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Comment by jbaudanza | Hacker News Reader

An unfortunate side effect of the overuse of these emergency vehicles it that makes it difficult for residents to get a healthy night's sleep. Frequent sirens and air-horns are the number #1 cause of noise pollution in the Tenderloin. Many residents here are elderly and low-income and cannot afford double-paned windows and thick curtains to protect from the noise.

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Would it be possible for firefighters to respond to mental health emergencies with another type of vehicle?

It depends how many crews you have at the firehouse. If you have multiple crews, then maybe. If you're taking the only fire crew at the house out to respond to this, the whole firetruck needs to come with because if there is a fire, you don't want the crew to have to drive back to the firehouse, get the firetruck ready to go and then go back out to respond to the fire.

And in many cases, if a city tried to put a (much cheaper) paramedic crew/ambulance in a firehouse to cover calls like this the union would point out that it violates their agreement with the city.

So we go on wasting resources, talent, and ability.

In my suburban NY town, something very similar is happening. There was a federal grant for some paid firefighters a few years ago. The grant expired and the firefighters were laid off. The union complained about how unsafe it was. The city hired consultants to look at the situation and they said most calls were not fires and medical care was needed most.

You'd think that would be the end of it, but one of the laid off firefighters is now running for council in a move most everyone reads as a "I'm going to give me and my friends our jobs back, so you should vote for me, otherwise the town will burn to the ground" move.

It's weird how Americans seem to have this huge anti-union thing going, and yet the same problems seem to never arise here in Europe, even though we are far more unionized.

Maybe it's because the only strong unions left standing after a long campaign against them are those that protect the already privileged categories: law enforcement, firefighters, etc.

> It's weird how Americans seem to have this huge anti-union thing going, and yet the same problems seem to never arise here in Europe, even though we are far more unionized.

Perhaps the American tendency to blame unions is, in part, a direct result of the fact that Americans are less likely to have direct experience with unions. (As well as being a cause of that effect -- its a positive feedback loop.)

I'm hoping the proliferation of self-driving cars in San Francisco will bring about some alternative to emergency sirens, but who knows.

I wonder how much attention this aspect of self-driving cars is receiving. We probably need some explicit protocol for (duly authorized) emergency services to assert priority in traffic. Relying on standard self-driving heuristic protocols, or anything that isn't cryptographically secure would be rife for abuse.

Interesting that you specifically mention San Francisco. SF-centric thinking on HN and in general is growing increasingly annoying, and this might be the reason your post is attracting downvotes. The world is bigger than your startup disneyland.

Always poor form to use an anecdote to shed light on an issue, but I once "cried wolf" to the SFFD because I thought a homeless person was in an emergency situation.

I was walking on (upper) Market St when a woman, sitting on a stoop, screamed out for help. I turned, saw her and then saw a flight of stairs behind her. She was wailing as if she'd just fallen down the stairs. I ran over to her, asked if she was ok (she was lucid so I figured she could tell me what had happened), but she just stared up at me screaming. I called 911 and told them what I thought had happened. The fire department, big rig and all, pulled up in about 2 minutes (station close by, but amazing response time, really) and the moment the first fireman hopped out of the truck you could just see the exasperation on his face. He made no urgent rush over to the woman. He just looked at me and asked if that was the woman and explained that they'd already been out to see her earlier that day, and many times in the past. I felt terrible, but of course had no way of knowing. Fireman just patted me on the back and said I did the right thing.

The moral (from an unnecessarily long story): it's almost impossible to know what's an emergency in these situations.

My thought (reading this on HN where I ignorantly think tech can solve everything) is to say that 911 calls in SF should include a picture of the person, but that's not sensible, of course, because seconds can sometimes literally be the difference between life and death.

Requiring a picture seems like a little much, but having the option of some sort of video chat for 911 calls (maybe like Facetime with a cellular audio call fallback) seems like it could provide a number of benefits, both in eliminating false alarms, and giving first responders more situational information that would help them respond appropriately.

Taking it a step further (in the tech can solve anything world), it might be interesting if emergency responders could send some sort of push notification to people inside a certain geofenced area and ask them to provide a live video feed of the situation as well.

Dreaming here, but I wonder if someone from the Periscope team could go around mid-Market/Tenderloin and try and get people to do exactly what you're describing. Spread the word: "Need to call 911? Use Periscope to educate the 911 dispatcher about the problem." Visit shelters, offices, etc. in a 1/2-mile radius or something and ask people to do it. Of course you then get into an issue where the 911 dispatcher is not the person who would actually know the street-level specifics, but you're right that there would seemingly be countless benefits. Tackle it from both sides, maybe, and talk to the city while you're at it (as slow as things move, the only way to actually change things is to start).

Right. I'd definitely share the video feeds not only with the 911 dispatchers, but with local fire, police and EMT workers, so everyone is on the same page and could provide additional insight from their knowledge of the area and/or specific people.

The Houston Fire Department is doing an experimental project that is pretty similar to what you're describing, only they have first responders deploying the video conference with online medical control in order to avoid transporting patients that don't need it, and to link them to primary care services if that would be helpful: http://www.houstontx.gov/council/h/committee/20140821/ethan....

One thing I wish this article would have touched on is what's featured in the caption to the photograph-- the ability for FD/PD to transport low-risk patients who are just drunk or high to sobering centers rather than to EDs. It's a fairly novel approach, and has made the quality of care provided to these people (and those others in the ED who actually need to be there) way better.

Anecdotes aren't poor form at all unless you're asserting that a single instance characterizes the system.

They're very helpful in giving context to data, and are commonly done by scientists etc. and called 'case studies'.

Your example starts well - a person with a need, another person tries to do the right thing - and then ends predictably poorly - emergency responders refuse to provide needed medical treatment.

Street triage for people with complex mental health needs is important money saving work that improves lives.

The problem is that our society is unwilling to actually step back and look at the root problems so we know where to expend energy most effectively at providing solutions.

Our social problems are ones that no single magic bullet can fix (except in the sense of destroying the problem by ending it all). If we want to be an advanced society we need to understand that every issue is a symptom. There is no one single cause, no one single solution. There are many contributing factors and each needs it's own solution that incentives the outcome we'd prefer to see.

Why is someone homeless on the street? Is it because housing is too expensive, there aren't enough jobs, they lack the skills for jobs that do exist, are they suffering from untreated illnesses (including mental), or is it some combination of those plus other issues that I didn't happen to list.

The above issues are also not in themselves entirely the causes of those issues. Our society is a complicated web of situations, and failure is both always an option and omnipresent among endeavors.

Only trouble with that is firefighters are supposed to be fully ready to leave a scene and immediately be prepared to go to whatever is next, whether that be another medical emergency or a 7 alarm structure fire.

Why use firefighters at all in situations where there isn't the potential for a fire to happen? It seems like police and any needed EMT workers could handle the situation without needing bigger fire trucks that are more expensive to run and more disruptive to traffic. I'd think the police would also be closer to respond to such situations as they may already be on the street or in a nearby police vehicle.

>Why use firefighters at all in situations where there isn't the potential for a fire to happen?

They have the equipment and muscle power to move people. What are a couple of EMTs going to do with a 600 lb guy on the third floor of an apartment building, or someone trapped in a smashed car?

Yes, it makes sense to have firefighters with better equipment/muscle power present in those cases (the smashed car is also a potential fire hazard).

Those seem like more edge cases (most people don't weigh 600 lbs and most car accidents are minor collisions with little to no fire danger). That doesn't justify the extra expense of using them in other situations like the ones mentioned in the article which could easily be handled by police and EMTs.

The problem is they often don't know what they're going to find until they arrive on scene. If that 600 pound guy is having a heart attack you don't want to have everyone sitting around for an extra five minutes waiting for the engine to arrive.

The EMTs aren't going to sit around, they are going to be performing first aid and calling the fire station for additional assistance. Do we really need to incur such additional cost on the odd chance that first responders will need to carry someone the weight of a sumo wrestler down stairs and that whoever is calling 911 won't be able to give them a physical description of the victim.

>The EMTs aren't going to sit around, they are going to be performing first aid and calling the fire station for additional assistance.

Right... and it's going to take that guy an extra five minutes to get to the hospital.

They can't depend on what people tell them on the 911 call. The average person is completely unreliable under stress.

You've got to draw the line somewhere. There's always situations where having more people/resources would have made the difference between life and death. In an ideal world, you've have a fire station on every block, dedicated traffic lanes just for emergency vehicles and you'd use a helicopter to get someone to the hospital as quickly as possible when it might be slightly quicker than regular ambulance transit.

It just not reasonable to use that many resources in 1 in a million scenarios like you are mentioning (where a 1-2 police officers and 2 EMTs couldn't handle the situation, the person calling couldn't provide enough information to determine whether fire fighters were needed and making it to the hospital 5 minutes sooner would have made a significant difference in the outcome of the victim)

Per the article, only 1.5% of the incidents the SFFD responded to involved fires and they had a budget of 330 million dollars. How much money could be saved by using police and EMTs in those situations? (and used in more effective programs that are actually going to help the homeless get off the street).

I'm not sure you'd actually save much money even if you could get by with EMTs. You still need a certain number of firemen on duty in case you actually have a fire, and it's not like you don't have to pay firemen while they wait for one. Labor costs dwarf everything else for that kind of service.

It would be interesting to see a cost breakdown of the police, EMT and fire department labor, transit and equipment costs too see the potential savings (or lack thereof). Given that the SFFD is only responding 1.5% of the time to fire-related incidents, you could probably reduce the number of fire department stations, trucks and employees considerably if they only responded to fire-related emergencies.

That's the part of this story that's not being told. A little over a decade ago, there was a political power grab wherein the fire department took over all emergency calls. Prior to that, SF had EMTs that would respond in ambulances. This has increased the cost of these programs because firefighters often respond in fire engines instead of ambulances and all responders need to be trained as both fire fighters and EMTs. It's a horribly wasteful policy that makes no sense beyond increasing the political power of the fire department.

Source: I had a friend who was an EMT at the time of the switchover who had to leave the city to work in a nearby area because he didn't want to train for and fight fires.

Ironically, a similar policy was put into effect in a nearby city to me (Waterbury, CT), and it wasn't a power grab so much as a "we're paying them anyway" thing. (They became mandatory first responders, but EMTs were still a separate thing.)

Of course, Waterbury has a habit of fatal accidents involving fire trucks (including hitting each other!), so that made me feel like everyone loses in that one.

Came here to say this. It is a waste of SFFD resources, but since when did "waste" become a concern in SF?

I remember one of the folks at Stamen design wanted to plot where SFFDs responders were going, and for what purpose. But he was stonewalled by SFFD and denied the info. SFFD does not want you to know that 90% of their calls are for homeless-related issues.

FOIA request ? Not sure how they could actually block that given the banality of the data in question.

I've heard they refused, citing HIPAA.

Yeah I kept looking around in the article for the part where it talks about what vehicles they use for this instead of fire engines, which are clearly wasteful and disruptive when used for this. What a shame.

It's a horribly wasteful policy that makes no sense beyond increasing the political power of the fire department.

According to one higher-up in the SFFD EMS, this has to do with the software used to dispatch apparatus to calls. It was designed for a two-tier response (ALS v. BLS, as is used in many other cities) but since we don't do that sort of bifurcation of dispatch, it just sends the closest rig which is often fire. Beyond being noisy, can you imagine the damage done to the SF streets by having pumpers filled with water driving on them every day, and the damage done to the apparatus which are by no means cheap?

When I used to work on an ambulance in a suburban area, we would sometimes go 'lights-only' at night so as not to wake residents.

That might be tougher to do in a city though, and it might not be allowed under some state laws.

Yeah I used to live right near the SoMa fire station and it was non-stop noise.

It's too bad we don't have decent, reliable public transportation so people can be housed relatively cheaply and still be able to get around quickly, easily and cheaply. This take the bus/bart for hours just won't work.

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