Sacramento Fire: 79 ‘High Utilizers’ Cost EMS System $12.5 Million in Under 5 Years

By MES Dispatch Staff

The Briefing

• The Sacramento Fire Department says 79 frequent 911 callers generated 5,191 EMS responses between 2021 and 2025, costing the department $12.5 million.
• Those calls consumed an average of 12% of the city’s annual EMS time despite representing about 0.014% of the city’s population.
• Assistant Chief Ryan Tweltridge said the repeat calls delay response to time-critical emergencies such as cardiac arrests and strokes elsewhere in the city.
• City Councilmember Eric Guerra is pushing to update Sacramento’s 2022 city-county homelessness partnership agreement to better address high utilizers and align with state mental health and substance use commitment laws.
• Fire officials say an alternative response program has since helped stabilize several of the identified individuals by connecting them with medical care, behavioral health support and social services.

SACRAMENTO, Calif. — Fewer than 80 frequent users of emergency medical services cost the Sacramento Fire Department $12.5 million over roughly five years, according to city data presented at a news conference Wednesday.

Between 2021 and 2025, 79 people accounted for 5,191 EMS responses, consuming an average of 12% of the department’s annual EMS time despite representing a tiny fraction of the city’s population. “We know this situation is unsustainable,” City Councilmember Eric Guerra said. “It is also terrible and inhumane for the people who are suffering.”

Fire officials said the concentrated demand strains resources available for the rest of the city. Budget constraints have taken as many as eight fire trucks out of service in recent months, Guerra said, and repeat low-acuity calls tie up staff and vehicles needed for emergencies elsewhere. “True emergencies are delayed because of the time we’re taking to respond to these high utilizers, so when fire engines and ambulances are committed to low acuity repeat calls, they’re unavailable to respond quickly to time-critical incidents such as cardiac arrest and strokes,” Assistant Chief Ryan Tweltridge said. One case study found a single individual consumed 287 hours of responder time over 15 months, contributing to response delays of more than a minute for more than 200 other 911 callers.

City officials and local advocates attribute the pattern largely to a lack of shelter capacity able to accommodate people with complex medical, mental health or substance use needs. “They’re not intentionally spending this money — these are people that are too sick for our shelters,” said Sonia Mogilner, a local emergency room social worker, noting Sacramento has no shelters equipped to receive homeless patients discharged from hospitals.

Tweltridge said the data reflects historical patterns and that several of the identified individuals are now in more stable circumstances through the department’s developing alternative response program, which connects high utilizers with medical care, behavioral health support and social services. “The strategy is compassionate, data-driven and focused on improving outcomes for both high utilizers and the broader community,” he said.

Guerra is pushing to update the city and county’s 2022 homelessness partnership agreement, which is set to expire in December 2027, to better incorporate California’s CARE Court program and involuntary commitment laws enacted after the agreement was signed. He said he wants the city and county to jointly sponsor legislation strengthening CARE Court’s enforcement mechanisms and to establish a shared data system allowing agencies to track high utilizers across jurisdictions.