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Saturday, February 27, 2010

A quick note to thank you for the encouragement.

To my small band of followers, thank you for sharing but as I learn more about the new social media and start to read the other blogs out there, I am profoundly struck by the thoughtfulness and lucidity of the other bloggers and their posts.

I was especially enthralled by reading a post that Mr. Chris Kaiser recommended.  I met Chris a few months ago when they had a small social occasion at Gordon Biersch Restaurant to tweet up a meeting with Mark Glencourse.

Chris recommended this post by Mr. Jeremiah Bush:, called "ALS Kills People".  I have read and re-read the post several times and I believe that every EMS manager, EMS educator, and Medical Director should use it as a starting point to discuss the future of how their system can progress in the future.

Kudo's and props, Jeramedic for making us all think about this.

Marching in a parade.

I want to thank my colleague Mark Glencourse from Medic 999 for encouraging me to continue adding to this blog site.  I was thinking what could I possibly write about in the future and something came to me as I was coming home tonight from a very nice occasion.

Tonight was the Chinese New Year's parade celebrating the Lunar Year of the Tiger.  The parade started in 1860 and as long as I have worked in San Francisco; the Public Safety Departments, police, fire and EMS have participated in the parade.  Tonight, the Command Staff of the SFFD, three San Francisco Fire Commissioners, and many uniformed members of the department and their families marched along the route to represent the Department.  Marching with us were members of the Neighborhood Emergency Response Teams (known as CERT in some communities) and the San Francisco Fire Reserve.

I try to make it every year but sometimes other commitments took precedence but I have been lucky to participate in a majority of the CNY parades.  I noticed this year that we had more spectators and many were happy to see the fire department, we received applause and in some sections of the crowd, they cheered us loudly.  I would estimate that there was about a hundred people out tonight marching.

We had members from all ranks and nationalities participating; it just wasn't for the Chinese or Asian members of the Department.  And that was what I realized was so great.  We really are a diverse department and we are so much richer because of that.  The San Francisco Fire Department has one of the largest percentages of female firefighters and female firefighter/paramedics.  SFFD is well represented in the Asian, Hispanic, and African American communities.

I realized how important it was that we showed this diversity to our community.  When I was a child, I remember my parents telling me how important it was to study hard in school and find a nice career as a doctor, or engineer, or pharmacist, or certified public accountant.  It was important to not go into a blue collar job and seek a respectable profession that wasn't hard on the body or dangerous to life.  I know that my parents who were poor and laborers wanted something better for me and my brother and sister.

But when I became a paramedic, they were somewhat hoping that I would come to my senses and go back and study harder to try and get into medical school.  I am glad that I became a paramedic because over the years, I realized how important it was for me to go back into Chinatown and take care of an elderly woman who did not speak English.  How important it was for me to ask her the OPQRST questions in Cantonese as I was working up her chest pain.  Cultural competency is an often overlooked value in our profession and EMS education.

After the parade, we all went to a local fire station to take a group picture and then we went to a Chinese restaurant for a large banquet dinner.  The dinner was paid for by the Asian Firefighters Association and during the welcoming remarks, the President of the AFA stated how glad he was to see all of the marchers at dinner.  He told us that we were all family in the Fire Department and in the Community regardless of our nationalities or creed.

Each and everyone of us who serves the community as an EMT, Paramedic or Emergency Medical Responder has one patient in their career that they made a huge difference in.  I am glad that I became a paramedic and that I get to work in the City where I grew up and I get to make a difference in the community of my youth.  Maybe tonight, there was a young boy or girl in the crowd who saw all the diverse firefighters and paramedics and thought, "Hey, he or she looks just like me, maybe I can be a firefighter or paramedic too.."  And we in San Francisco will be so much better off because of that.

Friday, February 26, 2010

I've waited 28 years for this.

Last night at a SFFD Fire Commission Meeting, the Chief of Department was able to report something positive to the Commission. A report of an occasion that was momentous in my 28 year paramedic career in San Francisco. It was the first time in 28 years that the public ambulance service in San Francisco had met it's response time goals in all districts of the City of San Francisco. From January 2010 to Feb 2010, the overall Citywide 90th percentile response time for a transport ambulance was 8 minutes and 58 seconds.

I remember when I first started riding along with the DPH ambulances in 1976. I was a Medical Explorer Scout at the United States Public Health Service Hospital at 15th Avenue and Lake Street. Robert Giudice was one of the paramedics I got to ride with. There were only 8 ambulances on during the day and 5 at night for a city of 700,00 people. There was no 9-1-1, the public had to call 431-2800 to reach CMED at 50 Ivy which was also Central Emergency Hospital to request an ambulance.

In the 1980's I went to paramedic school at John Adams and did my internship on a DPH unit with Ben Dorcy and Tom Pickford as my preceptors. The number of ambulances didn't change much in the 1980's. In the mayoral administration of Diane Feinstein, the SF Chronicle headlines castigated the ambulance response times of the Department of Public Health as, "Same Day Service."

In the lat 80's and early 90's, there was much hope that the ambulance response times would improve because of a change in leadership of the DPH SFGH Paramedic Division. A young emergency physician named Charles Saunders brought new management tools and administrative skills to upgrade the ambulance service. Dr. Jim Pointer was the Medical Director of the SF EMS Agency and revamped many of the backwards and antiquated medical protocols bringing San Francisco EMS to the forefront of the time in progressive EMS service.

In spite of all their efforts, the SF General Hospital just wouldn't expend any resources to fully fund the ambulance service the way it needed to be. When the merger of the Paramedic Division into the SFFD happened in 1997, the ambulance fleet consisted of 19 vehicles and we fielded 12-14 in our best days. The average response time was 10 minutes which meant that the 90th percentile response time was in the range of 14-15 minutes. Today, the ambulance fleet numbers 41 ambulances and we deploy 21 ambulances at the peak times.

I know the merger has been very hard on the paramedics and EMT's of the public ambulance service in the past 12 years. We lost some very good people because of many missteps and failures to address problems that arose. But regardless of how my colleagues feel the path should have been, one thing is unchallenged.

The San Francisco Fire Department has committed the resources necessary to achieve a goal that had been eluding my professional efforts for 28 years. I think I will try to absorb that for a few days to let it sink in and see if I can postulate about what that means for the future and what is in store down the road for EMS in San Francisco.