Funny, but something similar happened to librarians in public libraries: They became unofficial social workers! (I know this from my friend, who was a librarian in the Houston public libraries.)
Also, I find myself doing what amounts to social work in my volunteer life now.
To elaborate on this, here's (as accurately as I can remember it) what a librarian I know in Vancouver said recently: "Hardly anyone comes in wanting books any more, and the people who do already know how to find them. But nobody knows how to find government services, so when I'm not reading to kids I usually have a phone book open helping someone figure out which government office provides the services they need."
Is a library not a simple service? While they might not be intended to fill the role of helping you find government services it seems like they fill it appropriately.
Ideally. Making the application process sufficiently difficult that not all who qualify will fill out the paperwork successfully is often necessary to keep social services afloat. No one, not even a Democrat, gets elected on a platform of raising taxes to support more welfare spending.
Comments on web forums often make it seem as if this phenomenon is universal. So, I thought I would point out that where I live (Fairbanks, Alaska), we have a healthy, vibrant public library that lots of people go to for books.
The homeless folks say the San Jose State's MLK library is the only non-commercial place around that's climate controlled and tolerates their situations.
Interesting article. I see SF's finest out taking care of the homeless population more than they do anything else. I applaud them, and agree that society needs to do something better here. Unfortunately, I do believe that "the average american" believes homeless people are in fact not people, and should be left to die.
There was another callout to that video of '14 police officers taking down a one legged black man': "Many onlookers saw not the police grappling with a mentally disturbed man as he kicked and bit, but yet another incident of police brutality."
I strongly believe in facts and information about the world, and the medium piece was one of the most one-sided unfair articles. Yes it was an opinion piece, but in the past we recognized that those who are in privileged positions of publishing have a special responsibility. Now a days when anyone can be a journalist, and hit-count are the name of the game, this has really pushed a lot of bad-faith and lazy journalism.
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.
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.
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 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.
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.
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.
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?
It's sad that the SFFD is becoming demoralized by this. They're a good fire department. (The SFPD isn't very good.) A decade ago, the SFFD had a better plan for dealing with this.[1] Even now, there are better practical plans.[2]
In this case it's doubly silly, since the Super Bowl is being played 80km and two counties away in a different city for which SF has zero responsibility. Undoubtedly a few of the visitors will stay in or visit SF while there, but probably not all that many since it's a 2+ hour drive with traffic and there's no direct mass transit option. Seems like much ado about nothing, or perhaps an excuse or rationalization.
How are people not picketing this? Where the fuck are these people going to go? There are over 6,000 homeless in the city. Do they think they're just going to take a bus to some other city? (Which, by the way, is what both Sacramento and NYC have done in the past, among others)
If they can't get them out of the city or into permanent housing, they're just going to wander around looking for a new place to collect change, soup, methodone, dope, and a corner to sleep in. That's going to anger residents and result in many conflicts.
"By the end of this year 500 new single-occupancy units will be built and existing homeless resources will be expanded."
Are these units temporary housing for people on the street? What does the path away from homelessness look like in the bay area, with real estate costs and rent as high as they are?
Its hard to see how someone living on the street is going to be able to afford $1,000+ rent just for a studio apartment on whatever employment they can get coming off the street.
> Are these units temporary housing for people on the street? What does the path away from homelessness look like in the bay area, with real estate costs and rent as high as they are?
It starts the same way it starts everywhere: by getting sober, getting into a decent shelter, and becoming marketable as an employee. The cost of housing is neither the first barrier nor the primary one, and someone who is sober and marketable can always choose to seek work and housing elsewhere if that really becomes the primary obstacle.
Don't forget that although the cost of housing in SF is very high, so is the minimum wage. And the City has a lot of programs for people who are gainfully employed but struggling with the cost of market-rate housing. What they don't have is housing for someone who spends 20 hours of every 24 lying on the ground cracked out and shitting himself. No landlord can tolerate that kind of behavior, not even a publicly-funded one. It's a health hazard, a danger to other tenants, and does too much damage to the dwelling; never mind the fact that such a tenant will never be able to pay even token rent.
> What they don't have is housing for someone who spends 20 hours of every 24 lying on the ground cracked out and shitting himself. No landlord can tolerate that kind of behavior, not even a publicly-funded one. It's a health hazard, a danger to other tenants, and does too much damage to the dwelling; never mind the fact that such a tenant will never be able to pay even token rent.
Which makes sense in a practical way, what we should be doing (inclusive we) is funding social programs to help people avoid spending 20 hours a day cracked out shitting themselves, You aren't going to stop everybody but the cost of doing it upfront is so much lower than doing it later.
That of course require that a government have a cohesive and inclusive strategy for dealing with the welfare of it's citizens and we don't seem to have that in the UK let alone the US.
> just over 1.5 percent of its runs last year involved fires
The issue here is not homelessness, it's the waste of resources by sending the firefighters to tag along almost each and every ambulance call.
Looks like a classic case of perverse incentives. Somebody somewhere wanted to give them more work or more exposure and they ended up doing useless runs.
Perhaps emergency social services would be a better use of resources. Btw SF has social services people/volunteer orgs canvassing the Tenderloin during most daylight hours distributing resource info... it's almost impossible
to not cross their paths on the fin district opposite side. The issue is that emergency social workers whom can be assigned to a specific person to intervene until they're in a better situation are what's most needed. Not all homeless people know how to fill out forms, navigate, keep appointments or can stick to getting their basic needs met by themselves/know what to do next for whatever reason/s; some do too, sure. The U.S. really needs centrally-coordinated assigned caseworker management for social services so that all needs (food, housing, health, $, edu, work, mental, dental) can be met and addressed, not the patchwork /hit-miss system-of-infinite-cracks it is now.
> Jennifer Friedenbach, the executive director of the Coalition on Homelessness, a nonprofit in the city, said a lack of reasonably priced housing was the biggest problem.
Ms. Friedenbach, you make yourself and your ideological camp appear naive and out of touch. No doubt, there are a handful of gainfully employed, productive and law-abiding citizens of SF who are homeless solely or primarily because they cannot afford an apartment. I am sure that the time they are forced to spend living in shelters, sitting on the BMR housing waiting lists, and looking for better opportunities in other cities with more affordable housing is painful, degrading, and infuriating. That sucks.
As for the other 6600+ of SF's 6700 homeless population, it's not going to make any difference whether housing is $10,000 a month or $100. These are people with no marketable skills (not even the ability to show up), no desire to work, major addictions (usually following multiple treatment interventions), severe mental illnesses, a preference for the street lifestyle, or some combination of those. Most live in SF not because they were born there or because they have jobs or family there but because there is no freezing weather and the City is accommodating, like spending a large fraction of the $330m SFFD budget sending trained firefighters to pick up the same few hundred people twice a day every single day of the year. All the free housing in the world isn't going to get them off the streets.
Bitching about the cost of housing in SF is fashionable. But I would really expect someone who works directly on the problems of homelessness and with homeless people to know better. The cost of housing is at most a very minor contribution to the problem. When you can show me that most of the people in the City who are homeless have jobs and are reasonably healthy, it'll be time to pin the blame on the housing market. Until then, get serious about addressing the real problems, or just accept that you're never going to and stop pretending.
You obviously need to address the core issues of homelessness first. But then what? Once someone has marketable skills, mental health treatment and is in a better condition to contribute to society, do you ask them to leave the city because there isn't anywhere they can afford to live?
Unaffordable housing may not be the reason someone is on the street, but its definitely a problem on the path away from that situation.
> You obviously need to address the core issues of homelessness first. But then what? Once someone has marketable skills, mental health treatment and is in a better condition to contribute to society, do you ask them to leave the city because there isn't anywhere they can afford to live?
There are plenty of jobs in the rest of the state or the country, places where you can get an apartment for a couple hundred bucks a month. Given a choice between living on the streets in San Francisco or working minimum wage in Turlock, I know which I'd choose.
Agreed, that's what I would choose as well, but would the people that are already homeless make that decision as well?
It seems like part of getting someone off the street is building a support system to help them stay on the path to recovery. If you establish that system in the bay area (maybe with local friends, family, social workers, etc) and then ship that person out of the city or state, what are the chances that they will return to homelessness when things get tough?
> do you ask them to leave the city because there isn't anywhere they can afford to live?
I would expect most people in that situation to make that call on their own. Personally, if my choices were to live in a homeless shelter in SF or in an apartment in Cleveland, I'd head east. But the point is that the City does have a lot of programs to help people who have a job and family in SF but can't afford market-rate housing. Someone in that situation has many options, of which leaving the City is only one. Someone lying in a pool of vomit on Tehama St. waiting for his fourth SFFD pickup of the day doesn't have any of those options.
>Once someone has marketable skills, mental health treatment and is in a better condition to contribute to society, do you ask them to leave the city because there isn't anywhere they can afford to live?
Why not? There are a lot of people outside the city who would move there if they could afford it.
I think that you're think of the homeless who "sleep in the rough." There are many, many homeless and near-homeless people who do not fit the prototypical image of a homeless street person, and these are the type of people who are greatly affected by rising rents.
Those are not the people we are talking about, and they are not the people the article was talking about either. People who are homeless but living with friends or relatives or staying at a shelter are unlikely to be the people the SFFD is picking up off the sidewalks twice a day every day. And SF in particular has a very large population of people who are in fact sleeping in the rough, living on the streets, however you want to put it. I am well aware that this is not true everywhere, but it absolutely is true in SF, and it has zilch to do with housing prices.
While SF's mayor plans to kick out or hide as many homeless as possible to make way so Super Bowl partiers won't be offended or feel obliged to partake in some extrajudicially-unprosecuted hate crimes.
A better way to frame the spending is, how many additional people would be homeless if not for the efforts of San Francisco. There aren't just 6,700 people that refuse to be helped but tens of thousands on the cusp of a very bad situation.
I'd wager approximately 0. If you mean, how many additional people are homeless in San Francisco because of the efforts here, then the number surely isn't negligible but the wealthiest area in the country seems like a decent place to extend a little humanity. What's the alternative? Treat our homeless like shit so other people don't want to move here?
At that rate they could, you know, provide homes for them and feed them? Sounds like that's part of the plan (500 units), but not in a way that makes sense to me.
Micro-apartments at ~200sq.ft., with really basic (read: mostly plastic/easy to wash, plus maybe a cot) furniture, could go for ~$800/month and still be a good deal for a developer. That's $9600/year. Throw in inexpensive food at another $800/month, and it would be $19,200/year, or a savings of $14,800 per year. Partner with a developer, guarantee the rents, and let the private sector fork over the capital for the building of WAY more than 500 units.
A lot of the cost is actually far more than $34k/person, by the way. There are charities that leverage this fact by finding chronic emergency-room users and getting them a home, food, and sometimes a companion animal. [1] When a homeless person checked into a hospital can cost $9000. An emergency room visit can cost $3700. [2] When someone has serious health issues, they can visit the emergency room multiple times a month; some end up costing the taxpayer $44,400 per year.
Apparently 90% of the homeless at any one time are just going through a bad spot in their lives. And giving someone a place to live can break the cycle of homelessness: You need to have an address to get a job, typically. You also need to be able to shower. Let them keep living in the cheap apartment if they want, but if their income passes a threshold then they need to start contributing to the room & board.
Or don't force them to pay; food and shelter really should be human rights anyway. Why not start in San Francisco? Everyone else would benefit by there being fewer people peeing on walls or sleeping on sidewalks, and by the (relatively) cheaper labor pool that would be available.
Go one better. Provide them all of those things, as well as /a/ job (not necessarily one they're trained in) as well as time for and inclusion at, training for jobs that are open.
I imagine that maintenance of public infrastructure is a thing which won't go away any time soon.
If you define the above as a poverty line (and the re-education time slot is also usable for personal crafts/recreation/etc) then you've also very nicely defined a minimum wage which must be beaten. Providing the apartments at a monetary level in areas also defines a value level for housing in a given area, which is one way of eliminating price gouging (or at least giving added value when it is done).
Not a bad thought, though some of that 10% of the homeless who are chronically homeless probably should be allowed to just fail to go to their job with no consequences.
Ideally they'd have social services and/or psychiatric care, and some of them, after sufficient care might then be able to work. But some are just going to be chronically unemployable.
> Instead, the calls that ring in this and nearby fire stations tend to go like this: Male, apparently homeless, sprawled unconscious on a train platform.
I can confirm that this also happens in Tempe (Phoenix), all the time.
If you live in SF and you're reading this and you want to help the homeless, this may be a good option:
https://handup.org/giftcards
Also consider donating to a local organization, there are many good ones. I personally like Larkin Street Youth Services. They help homeless children and young adults (12-25) get back on their feet through housing, education, etc. At that age you really can put it all behind you with the right support.
Here in the UK, if you call the emergency services they ask which service you require (police, ambulance, fire). It would be absolutely unthinkable to respond "fire" if there wasn't a fire. How does it work in the US? Is the fire dept. a different number that is somehow acceptable to call for this kind of problem?
There have been a number of times when I've been in difficult situations with severely drunken or otherwise vulnerable people, and every time I've called the local police station (rather than the emergency number) and they've sent someone over. But it's always the police I would call - never the fire brigade.
> Here in the UK, if you call the emergency services they ask which service you require (police, ambulance, fire). It would be absolutely unthinkable to respond "fire" if there wasn't a fire.
Although most people have no problem saying "police" not "ambulance" when they see someone in psychiatric distress.
(Admittedly that's sometimes the right thing to do. Police have section 136 powers to take people to a place of safety for assessment, and there's started to be street triage services working with the police).
The answer is that fire departments respond to any call where there could be an injury or other related need, because they are also EMTs, and in the U.S. you just call 911 and tell the operator what's wrong. If you say you want an ambulance, chances are, you'll get an ambulance... and a fire truck. This is partly due to the fact that most ambulances are a private service and don't really represent the service of the city (which firefighters / fire EMTs do represent).
The problem is that we don't really have a sort of emergency first responder triage department. The operators are it. There's isn't an EMT who can speed to the scene in a fuel efficient car on his own to bring you some bandaids or water and check your blood pressure (e.g., in the case of a homeless person prone with a needle in his arm), and then call for more help if needed, so, instead, a $300,000 hook and ladder truck full of 4 highly trained firefighters (also trained as EMT) is deployed to do the same thing.
Where I live (in the SF East Bay), I often see multiple units servicing medical emergencies. I can't help but think that the extra units show up so that they can inflate their stats for community service when contract time comes.
Another factor here is that in most places, it seems including San Francisco, fire stations are much more evenly distributed across the city than hospitals with ambulances based out of them. So just in terms of travel time, the fire department is usually able to arrive before an ambulance, sometimes significantly.
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[ 2.8 ms ] story [ 84.9 ms ] threadAlso, I find myself doing what amounts to social work in my volunteer life now.
There was another callout to that video of '14 police officers taking down a one legged black man': "Many onlookers saw not the police grappling with a mentally disturbed man as he kicked and bit, but yet another incident of police brutality."
I strongly believe in facts and information about the world, and the medium piece was one of the most one-sided unfair articles. Yes it was an opinion piece, but in the past we recognized that those who are in privileged positions of publishing have a special responsibility. Now a days when anyone can be a journalist, and hit-count are the name of the game, this has really pushed a lot of bad-faith and lazy journalism.
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.
So we go on wasting resources, talent, and ability.
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.
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.)
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.
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.
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.
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.
They're very helpful in giving context to data, and are commonly done by scientists etc. and called 'case studies'.
Street triage for people with complex mental health needs is important money saving work that improves lives.
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.
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?
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.
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.
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).
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.
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.
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.
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?
That might be tougher to do in a city though, and it might not be allowed under some state laws.
[1] http://www.sfgov2.org/ftp/uploadedfiles/mocj/CommInvlv_News/... [2] http://endsfstrugglewithchronichomelessness.blogspot.com/
http://marginalrevolution.com/marginalrevolution/2012/07/fir...
China had similar approach for their Olympic Games :-(
Last college bowl season, I saw numerous college football players in downtown SF who had a game to play later that day.
If you make it all the way to the bay area, you're going to come into the city.
If they can't get them out of the city or into permanent housing, they're just going to wander around looking for a new place to collect change, soup, methodone, dope, and a corner to sleep in. That's going to anger residents and result in many conflicts.
Are these units temporary housing for people on the street? What does the path away from homelessness look like in the bay area, with real estate costs and rent as high as they are?
Its hard to see how someone living on the street is going to be able to afford $1,000+ rent just for a studio apartment on whatever employment they can get coming off the street.
It starts the same way it starts everywhere: by getting sober, getting into a decent shelter, and becoming marketable as an employee. The cost of housing is neither the first barrier nor the primary one, and someone who is sober and marketable can always choose to seek work and housing elsewhere if that really becomes the primary obstacle.
Don't forget that although the cost of housing in SF is very high, so is the minimum wage. And the City has a lot of programs for people who are gainfully employed but struggling with the cost of market-rate housing. What they don't have is housing for someone who spends 20 hours of every 24 lying on the ground cracked out and shitting himself. No landlord can tolerate that kind of behavior, not even a publicly-funded one. It's a health hazard, a danger to other tenants, and does too much damage to the dwelling; never mind the fact that such a tenant will never be able to pay even token rent.
Which makes sense in a practical way, what we should be doing (inclusive we) is funding social programs to help people avoid spending 20 hours a day cracked out shitting themselves, You aren't going to stop everybody but the cost of doing it upfront is so much lower than doing it later.
That of course require that a government have a cohesive and inclusive strategy for dealing with the welfare of it's citizens and we don't seem to have that in the UK let alone the US.
The issue here is not homelessness, it's the waste of resources by sending the firefighters to tag along almost each and every ambulance call.
Looks like a classic case of perverse incentives. Somebody somewhere wanted to give them more work or more exposure and they ended up doing useless runs.
Ms. Friedenbach, you make yourself and your ideological camp appear naive and out of touch. No doubt, there are a handful of gainfully employed, productive and law-abiding citizens of SF who are homeless solely or primarily because they cannot afford an apartment. I am sure that the time they are forced to spend living in shelters, sitting on the BMR housing waiting lists, and looking for better opportunities in other cities with more affordable housing is painful, degrading, and infuriating. That sucks.
As for the other 6600+ of SF's 6700 homeless population, it's not going to make any difference whether housing is $10,000 a month or $100. These are people with no marketable skills (not even the ability to show up), no desire to work, major addictions (usually following multiple treatment interventions), severe mental illnesses, a preference for the street lifestyle, or some combination of those. Most live in SF not because they were born there or because they have jobs or family there but because there is no freezing weather and the City is accommodating, like spending a large fraction of the $330m SFFD budget sending trained firefighters to pick up the same few hundred people twice a day every single day of the year. All the free housing in the world isn't going to get them off the streets.
Bitching about the cost of housing in SF is fashionable. But I would really expect someone who works directly on the problems of homelessness and with homeless people to know better. The cost of housing is at most a very minor contribution to the problem. When you can show me that most of the people in the City who are homeless have jobs and are reasonably healthy, it'll be time to pin the blame on the housing market. Until then, get serious about addressing the real problems, or just accept that you're never going to and stop pretending.
Unaffordable housing may not be the reason someone is on the street, but its definitely a problem on the path away from that situation.
There are plenty of jobs in the rest of the state or the country, places where you can get an apartment for a couple hundred bucks a month. Given a choice between living on the streets in San Francisco or working minimum wage in Turlock, I know which I'd choose.
It seems like part of getting someone off the street is building a support system to help them stay on the path to recovery. If you establish that system in the bay area (maybe with local friends, family, social workers, etc) and then ship that person out of the city or state, what are the chances that they will return to homelessness when things get tough?
I would expect most people in that situation to make that call on their own. Personally, if my choices were to live in a homeless shelter in SF or in an apartment in Cleveland, I'd head east. But the point is that the City does have a lot of programs to help people who have a job and family in SF but can't afford market-rate housing. Someone in that situation has many options, of which leaving the City is only one. Someone lying in a pool of vomit on Tehama St. waiting for his fourth SFFD pickup of the day doesn't have any of those options.
Why not? There are a lot of people outside the city who would move there if they could afford it.
https://news.ycombinator.com/item?id=10130589
$230M / 6,700 homeless = >$34K per homeless person per year
Micro-apartments at ~200sq.ft., with really basic (read: mostly plastic/easy to wash, plus maybe a cot) furniture, could go for ~$800/month and still be a good deal for a developer. That's $9600/year. Throw in inexpensive food at another $800/month, and it would be $19,200/year, or a savings of $14,800 per year. Partner with a developer, guarantee the rents, and let the private sector fork over the capital for the building of WAY more than 500 units.
A lot of the cost is actually far more than $34k/person, by the way. There are charities that leverage this fact by finding chronic emergency-room users and getting them a home, food, and sometimes a companion animal. [1] When a homeless person checked into a hospital can cost $9000. An emergency room visit can cost $3700. [2] When someone has serious health issues, they can visit the emergency room multiple times a month; some end up costing the taxpayer $44,400 per year.
Apparently 90% of the homeless at any one time are just going through a bad spot in their lives. And giving someone a place to live can break the cycle of homelessness: You need to have an address to get a job, typically. You also need to be able to shower. Let them keep living in the cheap apartment if they want, but if their income passes a threshold then they need to start contributing to the room & board.
Or don't force them to pay; food and shelter really should be human rights anyway. Why not start in San Francisco? Everyone else would benefit by there being fewer people peeing on walls or sleeping on sidewalks, and by the (relatively) cheaper labor pool that would be available.
[1] http://www.npr.org/templates/story/story.php?storyId=1015075...
[2] http://greendoors.org/facts/cost.php
I imagine that maintenance of public infrastructure is a thing which won't go away any time soon.
If you define the above as a poverty line (and the re-education time slot is also usable for personal crafts/recreation/etc) then you've also very nicely defined a minimum wage which must be beaten. Providing the apartments at a monetary level in areas also defines a value level for housing in a given area, which is one way of eliminating price gouging (or at least giving added value when it is done).
Ideally they'd have social services and/or psychiatric care, and some of them, after sufficient care might then be able to work. But some are just going to be chronically unemployable.
> “You’re going to roll out of a station 20 times a day to go see the same chronic inebriate, the same mentally ill guy,”
You sure spend a lot of money for saving on socialized health care.
I can confirm that this also happens in Tempe (Phoenix), all the time.
Also consider donating to a local organization, there are many good ones. I personally like Larkin Street Youth Services. They help homeless children and young adults (12-25) get back on their feet through housing, education, etc. At that age you really can put it all behind you with the right support.
There have been a number of times when I've been in difficult situations with severely drunken or otherwise vulnerable people, and every time I've called the local police station (rather than the emergency number) and they've sent someone over. But it's always the police I would call - never the fire brigade.
Although most people have no problem saying "police" not "ambulance" when they see someone in psychiatric distress.
(Admittedly that's sometimes the right thing to do. Police have section 136 powers to take people to a place of safety for assessment, and there's started to be street triage services working with the police).
The problem is that we don't really have a sort of emergency first responder triage department. The operators are it. There's isn't an EMT who can speed to the scene in a fuel efficient car on his own to bring you some bandaids or water and check your blood pressure (e.g., in the case of a homeless person prone with a needle in his arm), and then call for more help if needed, so, instead, a $300,000 hook and ladder truck full of 4 highly trained firefighters (also trained as EMT) is deployed to do the same thing.
Why is a fire truck helping a drunk instead of an ambulance?
https://upload.wikimedia.org/wikipedia/commons/f/f3/SFFD_amb...
Apparently sometimes they send the actual fire trucks, though. It would be interesting to know if these stats included the ambulance service.