Dr. Gary Smith, medical director of Mesa (Ariz.) Fire and Medical Department, described how the agency’s unique delivery model is changing the role of EMS during a presentation at Fire-Rescue Med in Henderson, Nev.
In the session “Blazing a Trail for the Future of EMS,” Smith explained that the department’s Transitional Response Vehicle is staffed by a captain and firefighter (both paramedics), and a physician’s assistant or nurse practitioner from a participating hospital. The unit responds to low-level or –acuity calls; providers access the patient and delivers services on scene rather than transporting to the ED, or transports to alternative destinations.
“We take patients to appropriate facilities the first time. Hence we need to manage these patients a little differently,” said Smith.
Examples include patients experiencing a urinary tract infection that can be treated at home, or a mental health patient who has cut himself and is transported to a behavioral health center.
The cost savings for Mesa are significant. “If we can avoid certain costs of not taking patients to the ER, we’re looking at a $4.6 million change,” said Smith.
Key takeaway: Project was data driven
- The Transitional Response Vehicle model emerged as a result of changes to health insurance from the Affordable Care Act, a decrease in fire calls, and an increase in BLS calls.
- The department analyzed its data and realized 70 percent of calls dispatched as ALS were actually BLS in the field, and 30 percent of calls dispatched as BLS were actually ALS in the field. Department leaders explored ways to better triage patients, which led to the development of the Transitional Response Vehicle.
- Mesa Fire and Medical also realized mental health incidents accounted for 14 percent of all dispatches for service and 80 percent of those calls were medical. The department partnered with a behavioral health organization to bypass the ED and transport patients to a mental health facility, and coordinates with police to determine alternative destinations based on the situation.
Most memorable quotes
“You have to step up and start making some in roads with health care systems and your hospitals. Once you do, you will find willing partners.”
“You have to sell what they’re buying. Identify what their needs may be, then develop a solution.”
“I would propose each of us move away from patient care reports: a single snapshot of a patient at that moment in time. I would move toward electronic medical records, which show evaluations over time and the ability to track care.”