It’s a single square mile. Third Street to Main Street to 7th Street to Alameda Street.
The work is so fatiguing, emotionally draining, and physically demanding, the firefighters assigned to 430 W. 7th St. in downtown Los Angeles usually transfer in just two or three years.
“It almost feels like you’re in a different world,” rookie Firefighter Steven Osterberg told SoCal Connected. “It’s hard to even describe. It’s almost like a third-world country type thing. You see people all over the street, see fires all the time, warming fires, cities full of tents...”
Just blocks from Disney Hall, the Ahmanson Theater and Staples Center, where some of the city’s richest people gather nightly, the firefighters assigned to Station 9 spend their days among those living at the bottom of Los Angeles’ social ladder – the homeless, the drug addicts and the mentally ill, who have found themselves on Skid Row.
Los Angeles City Fire Station 9, with more than 21,000 calls last year, is the busiest fire station in the country. On average, firefighters respond to 97 calls a day, or four times an hour in a 24-hour shift, often exposing themselves to violent and dangerous people, contaminated needles, and infectious diseases like tuberculosis, typhus and hepatitis.
“Growing up when I was a kid, I thought firefighters, you just go to fires, and that's it,” Osterberg said. “But a lot of our job isn't going to fires.”
To many of the thousands on Skid Row, the Station 9 firefighters serve as their primary medical, and often, mental health care providers. Firefighters treat drug overdose victims, assist assault victims, help those with hypothermia, and encounter people with illness, loneliness and mental health issues.
“It’s kind of shocking at first,” Osterberg said. “It’s sad to see. Sometimes you wonder how people got here, what kind of led them to be where they’re at now.”
SoCal Connected recently joined the firefighters at Station 9 for a 24-hour shift, responding with them on call after call, allowing the firefighters and Skid Row residents to tell their own story. They encountered an assault victim near death, a man so high on a drug called “spice” he flopped around uncontrollably in the street, and a man so afraid of dying alone he called out , as the paramedics strapped him in for transport to the hospital.
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Sometimes, says firefighter Mark Tostado, people call 9-1-1 because they’re just lonely, feeling down or need someone to talk to. Sometimes they need to be talked out of suicide. Often, they just need to sober up.
“They call us for everything. They call us for a stubbed toe, toothaches. Broken hand. We’re their medical providers,” Tostado, who has worked at Station 9 for over a decade, said. “So, we go in there and we take care of them.”
In a city grappling with how to cope with an estimated 60,000 homeless people, the daily response to those in need is taxing for both first responders and emergency rooms. Doctors trained to repair broken bodies can treat medical problems, but are often unequipped to tackle the huge influx of patients with mental health issues they see on a daily basis.
“Clearly, clearly the system is broken,” said Dr. Marc Eckstein, the Los Angeles Fire Department’s Medical Director. “When you see tens of thousands of people living on the street in tents, in absolute squalor, dying on the street.”
Eckstein said transporting patients with mental health issues to an emergency room “is probably the worst thing possible.” Physicians are trained to treat medical problems like drug overdoses and infections, but must call for psychiatric teams to evaluate those who are mentally ill. Patients can be kept for 72 hours on a mental health hold, but “there’s a huge paucity of inpatient psych beds in the county.”
Without medical insurance, a patient can sit in an emergency room for days waiting for a bed to open in a mental health facility, not getting the medication or treatment he or she needs in the meantime, he said.
The mentally ill tie up doctors, nurses and staff and take up space for those arriving with medical needs.
“It taxes the staff in the emergency department. It ties up beds, ties up paramedics and adversely affects the whole community,” Eckstein said. “So, clearly there has to be a better way. The number of individuals in our society who have mental health issues that are untreated or undertreated is huge and obviously is a direct nexus to the homelessness issue.”
Frequently, the firefighters at Station 9 respond to the same patients again and again, often in the same day. Patients taken to hospitals for drunkenness or drug overdoses often sober up and are released back onto the street, only to repeat the cycle a few hours or days later.
“It is frustrating when you go on the same people, two, three times a day and you have to take them to hospital,” said Firefighter Ernie Orrante, who has been with the station for four years. “Maybe, they’re just drunk or they did drugs or they’re just high. But we have to take them. It’s a short-term fix just to get them out of the street real quick for that hour or two and then they’ll be right back, and then we’ll respond right back to them.”
During SoCal Connected’s ride-along, firefighters responded to a man so high on narcotics, they found him rolling in the gutter in the street. Firefighters encounter victims on heroin, methamphetamine, fentanyl and increasingly, a new drug called “spice,” a synthetic cannabis that can be four to 50 times more potent than marijuana. Spice causes hallucinations, extreme anxiety, and violent combative behavior, in addition to medical problems like organ failure.
Firefighters sedated and restrained the man to stop him from resisting and took him to a hospital. Eckstein said Spice is becoming a huge problem, with firefighters sometimes transporting 20 spice overdose victims to the hospital in just one day. The appeal? Spice is readily available on Skid Row for about a dollar a cigarette. It’s a cheap high and even when users find themselves having violent reactions to the drug, they often go back for more.
“Next thing you know that person may be pulling their clothes off and running through traffic,” Eckstein said. “That requires law enforcement, use of force. Paramedics are called. They have to wrestle this person to get them under control. They have to sedate them with medication because their heart rate and blood pressure are usually markedly elevated.”
Spice patients, Eckstein said, tie up police, firefighters and paramedics. Emergency rooms require behavioral response teams to restrain them physically. Patients usually stay there for about 12 hours. And then they’re back on the street.
Eckstein said the county needs more than five or six mental care facilities for the mentally ill, and more than just the one “sobering center” at 6th and Maple Streets for those with chronic drug and alcohol problems.
The Fire Department, he said, is “just dealing with the fallout,” trying to find innovative solutions. Recently, the LAFD expanded its Fast Response Vehicle program, paramedic units that can quickly respond to medical emergencies without a fire engine. Started in 2015, the program now has four units in service citywide. Paramedics assigned to the units are approved to medically clear some patients experiencing acute behavioral crises or chronic public inebriation for transport to a sobering center or mental health urgent care center, instead of a hospital emergency room.
But without enough units, the firefighters of Station 9 will continue to do what they’re trained to do. Respond to mental health and drug emergencies again and again and again.
Eckstein says the problems found on Skid Row don’t just impact the firefighters, though-- the homelessness affects everybody in every community, including police, firefighters, paramedics and local emergency rooms.
“What these men and women do here at the station is noble,” Eckstein said. “In one of the world’s wealthiest cities, it’s a particular tragedy. Tens of thousands of people living in these conditions and Fire Department, we’re doing what we can to try to respond and help these folks. But it’s a band-aid. You’re not getting to the root cause of the problem, which is dealing with their mental health issues, substance abuse and housing.”