Early on a Thursday morning in late July, a Chrysler minivan loaded with Narcan, a medicine that reverses opioid overdoses, fentanyl test strips, COVID supplies, and stacks of water bottles and snacks rolls out of the Oakland Fire Department’s training grounds near Jack London Square. 

Two radios are providing distinct soundtracks for the three-member crew. One is dialed to a FM hip hop and R&B station. The other, a hand-held radio, is connected to the Oakland Fire Department’s dispatch center, where emergency calls are routed to first responders. 

“MACRO 4 is in service for the day,” community intervention specialist Rob Hanna says into the radio’s mic, as Tupac raps in the background. Hanna steers the van toward the Nimitz Freeway en route to East Oakland as his fellow crew members game plan what they’re about to do. 

They’ll check on “sleepers”—unsheltered residents at their campsites who might be waking up—and offer them food, water, and an opportunity to receive services through the city’s CARES program. Chiarra Duncan-Perry, who goes by “Key,” clutches a legal pad ready to take notes on their encounters with Oakland residents. In the front passenger seat, Rick Fitzsimmons, an emergency medical technician, says he wants to track down a couple in their 60s who he hasn’t seen in a while, not since the car they were living in was towed. 

“They are one of the ones I like to check on,” Fitzsimmons says. “There’s a crazy opioid epidemic in Oakland right now. I just want to make sure they are ok. We are going to see some people I know are not going to want services, but I still feel obligated to swing by and see what’s up.” 

Duncan-Perry, who grew up in East Oakland, knows the neighborhoods well, but in her third week is still getting to know the list of people Hanna and Fitzsimmons want to check on during each shift. 

“There are people who flag us down. They are starting to know our names,” Duncan-Perry says. 

This is how the day begins for members of the Mobile Assistance Community Responders of Oakland, or MACRO. Now in its third month, the pilot community response program is becoming a familiar presence in several areas hard hit by the housing and homelessness crisis, drugs, poverty, and other social ills. 

MACRO was designed to have civilian workers respond to non-violent, non-emergency 911 calls, a dramatic shift away from the traditional response of sending police officers to deal with a multitude of problems—the majority of 911 calls, in fact—like a person suffering from mental illness and causing a disturbance, or someone sleeping in a park, or a welfare check needed for someone unconscious on the sidewalk. 

Since April, MACRO crews have roamed about in search of people who may need their assistance. City officials and community members are deeply invested in the program, which is one of a few of its kind in the nation, part of a movement by some cities to try to respond to crises with civilians who are armed only with compassion and resources.

An effort years in the making

Rick Fitzsimmons, a MACRO emergency medical technician, shows the equipment the team goes out with for the day, including water, snacks and emergency medical supplies to treat anyone who made need medical assistance. Credit: Amir Aziz

MACRO could fundamentally change how the city responds to nonviolent and non-criminal 911 calls by sending unarmed civilian responders—EMTs and community intervention specialists—instead of police. Its origin can be traced back to early 2019, when the Oakland Police Commission held a public hearing in West Oakland to hear from unhoused residents about their encounters with police. 

Many complained that the police couldn’t help them and often did more harm than good. At the same time, members of the Coalition for Police Accountability, a community group focused on police reforms, were recommending that Oakland take a close look at a little-known program from Oregon that sent civilians out on patrol with harm reduction supplies and de-escalation skills. Called CAHOOTS—Crisis Assistance Helping Out On The Streets—the Eugene-based service has been around since 1989 and was shown to have saved the city millions each year while treating people suffering from mental health crises. 

The Urban Strategies Council was tapped by the Police Commission to lead a study to see what it would take to set up a CAHOOTS-like program in Oakland. While the effort predated the police killings of George Floyd in Minneapolis and Breonna Taylor in Kentucky, which caused nationwide protests and calls to “defund” police departments, it became part of Oakland’s “reimagining” of public safety. 

The Oakland City Council approved the MACRO pilot program in March 2021 under the control of the Oakland Fire Department after proposals to work with community organizations fell apart. 

The city hired Elliott Jones, an Oakland native and Bishop O’Dowd High grad who as a youth tagged along with his mother to City Council and other community meetings, as MACRO’s first program manager in November. Crews of EMTs and community intervention specialists hit the streets in mid-April.

‘One day I won’t wake up’

On the morning shift The Oaklandside rode along, Fitzsimmons, an EMT, suggested the first stop they make be a church on High Street across from Fremont High School. There, he jumped out of the van with water and snacks to wake up a bearded man covered in a blue blanket on the church’s front steps. 

“How was your night last night? Sorry to wake you up but just wanted to check in,” Fitzsimmons said. The man rose up on his elbows, still draped in his sleeping bag, and thanked the crew for stopping by, telling them, “that’s ok, cause one day I won’t wake up.” 

“That’s a reality for him,” Fitzsimmons said as he left. Before driving off, Hanna notified dispatchers that they were clearing that scene. Duncan-Perry noted on her legal pad that the man accepted water and a snack and documented the incident. 

On E. 12th Street and 50th Avenue, Hanna pulls the van over and they walk up to two people in sleeping bags. Duncan-Perry, who joined MACRO as a community intervention specialist after working for Bay Area Women Against Rape for over six years, asks in a soft voice whether the woman needs any medical attention. She politely declines. 

As the crew drives along International Boulevard, Duncan-Perry recalled one encounter where a resident was confused by her wearing an Oakland fire department shirt. 

“Some people don’t want to talk to the fire department,” she explained. 

As the sun burns off the marine layer, the crew braces for a shift in the kinds of incidents they’ll be responding to. While the morning hours involve checking on sleepers, things pick up by the afternoon, Fitzsimmons says. “There will be a whole variety of people on International doing whatever.”

International Boulevard is one of Oakland’s busiest streets, running from Lake Merritt through Fruitvale and East Oakland to the San Leandro border. It’s home to diverse Asian, Latino, and Black communities and has some bustling commercial districts and thriving small businesses, but it’s residents also have to endure intense problems like human trafficking, gun violence, high rates of crime including robberies and homicides, disproportionate numbers of traffic injuries, homelessness, and drugs like fentanyl and heroin.

Hanna says he keeps his head “on a swivel” while driving. Earlier in the day, the crew worked out a code word to use if they sense danger. In front of a laundromat on International, where Duncan-Perry and Fitzsimmons were speaking with a woman to see if she wanted a shelter bed that night, Hanna stood on the curb near the van keeping watch. 

MACRO community intervention specialist Rob Hanna talks with fire dispatch during a recent morning shift. Credit: Amir Aziz

“I don’t like to hang out on one corner too long,” he says. 

Jones also worries about the safety of his workers. He says that’s one of the reasons why MACRO is not a 24-hour operation yet. 

“The later we get into the night, the less opportunity there is for us to refer people to services and make connections that will be beneficial to individuals. Our exposure in some of these areas, even with our trusted messengers, does put us at risk. I am always going to prioritize the safety of my team,” Jones said in a recent interview. “Once I can assure our activities later in the day are going to be fruitful, then we will talk about graveyard shifts.” 

By the end of the year Jones expects crews will be out for 16 hours a day, seven days a week. But for now they’re working only a 7 a.m. to 3 p.m. shift, as requested by dispatchers. 

More than 2,000 contacts in the first few months

When MACRO first hit the streets, Oakland’s dispatch center was not ready to begin assigning them to calls for service, so over most of the past three months crews have been on proactive patrols looking for people in need of help. According to a report Jones presented to the City Council last month, crew members mostly have been conducting welfare checks of people who appear in distress. 

Of the 2,105 calls MACRO responded to, 1,530 were welfare checks, including 433 people sleeping in public places, 61 behavioral health concern cases, 24 cases of panhandling, three instances of nudity, and 54 incidents listed as “other.” Each MACRO unit keeps a log of their encounters, with information about the individual, and what services they were offered.

Not taking calls from dispatch has allowed MACRO team members to take their time in introducing themselves and the program to residents they encounter, said Jones. Disturbed by recent news reports that about 400 unhoused people died on Oakland streets between 2018 and 2020, Jones asked his staff to begin shifts by checking on people sleeping on sidewalks and in encampments. He called the proactive patrols “truly innovative,” something MACRO plans to continue to do even after they start responding to dispatch. The team already has a list of incidents they can recount to prove their efficacy. 

Hanna and an emergency medical technician spotted a man at a gas station who appeared distressed. According to Jones, “by the time they parked he was downhill, on the path to an overdose.” The crew gave him Narcan and helped him get an ambulance to the hospital. “We just happened to be where we were,” Jones said. 

Another situation on 98th Avenue and MacArthur Boulevard demonstrated how MACRO hopes to work with Oakland police. A MACRO unit came upon a person “twirling barefoot” in the middle of the street, putting themselves and others in harm’s way. Determining the person needed to be placed under an emergency psychiatric hold, the responders needed to call OPD to notify the Alameda County Community Assessment & Transport Team, which is comprised of EMTs and behavioral health clinicians who respond to calls of suicide and self-harm in public settings. 

The Oakland police officer who arrived “never got out of their car,” Jones told The Oaklandside. This was important because the mere presence of police, even if an officer is calm, can sometimes escalate situations and lead to worse outcomes for everyone involved.

On Aug. 1, fire dispatch began sending MACRO teams to calls determined not to need a police response, like reports of people suffering from a behavioral health concern. Locally, there are several dispatch centers run by the county, California Highway Patrol, Oakland police, and Oakland fire. Dispatchers were trained to identify calls best suited for a MACRO response, Jones said. The way it works is all calls determined to need a MACRO crew get routed to fire dispatch, which relays the incident to the proper on-duty MACRO unit. 

In the first 10 days or so, about 15 to 20 behavioral health concern calls have been routed to MACRO, according to Jones. And in some cases, police officers have notified the civilian responders of situations unfolding in front of them. 

Jones is managing a staff of eight EMTs and nine community intervention specialists. Of the 17 responders, there are 10 women. Six employees are Black, four white, four Latino, and two Asian Pacific Islander, reflecting the diversity of the city they serve and hopefully helping build trust in the community. 

For now, MACRO only serves West Oakland and the flatlands of East Oakland in four zones. Zone 3 is bordered by Interstate 580, Interstate 980, the Port of Oakland and the 7th Street and Maritime area, blanketing West Oakland. The central East Oakland Zone 2 is from 14th Avenue to High Street, below Interstate 580. Zone 4 goes from High Street to 73rd Avenue and from there Zone 2 runs in the flatlands to the San Leandro border at 106th Avenue. If successful, the program will eventually expand citywide. 

Some constructive criticism  

Elliott Jones, the MACRO program manager, in his office at the Oakland Fire Department’s training facility. Credit: Amir Aziz

Rashidah Grinage of the Coalition for Police Accountability, the group that was instrumental in pushing for MACRO, told The Oaklandside that she’s concerned the city is more focused on expanding the program geographically and not focused on extending its hours of operation. Grinage and other members of the coalition believe that MACRO should be running 24 hours a day to prove its effectiveness.

“We immediately got push back with the explanation that it was too dangerous for MACRO folks to be out in the middle of the night,” Grinage said. “This is just unacceptable and there is no evidence to suggest there is more violent activity between 11 p.m. and 7 a.m. than there is during the day. It’s an irrational position.” 

Although excited that the program has begun, other MACRO supporters said there could be more transparency around the hiring process, if employees are from Oakland, and what barriers applicants face. 

Millie Cleveland, a member of the MACRO advisory board, an official city panel which acts as the community’s voice to ensure the program is living up to mandate, said they aren’t yet privy to the program’s inner workings. She is calling on City Council to strengthen the board’s role and restructure it so members are appointed by council and not the City Administrator’s Office. 

“I think our job is to get the council to acknowledge there is a problem and to fix it,” Cleveland said. “It’s during a pilot phase that you want community input.” 

Anne Janks, another member of the Coalition on Police Accountability, thinks the city should take advantage of MACRO’s popularity. “The thing that was always striking about MACRO is the level of community excitement, and engagement,” she said. “You could whisper out your back door at midnight that we were going to have a town hall and 100 people would show up. It’s a remarkable opportunity. There’s a level of excitement that remains that’s not being harnessed.” 

Jones has asked the community for patience during the pilot phase. He said expansion of coverage areas and shifts will be based on data they are collecting. 

“I want to make this perfectly clear: the support from the community as a whole has been overwhelmingly positive. The community also wants to see more. They want us to move even faster,” Jones said. “While we are in the pilot phase and have had some initial success, we are trying to push back and reinforce that we have to collect data. The data will dictate what the expansion looks like.” 

He thinks MACRO’s proactive approach is making a difference, even if it’s hard to quantify. Jones emphasized that MACRO is focused on individuals and are not the blight police. 

“When someone dies you may have to call the fire truck, they may have to stay there until the coroner comes, it clogs the system,” Jones said. “We want to put eyes on people hopefully before they expire and see what we can do to reach them before they will desperately need emergency services. If you have a wound, let’s clean it so it doesn’t get infected in six days and you need to go to the hospital. 

“If we have to come by and clean your wound every couple of days, we are praying that one day you will look at us and say can you help get me out of the street and into housing. That’s building rapport.” 

Rick Fitzsimmons and Chiarra Duncan-Perry of the MACRO team address Michelle Ramon, an unhoused woman in East Oakland for a wellness check. Credit: Amir Aziz

Back on International Boulevard, the MACRO 4 crew continued making its rounds. An hour into their shift, they had contacted six unhoused residents. As they pull up to another scene, Fitzsimmons hops out to speak with a man sleeping on the steps of Lockwood Gardens School. The conversation, like most on this morning, is brief, but he’s learning more about each individual. 

“He’s only 28,” says Fitzsimmons. “I’ve never seen him intoxicated or with alcohol bottles or drugs. But he never leaves those stairs.” 

The longtime EMT seems to keep a file in his head of who he wants to check on next. Minutes later, the trio is at the corner of International and 71st Avenue, near the edge of their coverage area. Fitzsimmons rolls down his window as they pull to the curb, explaining he likes “people to see his face” before he approaches. 

Michelle Ramon recognizes their faces. Ramon, who is without one of her arms, is seated on the sidewalk next to a cart filled with her clothes. Fitzsimmons and Duncan-Perry tell her about shelter services, but she’s not interested on this day. She does, however, want a soda. 

Fitzsimmons goes into the corner store and brings back a coke. Hanna looks on and says much of the work is about repairing relationships with residents. 

“Relationships can’t be built when people are in crisis,” he says. “You have to build that beforehand.” 

David DeBolt reported on City Hall and policing for The Oaklandside. He spent 12 years working for daily newspapers in the Bay Area, including on the Peninsula and Solano County. He joined the Bay Area News Group in 2012 where he covered a variety of beats, most recently as a senior breaking news reporter. During his time at BANG, DeBolt covered Oakland City Hall, the Raiders stadium saga and the A’s search for a new ballpark, as well as the Oakland Police Department and police reform efforts. He was part of the East Bay Times staff honored with the Pulitzer Prize in Breaking News for coverage of the Ghost Ship warehouse fire.