California’s San Francisco Department of Public Health is staffed by over 8,000 employees serving 875,411 people who are approximately 50% White, 36% Asian, 15% Latino, and 6% Black (some reported > 1 race). Serving people who are most impacted by poverty and health inequities, the department delivers health promotion services and direct medical care,

During the initial phases of San Francisco’s COVID-19 response, the city’s Emergency Medical Services Agency (SF EMSA) developed a pandemic response Transportation Hub to stage and dispatch medical transport resources independently from the 911 system. The Hub played a critical role in providing pandemic relief to vulnerable populations by facilitating the movement of people experiencing homelessness off the streets and into Shelter-In-Place (SIP) sites. It ensured testing and vaccination of people who bore the burden of COVID due to ethnicity, geography, language, age, profession, and/or incarceration. The Hub prevented delays to the 911 system that service these communities.

The goal of the EMSA Transportation Hub was to provide non-emergent medical transport for Patients Under Investigation and COVID-19 positive patients between medical centers and field care clinics, assume routine patient transfers normally requested through the 911 system, transport mobile COVID-19 testing teams of nurses, and meet other Emergency Medical Technician (EMT) needs as identified by San Francisco’s COVID-19 Command Center (SF CCC).

The EMSA Transportation Hub engaged the Department of Emergency Services (DES), Emergency Medical Dispatchers (EMD), Basic Life Support (BLS) ambulances and EMT crews, paramedic supervisors, mobility transit van operators, nurses, and certified industrial cleaning teams for decontamination. Daily operations were staged at a downtown concert halll because it offered centralized accessibility and provided a large, open space to organize the various roles and duties and provide safe social distancing. A Hub control center streamlined communications with the 911 call center, SF CCC, operational branches, medical centers, clinics, and various entities functioning under COVID-19 response plans. The SF CCC procurement process activated the staffing, venue, ambulances, and equipment allowing for contracts and agreements between SF EMSA and its partners, e.g. ambulance service providers, Department of Emergency Services, and SF Municipal Transportation Agency.

Utilization was tracked and reported weekly to Hub partners and the SF CCC. Within a month of launching, the Hub fulfilled more requests than the 911 system and operated 6 BLS ambulances, 15 mobility transit vans, 4 EMD, 1 EMSA specialist, 6 to 8 nurses staffing 3 mobile testing teams, and industrial cleaners. In the latter phases of the pandemic, EMT staffed mass vaccination sites and mobile vaccination teams. These efforts are validated through a 16-month period in which the EMSA Transportation Hub logged 12,500 transports, 20,000 field tests, and 3,400 person hours at vaccination sites.

The EMS Agency COVID-19 Transportation Hub took steps to ensure uninterrupted standard 911 services while launching testing, vaccination, and transportation services for people living in the most highly impacted communities. As seen by San Francisco’s record of low COVID case and hospitalization rates and high vaccination rate of BIPOC communities, the practice led to reduced health inequities.

San Francisco Emergency Medical Services Agency COVID-19 Transportation Hub

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