A specialized response unit that reduces patient visits to the emergency room.By Jim Crawford Published Wednesday, June 1, 2016 | From the June 2016 Issue of FireRescue "I have written about the concept of what I call community paramedicine before. I think it is one of the fastest growing aspects of public safety the fire service must embrace to survive tightening budgets and questions from community leaders who ask why we are a more expensive public entity than we were in the 1970s when fire deaths were so much higher than they are today. . . So the reason I focus on the medical aspect of our service is because it accounts for the largest part of our collective call volume for most fire departments across the nation. And it’s an opportunity to reduce community risks in new ways, with significant partners." [Image of June 2016 cover to the left]
Managing Low Acuity Calls
The most recent example I’ve encountered is in Mesa, Arizona. The leadership team there has embarked on a multiyear program establishing community care units that manage low medical acuity calls in a more efficient and effective manner. Funded by a three-year Centers for Medicare and Medicaid Services Healthcare Innovation grant, Mesa began this program in 2012 with a specialized response unit staffed by a captain paramedic and a physician’s assistant. That unit ran for 60 days, 40 hours a week, and managed 196 patients. The goal was to manage calls like nose bleeds, back pain, simple lacerations and wounds, illness, and infection at the mid-level so that people would not have to visit the emergency department at the hospital.
[Image at above right: Tom Morris, FNP-Mountain Vista Medical Center; Dr. Gary Smith, medical director for Mesa Fire and Medical Department; Captain Seth Johnson, Mesa Fire and Medical Department. Photo by Rick Montemorra, Mesa Fire and Medical Department.]
In that phase, 58 percent of patients were able to be managed at the mid-level with a follow-up visit the next day. Since then, the model has evolved into an ongoing partnership with the Mountain Vista Medical Center, Crisis Preparation and Recovery, Inc., and the Superstition Fire and Medical District.
Since August 2012, a nurse practitioner and paramedic assigned to the unit have assessed more than 900 patients, and the model has expanded into what they call a community care specialist unit that includes a behavioral health care professional. They’ve determined that about 10 percent of their medical responses are for patients with behavioral and/or drug- and alcohol-related issues.
Currently, they estimate that 75 percent of their patients covered by this program were routed to a more appropriate facility or to a primary care physician when they would normally have been sent to an emergency department. Mesa is constantly assessing its program with an eye on the end of the grant funding to make it self-sufficient. As demands for emergency response and treatment increase and health care costs also increase, local communities are going to be pressed to come up with more efficient ways to manage this continuum of care.
Changes in the Affordable Care Act, Medicare, and Medicaid systems and health care provisions in general are going to continue to put stress on changes in services levels. The insurance companies, the hospitals, urgent care clinics, and others are all asking themselves how to provide more efficient service and reduce costs.
The question we have to ask ourselves is, Where does the fire service fit in? And, you might ask, What does this have to do with a community risk reduction column? Well, it reduces community risks overall and helps manage our call volume in a more effective and efficient way.
Remember, emergency response is the most basic of our community risk reduction strategies and will always be part of what any community needs to manage community risks.
Those who wish to learn more about Mesa’s effort can reach out to Gail Coakley of the Mesa Fire and Medical Department: gail.coakley@mesaaz.gov.
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