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Disaster prep, SF-style: Giant ambulances built from old Muni buses

Eli Wirtschafter / KALW
One of San Francisco's mass casualty ambulances, capable of carrying up to 22 patients. (From left: Chief Andy Zanoff, Lieut. Jonathan Baxter, and Capt. Clem Avila.)

As American cities recover from floods, hurricanes and violent political demonstrations, we take a look at one of San Francisco’s more unusual tools for disaster response.

The whole thing started with a crazy party.

It was New Year’s Eve 2010, and there were big celebrations planned at the Embarcadero. To provide extra medical support, the San Francisco Fire Department borrowed a 40-foot Muni bus. Muni mechanics stripped out some of the seats and made room for a gurney. Fire department medics loaded the bus with medical gear and took it to the Embarcadero. They used it as a makeshift mobile clinic, treating people who might have partied a little too hard.

From that time on, the idea of having a bus-sized ambulance “just stayed with us,” says Andy Zanoff, Chief Paramedic for the fire department.

“Mass casualty ambulances” exist, but new ones can cost around half a million dollars.

In 2015, Muni donated two old buses they were taking out of service. Muni engineers converted the buses into ambulances over the course of six weeks, using kits purchased from a Virginia company.

Metal frames were fitted into the shell of the buses to support stretchers and other medical equipment.

The fire department says the “ambu-buses” are the first in California. The California Emergency Medical Services Authority is not aware of any others in the state, according to spokesman Adam Willoughby.

The project cost the city $79,000, and was supplemented by $67,000 from the Department of Homeland Security — in all, far less expensive than buying the ambulances new.


Credit Eli Wirtschafter / KALW
Inside the ambulance bus, seats have been removed to make room for portable stretchers.

Goodbye seats, hello stretchers

Think your Muni commute is uncomfortable? Imagine lying strapped down to a cot in a stack of disaster victims, with three more victims across the aisle.

The buses have the size and shape of standard Muni buses, but they’re painted red and white. The sides say, “Mass Casualty Transport,” in fat gold letters.

Inside each bus, most of the seats have been replaced by stretchers. They’re in stacks of three like triple bunk beds.

Each bus can carry up to 22 patients in all — ten in ordinary bus seats, and twelve in the stretchers.

The ambu-buses are fully stocked with medical equipment, like oxygen supply gear, gloves, shears, and bandages.

In a regular ambulance, “we would have cabinets where we could store all this equipment” says Zanoff. Here, they use a system of pouches that hang by the backdoor of the bus.

Ready at a half-hour's notice
The ambu-buses are kept in one of SFMTA’s bus yards, but the exact location is a secret.

“We don't want to give somebody who has nefarious thoughts an idea of where these would be housed on a normal basis,” says fire department spokesman Lieutenant Jonathan Baxter.

The buses were originally built in 1999, so the driver’s controls look more than a little dated. But Tom Curran, acting deputy director for bus maintenance at Muni, says there are “no concerns” with the bus’s operations.

“We found the two best buses of this fleet and we dedicated them to the fire department,” says Curran.

Muni — not the fire department — provides the drivers for the ambu-buses. The drivers comes from a pool of extra operators that Muni keeps at the ready.

Although the buses lack sirens, they would travel with a police escort. In the event of a large-scale emergency, “the buses can be ready to roll in less than thirty minutes,” says Zanoff.

Thirty minutes may seem like a long time to wait. But so far, the buses have rarely been used to respond to crises. Most of the time, they wait in the bus yard.


Credit Eli Wirtschafter / KALW
Muni drivers neither receive nor require extra training to drive the ambulance buses, according to an SFMTA spokesperson.

Preparing for the worst

Since coming online, the fire department has only used the ambulance buses to transport patients once.

Soon after their initial deployment in 2015, an ambu-buses was used to transport seniors after a convalescent home lost power in Burlingame, in San Mateo County. The San Francisco Fire Department says if the buses are not needed in San Francisco, they can be loaned to nearby counties.

The bus “worked efficiently, and that was on a mutual-aid basis,” says Baxter.

The buses have been sent to other events, like Halloween in the Castro, and to Marina Green during Fleet Week. On August 26 the department sent the buses to Crissy Field, where far-right groups and counter protesters had planned to rally. So far, they haven’t been needed to treat or transport any patients, according to the fire department.

But emergency medical services chief Tony Molloy says one of the ambu-buses' most important jobs is to be ready in case there’s an unplanned incident.

“We know there's going to be big events,” says Molloy. “We know we're going to need something during these events.”

Molloy says during a major natural disaster, the ambu-buses could evacuate patients from a hospital that became unsafe. Or if the roads to hospitals become inaccessible, the buses could serve as mobile hospitals for disaster victims.

But even ambu-buses can’t serve rescue needs in all conditions. Ambulance buses deployed in Texas last month to evacuate flood victimswere useless on deeply flooded streets. Ordinary citizens joined the rescue effort with private boats and even monster trucks.

Following the news from home, Chief Molloy says he was struck by how many citizens were involved in the rescues.

“When there is an incident” in San Francisco, says Molloy, “we're going to bring out all the stops, and we're probably going to need outside help as well.”

That means citizens too. If disaster strikes, even a pair of ambu-buses can only do so much. We’ll have to rely on each other.

Got an idea for a transportation story? Email Eli Wirtschafter at transportation@kalw.org