Community Paramedicine: San Francisco Pilots Sobering Center as ED Alternative

Karen Shore, Golden State Health Policy


Founded in 2003, the San Francisco Sobering Center provides an emergency department (ED) alternative to patients with a history of alcohol use disorder but no acute medical conditions. Patients who arrive there are assessed by registered nurses, given food and water, and connected to relevant social services where possible. One of the center’s goals is to provide a safe space where people can become sober without diverting ED resources away from people with acute medical needs.

In 2017, California’s Office of Statewide Health Planning and Development approved a pilot project that is a collaboration between community paramedicine (CP) teams, paramedics, and the SF Sobering Center. All 450 of the city’s ambulance paramedics were given training in identifying patients who would be better suited to the Sobering Center than to the ED, and 10 paramedic captains with CP training provide support and serve as connectors between the paramedics and social services. The pilot’s trained paramedics successfully diverted 267 patients from the ED to the Sobering Center between February and July of 2017.

Key highlights in the pilot’s first six months include:

  • Paramedics were provided with precise medical eligibility criteria for assessing a patient’s suitability for transport to the Sobering Center.
  • Paramedic captains trained in CP gave close support to paramedics in the field.
  • 274 patients were taken to the Sobering Center instead of the ED as part of the pilot; 7 were subsequently transported to the ED.
  • Close collaboration between paramedic captains, ambulance paramedics, nursing staff at the Sobering Center, and community social services was essential to successful implementation.

For more information on community paramedicine, watch this video and learn about the progress of the pilot programs.

Learn more about CHCF’s work on community paramedicine.