losses even if they become redundant through a new system. Looking forward to your coming material on this matter. Thank you.

Liam Dillon
Liam Dillon

I plan to dig into this issue more, but one note re: the concept of the two-person fast response squads here. The city and fire union have negotiated a plan for them so everyone is on board with the concept. At this point, they just need to be funded.

Joshua Brant
Joshua Brant

Thanks for following up on the comments Liam. In addition to considering "Fast Response Squads" for new stations, I think it's appropriate to evaluate adding that capability to existing stations to improve response times and work more efficiently.

Liam Dillon
Liam Dillon

Joshua and Derek. I hope to explore this issue further in more stories. In short: Do we need to build new fire stations to address this problem? The city response time consultant has identified certain areas that should receive "Fast Response Squads" rather than full fire stations. These squads are what you say: 2-person teams operating out of a storefront/SUV for medical calls and initial fire suppression. The Encanto station is recommended to be a Fast Response Squad rather than a full fire house. These Fast Response Squads are projected to cost about $1 million each per year. They haven't been funded, either. Also, Derek thanks for linking to a Washingtonian story. I interned there during college and have fond memories.

Derek Hofmann
Derek Hofmann

Some places are moving to rapid-response SUVs manned by two paramedics. This can cut response times to 2 minutes and save a LOT of money. But paramedics seem to be resistant to this, arguing that because there are times when you need more than 2 paramedics, or when you need to rush a patient to the hospital, or when you need to put out a fire, you should always send the fire truck and an ambulance to every call.

Liam Dillon
Liam Dillon

Hi Joshua- The map just shows the responses that arrived late during the time from July 2011 to March 2013, not all of the responses. If you take a closer look at the Fusion table map, you'll be able to filter based on intersection. There might be more than one late call at each intersection.

Liam Dillon
Liam Dillon

Sure. Sanders commissioned the study in 2010. He supported the plan the council passed unanimously to build the top five priority stations by 2017. But he didn't include the money for the new stations in his 2013 budget, the most recent capital improvement loan or in his five-year financial outlook.

Chris Brewster
Chris Brewster

Thank you for that. Excellent information. Also not included, I guess, is ring time or hold time. That is, how long it takes before the caller initiates the call and an operator speaks with you. Long ring or hold times have a similar impact.

Joshua Brant
Joshua Brant subscriber

Interesting Liam. I wonder if the fire union is on board because they negotiated a plan that limits their personnel losses even if they become redundant through a new system. Looking forward to your coming material on this matter. Thank you.

Liam Dillon
Liam Dillon memberadministrator

I plan to dig into this issue more, but one note re: the concept of the two-person fast response squads here. The city and fire union have negotiated a plan for them so everyone is on board with the concept. At this point, they just need to be funded.

Joshua Brant
Joshua Brant subscriber

Thanks for following up on the comments Liam. In addition to considering "Fast Response Squads" for new stations, I think it's appropriate to evaluate adding that capability to existing stations to improve response times and work more efficiently.

Liam Dillon
Liam Dillon memberadministrator

Joshua and Derek. I hope to explore this issue further in more stories. In short: Do we need to build new fire stations to address this problem? The city response time consultant has identified certain areas that should receive "Fast Response Squads" rather than full fire stations. These squads are what you say: 2-person teams operating out of a storefront/SUV for medical calls and initial fire suppression. The Encanto station is recommended to be a Fast Response Squad rather than a full fire house. These Fast Response Squads are projected to cost about $1 million each per year. They haven't been funded, either. Also, Derek thanks for linking to a Washingtonian story. I interned there during college and have fond memories.

Derek Hofmann
Derek Hofmann subscribermember

Some places are moving to rapid-response SUVs manned by two paramedics. This can cut response times to 2 minutes and save a LOT of money. But paramedics seem to be resistant to this, arguing that because there are times when you need more than 2 paramedics, or when you need to rush a patient to the hospital, or when you need to put out a fire, you should always send the fire truck and an ambulance to every call.

Liam Dillon
Liam Dillon memberadministrator

Hi Joshua- The map just shows the responses that arrived late during the time from July 2011 to March 2013, not all of the responses. If you take a closer look at the Fusion table map, you'll be able to filter based on intersection. There might be more than one late call at each intersection.

Liam Dillon
Liam Dillon memberadministrator

Sure. Sanders commissioned the study in 2010. He supported the plan the council passed unanimously to build the top five priority stations by 2017. But he didn't include the money for the new stations in his 2013 budget, the most recent capital improvement loan or in his five-year financial outlook.

Liam Dillon
Liam Dillon memberadministrator

Yes, you are correct.

Chris Brewster
Chris Brewster subscribermember

Thank you for that. Excellent information. Also not included, I guess, is ring time or hold time. That is, how long it takes before the caller initiates the call and an operator speaks with you. Long ring or hold times have a similar impact.