Frequent Flyers

FossilMedic points out solutions:

MEMPHIS RESPONSE TO FREQUENT FLYERS:
HOW ONE PARAMEDIC STOPPED 3000 EMS CALLS

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The Memphis Fire Department’s 2007 strategic plan included “Reduce call volume from 16 of top 25 addresses.” At the tenth annual Gathering of Eagles [ http://www.gatheringofeagles.us/ ] Doctor Joseph Holey shared information about the initial results of the 911 Alternatives program. A lieutenant paramedic/firefighter was assigned as the coordinator of the program.

FRAGMENTED SUPPORT SYSTEM

Looking at the top five individuals that called for an ambulance, two factors became clear:

Super-users are in an emergency department every day.

Hospital case workers can only address the issues from their facility.

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The 911 Alternatives program coordinator functions as the focal point on matching the patient’s needs and the community resources. Regardless of the destination hospital, all of the transports were made by a fire department ambulance.

The coordinator works to get the super-users a primary care physician, social services or whatever was generating the inappropriate 911 calls for an ambulance.

MAKING THE CONNECTIONS

Lack of transportation is a significant issue with super-users. The 911 Alternative coordinator takes super-users to doctor appointments and clinics. While this moves far from the traditional role of a paramedic/firefighter, Dr. Holly points out “it is cheaper sending a paramedic in a crown vic versus two medics in a truck.”

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FIRST YEAR RESULTS

Four of the top five Memphis frequent flyers significantly reduced the number of times they called 911 for an ambulance, representing 3000 fewer calls in a system that handles 91,000 responses a year. The eliminated calls represent 3% of the “alpha” calls handled by MFD. Alpha calls represent the lowest level of urgency when processing requests for medical service.

WHAT OTHER CITIES ARE DOING

Richmond (VA): Started a Nurse triage system after two years of shadowing EMS operations. Estimate up to 14% of the Richmond EMS 9-1-1 calls do not need an ambulance. Like Memphis, transportation is an issue. While Richmond Ambulance Association is contracting out for a service to provide transportation to and from a medical facility, they may bring that in-house. Cost: $354 paramedic ambulance vs. $56 for nurse triage and transportation

Tuscon (AZ): Alpha truck. Two firefighter/emt’s in AED equipped non-transport vehicle proceed non-emergency to incidents that fall into the Medial Priority Dispatch System as Alpha (no symptoms) calls. Alpha truck stays until issue is resolved (about 45 minutes per incident.) First unit handled 3000 calls in pilot that just covered the busiest fire station district. Plan to have four Alpha trucks handle 9000 calls a year.

Atlanta (GA): Grady Hospital provides the 9-1-1 ambulance transportation for the city. 27% (24,000) of the 9-1-1 calls are classified as alpha calls, with 9,000 as Alpha 26-1 [no apparent problem/symptom]. Obtained state grant to improve the 211 system and cover the cost of non-urgent transportation to and from a medical facility for alpha patients.

Washington DC: DCFEMS is establishing six community service units, one in each battalion. Staffed by a sergeant and a firefighter, these units will perform both fire and ems tasks.