SF Paramedic - Street People Harming EMS

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http://www.emsresponder.com/online/article.jsp?siteSection=1&id=6735
San Francisco Paramedic: Street People Harming EMS


C.W. Nevius
The San Francisco Chronicle (California)



Niels Tangherlini is willing to state the hard truths about San Francisco's street population. And he's doing it, even if it causes howls of protests from advocates for homeless people or from some city political leaders.

<snip>

And most of all, Tangherlini thinks that the current system of support, where a 911 call sends an ambulance rushing out to treat someone who is likely to be a "chronic inebriant," is an ongoing disaster. Some of those who call clearly need medical care, but many are using the ambulance and the Fire Department as a personal taxi to the emergency room. He says it is stressing the system, the care providers and the city's financial well-being.

<snip>

...and - in what he thinks is his most worthwhile achievement - sometimes arriving at 911 calls in time to call off both the ambulance and fire rescue crew because he knows the callers well and can get them help without a trip to the overcrowded emergency room. Sounds great, doesn't it? A Chronicle story in 2005 praised Tangherlini's efforts and noted that between March 2004 and August 2005, a relatively small group of people - just 362 individuals - accounted for 3,869 ambulance trips to the hospital. The story estimated that at roughly $3,000 per pickup and visit to the ER, the cost to the city could be over $11 million.
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Read the rest here



What do you guys think of this? The part that struck me is that in an approximate 18 month period, 362 people accounted for 3869 trips to the hospital. This averages to 10.7 trips per person, or just about one trip every other month.
 
I think the guy's doing the right thing. But it'll take a lot more like him to make a difference, as well as facilities to care for the people, and a change in the way that some "enlightened individuals" view the homeless. It'll also take a hell of a lot of work and several boatloads of money, which won't happen. This says a lot:

Those who are out working the streets for a better San Francisco can't understand the bickering over policy.

"We've got to stop making this a battle line between the advocates and the providers," Tangherlini said. "As paramedics, we are the ones working with these people. And we are the ones declaring them dead in the gutter."
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Until people are willing to open their eyes and admit that homeless are a problem that CANNOT AND WILL NOT be fixed in all cases, nothing will change, and this guys program won't get off the ground. Instead ambulances and ER's will continue to be used as catch basins for these people when they've drank to much or want somewhere warm to sleep, and all the great advocates and "friends" of the homeless can continue to rest easy knowing that they've been taken care of, and best of all, they never had to get their hands dirty and still can look like a great humanitarian. Pathetic.

Don't call a spade a spade, be nice and PC in every aspect of your life! To not do that is to be an uncaring inhumane animal! Doubly pathetic.

95% of the bums I've hauled do not need an ER or any type of medical care, but I've got nowhere else to take them, and no ability to turf them given their level of intoxication each and every time. What these people need is the somewhere to sleep it off and the option for treatement when they're sober. That's it. But ask any high-minded :censored::censored::censored::censored::censored::censored::censored: here and they'd be aghast at leaving that poor person anywhere that didn't have at least 2 doctors available to care for them. Triply pathetic.

/end rant.
 
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ffemt8978 said:
What do you guys think of this? The part that struck me is that in an approximate 18 month period, 362 people accounted for 3869 trips to the hospital. This averages to 10.7 trips per person, or just about one trip every other month.
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Those 362 people may have so many chronic problems, including illnesses both mental and medical, along with malnutrition related to their lifestyle that may involve drugs and alcohol. These problems are exacerbated by being outside in a cold and damp SF environment. There is no way their bodies will ever heal properly no matter how hard the healthcare system tries in their current state and living conditions.

SF has done alot to place those that do need chronic medical attention is city owned hotel like properties. For long term SF has an enormous facility, Laguna Honda, that is over flowing with people with people with debilitating illnesses that had to be removed from the street. The hospitals may also try to find long term placement for some repeaters out of their area. It's not exactly the same as the dumping that alledgedly took place in LA. The pts will be placed in some type of "bed and board" housing, just not in the same area as the hospital.

There can be a drawback to building a better system to care for the homeless. More homeless may cross the bridge from the other side of the Bay to partake in a better system, thus the system will still be overwhelmed.

San Francisco also has a universal healthcare plan for its uninsured residents.
http://www.nytimes.com/2007/09/14/h...22400&partner=rssnyt&emc=rss&pagewanted=print

San Francisco General and SF EMS are also part of the city's services.
 
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Here's another good article by the same author of the original post from the San Francisco Chronicle that brings in different approach to another part of the issue.
www.sfgate.com
http://www.sfgate.com/cgi-bin/article.cgi?f=/c/a/2007/12/20/BAJRU1JHG.DTL&hw=tacoma&sn=001&sc=1000

Tacoma's novel notion to aid inebriants: cheap-booze-free zone
C.W. Nevius

Thursday, December 20, 2007

For a city that prides itself on coming up with cutting-edge solutions to difficult problems, San Francisco finds itself behind the curve on an idea out of the Pacific Northwest to treat chronic street alcoholics.

Five years ago, officials in Tacoma, Wash., tried a deceptively simple plan to cut down on public drunkenness - they made getting drunk more expensive.

Simply put, they found out what the "chronic inebriants" were drinking - "fortified" wines like Cisco, Thunderbird and Boone's Farm. Then they created an "Alcohol Impact Area" within which liquor stores were banned from selling that cheap, rotgut booze.

The result? A study from Washington State University found a 35 percent decrease in "emergency medical service incidents and a 21 percent decrease in admissions to the local detoxification center."
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"We still have people commenting on how great it is," said Tacoma police Officer Greg Hopkins, a community liaison officer. "What surprised us was that you guys in San Francisco had a sobering center, but you didn't have an Alcohol Impact Area."

Actually, there is a reason for that, according to Newsom administration officials, who insist they are big backers of the idea.
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http://www.sfgate.com/cgi-bin/article.cgi?f=/c/a/2007/12/20/BAJRU1JHG.DTL&hw=tacoma&sn=001&sc=1000
 
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Thunderbird?

How about banning the sale of 40's!
 
Homeless problem

This problem's been around a LONG time . When I was working in San Diego , the system would get flooded with calls every time the weather got nasty . You knew they were bogus most times , but you still had to handle it . We had one walk right past our rig at a standby point to a payphone 2 blocks away and call 911 . While we were with him , there was an MVA under a mile away in I - 5 with fatalities and several red and yellow tags . We would've been first in BLS rig . It's great that someone's finally dealing with it .
 
Jon said:
Thunderbird?

How about banning the sale of 40's! That was a stupid thing to say 90% homeless people that we transport arn't drunk they just need a place to get warm. We transport more drunk college kids than we do the homeless.
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If you run a lot of calls you get to the point where you know from the chief complaint, age/sex of pt and location, which homeless regular it is. 62 yo male c/o chest pain, on a city street corner (one of three favorites) after dark meant the medics would put a sandwich or granola bar or some cookies in their pocket. The guy would fake a heart attack in front of some unsuspecting, kind faced pedestrian in order to get a trip to the ER and a hot meal. By bringing him food, often the pt. would have a miraculous recovery!
 
VentMedic said:
Simply put, they found out what the "chronic inebriants" were drinking - "fortified" wines like Cisco, Thunderbird and Boone's Farm. Then they created an "Alcohol Impact Area" within which liquor stores were banned from selling that cheap, rotgut booze.
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The problem with restricting sales of cheap strong booze is that the people who buy it simply migrate to another area where it's easier to buy. It's not eliminating or fixing the problem, it's just moving it. Alternatively, they just switch to a different drink. In Seattle, which keeps expanding AIAs because of the migration problem, Icehouse and Joose (energy drink with alcohol added) are the drinks of choice for homeless alcoholics. The more destitute ones go for listerine because it's easier to shoplift.


Re the original post: 1 ER trip every 2 months is an amazingly low rate for homeless addicts. I have regular patients who end up in different hospitals 3 or 4 times a week, sometimes multiple times in a day. Even though they don't stay long before being transferred to the sleep-off center, the cost adds up. This is in Seattle, which has tons of social service and health care programs targeting high utilizers: Housing programs, short term detox, longer term treatment facilities, mental health services, low or no cost clinics, visiting nurses, the sobering/sleep-off center... all these have kept a lot of the high utilizers away from ERs except when having a real problem, but there's still way too many falling through the cracks, or who are simply not willing to take advantage of what's out there.
 
Not meaning to go into the gloomy details of our nations politics--

I just think it's sad that so much money is going into this "war" overseas, since we could barely afford take care of our own to begin with. Breaks ma heart

End short rant.
 
Mandy ,

If we weren't fighting them there , we'd be fighting here . Those troops and Bush's stand to go after them are the reason we're not dealing with terrorist MCI ' s . I wish more folks would wake up and understand that . Being ex - navy , if I wasn't too old and banged up , I'd go . Those of us who can't go should do the next best thing and pray for those who protect us .

REMEMBER , THEY DECLARED WAR ON US AND ATTACKED FIRST USING THE INNOCENT IN THE PROCESS . THEY'RE NOT SOLDIERS , THEY'RE LUNATICS WITH NO DECENCY OR HONOR AND IF WE DON'T FINISH THE JOB , THEY'LL BE BACK .

END OF SLIGHTLY LONGER RANT .
 
Keep it on topic.

If you wish to debate our nation's politics, there are other forums out there.

/END ADMIN RANT
 
ffemt8978 said:
Keep it on topic.

If you wish to debate our nation's politics, there are other forums out there.

/END ADMIN RANT
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Sorry...I used it strictly because I saw a correlation between that and the thread topic. Personal opinion not meant to debate any further. B)
 
EMTMandy said:
Not meaning to go into the gloomy details of our nations politics--

I just think it's sad that so much money is going into this "war" overseas, since we could barely afford take care of our own to begin with. Breaks ma heart

End short rant.
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It isn't that simple. Many of these "street" people get a lot of help. They don't want the long term help. Their addictions always win in the end and they go back to the same routine.
 
Maybe, but I guess what I'm saying is that we are simply headed in thewrong direction. Saving our pennies will not by ANY means solve our nation's problems such as these, but It would have at least been putting one foot in front of the other.
 
Mental illness, addiction and the combined issues of dual diagnosis are not just looking for more money to be tossed at the problem. Often, you have someone with significant mental health issues, unable to participate in the healing process due to addiction. Many of the available shelters and programs require the residents to be 'clean and sober' in order to stay there. So, when the voices in your head are telling you that the medication that you are on is poison, and the only way you can deal with your homelessness and poverty is to drink or use, having more options available to you is not going to make the difference.

Many of these people have family who would take them in and friends who want to help, but the situation is too crisis oriented for them to stay on the rollercoaster indefinitely. Statistics show that homelessness is generally a short term situation for the individuals affected, though some return to it over and over again.

Yes its awful, yes its tragic, but we humans are a complicated bunch. Tossing more money at the problem is like putting a bandaid on an arterial bleed... it might make you feel like you're doing something, but mostly ineffective.
 
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