The audit of the Sacramento Fire Department’s Emergency Medical Services Division found the department responded to 98,157 calls between July 2023 and June 2024, with nearly 40% classified as “low-acuity” incidents that posed no immediate threat to life, health or property.
“In other words, about one out of every three times that an ambulance responded to a call for medical assistance, there was no emergency,” the report said. The audit was released last week and presented to the City Council’s Budget and Audit Committee on Tuesday.
The burden on emergency services has grown as calls for service increased nearly twice as fast as staffing levels in the Sacramento Fire Department since before the COVID-19 pandemic, rising 15.1% compared to 6.1%, according to the report.
The findings come as Sacramento leaders work to close a $66.2 million budget deficit through a combination of spending reductions, position eliminations and service cuts. The City Council is expected to finalize the budget on June 9.
The report recommended expanding alternative response programs to reduce pressure on the all-hazards department, along with improving data collection and performance tracking, strengthening partnerships with hospitals and community service providers, and pursuing additional strategies to divert low-acuity calls from ambulances and paramedics.
The Sacramento Fire Department has already piloted some alternative response strategies, but officials said expanding those programs citywide could be costly.
Calls for mental health, substance abuse
According to the audit report, the significant volume of low-acuity calls tied up paramedics and ambulances, delaying response times for patients requiring urgent intervention and transport to emergency rooms.“People call sometimes for medication refills, various things like that, whereas an ambulance should be responding to someone who’s having a heart attack, stroke, difficulty breathing — things of that nature,” Captain Justin Sylvia, a spokesperson for the Sacramento Fire Department, said in a Thursday phone interview.
The report also found that emergency medical services were increasingly used to respond to mental health and substance abuse crises — complications disproportionately experienced by unhoused people — contributing to the high number of low-acuity calls linked to homelessness.
According to the report, nearly 20% of the department’s incident responses were linked to individuals experiencing homelessness. Of those 19,020 cases during the review period, approximately 37% were medical non-emergencies.
“The low acuity calls that they call for — that could be needing a ride to a doctor’s appointment because they have no other alternative,” Sylvia said. “They’re calling for non-emergent issues, that’s why we’re seeing that, and chronic issues.”
The majority of homelessness-related 911 calls were concentrated in the downtown and midtown neighborhoods, the report said.
The cumulative increase in low-acuity calls among housed and unhoused populations added to the workload for emergency personnel, who were more prone to burnout, medical errors and on-the-job injuries.
Non-emergency calls cost city over $4.6M
The financial burden of non-emergency calls was also significant. Fire engines, fire trucks and ambulances spent more than 1.2 million minutes responding to low-acuity calls in fiscal year 2024, amounting to more than $4.6 million in city and department costs.The report recommended that instead of sending paramedics, ambulances and fire trucks to address medical or fire-related non-emergencies, a registered nurse could provide real-time assistance to the caller through a nurse triage hotline.
Ride-share services for hospital transportation could also reduce the use of emergency services as a means of non-urgent transportation to medical facilities.
The report also suggested expanded rerouting efforts for those experiencing behavioral health crises. Behavioral health, community, and street outreach responders could support those requiring mediation and social services. Mobile crisis team clinicians — already piloted through the department’s mobile integrated health unit — could provide medical support during high-risk crises.
“In trying to divert some of the low-acuity calls and respond in maybe a more cost-effective way, we can save our precious emergency resources for the truly life-threatening emergencies that we want to make sure they’re available to respond to,” Farishta Ahrary, the city auditor, said Thursday.
Cost hinders broader rollout
The Sacramento Fire Department, however, said cost remains a barrier to implementing some of the recommended measures more broadly. According to the report, the nurse triage line could cost between $500,000 and $750,000 annually — funding Sylvia said the department does not have.Similarly, the ride-share program would require “some type of expenditure that’s just not in the budget right now,” Sylvia said.
In the interim, the department has partnered with Medic Ambulance to meet transportation needs and allow alternative resource allocation without significant new spending. Four ambulances providing basic life support services have been deployed through the private company, with two alternative destinations besides emergency rooms, including sobering and mental health facilities, according to Sylvia.
Still, additional resources are needed, Sylvia said, pointing to the immediate need for two new fire stations in Metro Air Park and Delta Shores amid ongoing development.
However, Ahrary noted that such expansion was not financially feasible for the city at the time of the audit, which led auditors to focus on strategies for managing low-acuity calls rather than expanding infrastructure.
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