CONNECTING THE DOTS
bladder, which had been ruptured by a severe
pelvic fracture. After 15 seconds, he thought
he might faint and excused himself.
At that moment, he recalled a story his
dad, a pilot in World War II, once told him.
After witnessing a dozen fellow pilots die in
a plane accident when their parachutes didn’t
open in time, Dunford’s dad and other pilots
were immediately ordered up in the air before
they could let the fear of the situation cripple
them. So Dunford decided to jump back in
the saddle with his trauma patient.
He thought to himself, “Now I’ve got to
decide whether I’m going to be a subjective
college kid who’s going to faint at the sight of
blood or if I’m going to become the guy who
fixes problems like this. The sooner I can get
to that strategy, the better off I’ll be.”
Experiences like that, particularly during
a year spent in the San Diego VA Healthcare
System overseeing a staggering 100-person a
day intake center with widespread acute illness,
led Dunford to choose emergency medicine.
In 1980, Dunford was asked to join the first
civilian aeromedical program in the country,
Life Flight San Diego. Over the next 6 years
he treated hundreds of acute trauma and medical field emergencies.
In 1988, he founded the University of Cal-
ifornia, San Diego (UCSD) emergency med-
icine training program and in 1990, Dunford
was tapped to help San Diego Fire-Rescue
Department (SDFD) add paramedics on fire
engines in difficult-to-serve communities. He
was a natural fit for this task because he was
already advising SDFD on dispatch and use
of automated external defibrillators (AEDs).
Spearheading initiatives to advance medical
care is an observable trend in Dunford’s career.
He’s tackled many EMS challenges, including implementation of the tremendously successful regional public access to defibrillation,
ST–elevation myocardial infarction (STEMI)
and stroke systems, identifying pitfalls to endo-tracheal intubation in traumatic brain injury
through use of continuously recorded end–
tidal CO2 (EtCO2) data and, more recently,
promoting real-time EMS access to patient
data through the regional health information
Countless students sing his praises as professor emeritus of emergency medicine at the
UCSD School of Medicine. But Dunford’s
real talent is seeing the big picture, which is
exactly what you’d want in a city medical director, a position he’s held in San Diego since its
inception in 1997.
He’s playing the long game in affecting
change in his medical community with pro-
grams that continue to inspire both nationally
and internationally. He’s not looking to just
do something like lead the nation in public
access defibrillation; he’s looking to break the
paradigm of healthcare.
DOLLARS & SENSE
Dunford has championed many programs in
San Diego that redefine the healthcare system
and connect vulnerable patients to the resources
they need. The easiest way to justify these programs is to show the cost savings, which Dunford has been able to do time and again.
In 1996, Dunford observed the San Diego
Police Department’s (SDPD) program for
homeless outreach. With the assistance of two
police officers, he recognized a handful of individuals frequently using the city’s services, both
police and medical. This led to a simple study
of 18 individuals which found that those 18
frequent flyers cost two hospitals and the community a total of $1.5 million.
When the mayor and police chief saw these
costs, they were galvanized to recommit to
problem-oriented policing. This gave birth
to the Serial Inebriate Program (SIP), hoping to address the vexing issue of chronically
intoxicated individuals who consume community resources.
“No one wants to put someone in jail for
being drunk, but the consequences of some
people’s recidivism on society can be so catastrophic that we need a rehabilitation strategy
to convince some folks to accept a meaningful treatment program or face consequences,”
SIP was designed as a pilot program with
Dunford, the cooperation of SDPD and a
handful of key stakeholders, including the
court, city attorney, public defender, jails, sobering center and an alcohol treatment provider.
Together, this group decided they would propose an alternative to incarceration for individuals with recidivist alcohol abuse problems.
The SIP criteria were defined by sobering
center personnel as any individual transported
by police to the detox center six times in 30
days. Instead of spending the night sobering
on a mat in the center, they’d have to spend
the night in jail and explain their behavior
to a judge.
After showing positive results for approximately 580 people, SIP gained national recognition, bringing much-needed science to
In 2007, SIP was awarded the Interagency
Council on Homelessness Pursuit of Solutions
Research Award in Washington, D.C.
The California Supreme Court also
In 2007, Dunford received the A Home for Every
American national research award from the U.S.
Interagency Council on Homelessness at the National
Press Club for his study of the San Diego Serial Inebri-
ate Program. Photo courtesy James Dunford
Dunford was one of the six original physicians on
San Diego Life Flight (1980–1986), the first civilian
physician-staffed aeromedical program in the U.S.