Last week, San Diego Mayor Kevin Faulconer gathered just about everyone who deals with emergency medical responses in San Diego to announce that a new ambulance crew had arrived to serve the city’s border with Mexico.
The ambulance, which came as part of a deal with private provider Rural/Metro, would resolve a longstanding problem, Faulconer said.
“We took a look at the ambulance service provided throughout the city to see where we could do better,” Faulconer said. “What was found was that the southernmost neighborhoods have consistently been a hard area for the city to provide the adequate service that it deserves.”
A look at the numbers, though, shows the problem is more specific than that. The city’s ambulance system hasn’t had trouble serving southern neighborhoods. The issue has been with one address: the San Ysidro border crossing.
Ambulances are supposed to arrive at high-priority medical emergencies, such as heart attacks, chokings and shootings, within 12 minutes, 90 percent of the time. The city monitors this figure citywide and also in four neighborhood zones. Here’s how the ambulance system performed the last two years:
The zone that covers southern San Diego consistently had the lowest percentage. But the numbers still far exceeded the 90 percent requirement.
Those figures, however, have come under significant scrutiny. A provision in the city’s contract with Rural/Metro allowed the ambulance provider to exempt incidents during especially busy periods from counting toward the 90 percent stat. It didn’t make much sense: Busy periods are the test of whether an ambulance system can deliver under stress.
Busyness exemptions have increased substantially in recent years, and the city wanted to do away with them. During negotiations to extend Rural/Metro’s contract earlier this year, the city analyzed what the numbers would say if the exemption was gone. Here’s what they found by looking from July 2013 through January 2014:
Yes, the southern San Diego zone is below 90 percent. And yes, this would have triggered a penalty for Rural/Metro under the old contract. But the numbers are so close to the benchmark that they’d hardly constitute a public health crisis. The figures also look a lot better when you compare them with the problems first-responder fire crews have arriving at high-priority emergencies. Fire crews are supposed to get there first, within seven minutes and 30 seconds, to provide initial medical assistance. Ambulances follow with an additional paramedic and transportation to the hospital. Fire crews only meet their target about 70 percent of the time, with a small cluster of neighborhoods south and east of downtown disproportionately affected.
Regardless, the ambulance stats prompted the city and Rural/Metro to get a new ambulance stationed the border as part of the new deal inked in April. The ambulance cost $313,000, with the city paying $110,000 and Rural/Metro picking up the balance. The deal also eliminated the busy exemption.
In reality, the problem with ambulance response in southern San Diego was a problem with the border crossing. Calls to the southern San Diego zone made up less than 8 percent of the ambulance responses citywide over the last two years. But the San Ysidro crossing is the busiest address in the city. Beyond the call frequency, the border’s distance from hospitals and the rest of the San Diego as well as traffic make it particularly hard to serve.
First numbers from the new border ambulance are encouraging. Average ambulance response times were a minute quicker last month compared with the same period a year ago.