Updated June 2015
Sedgwick County EMS in Kansas recently implemented a policy designed to discourage frequent 911 callers from going from hospital to hospital seeking care. According to the policy, patients transported to an ED who call 911 again within 72 hours must be transported to the same ED.
“We have a group of patients who would call us and say they didn’t like the staff at this hospital, or they didn’t get what they think they should have received … so take me somewhere else,” says Scott Hadley, director of Sedgwick County EMS.
Some of the patients may have substance abuse issues and are seeking pain medications, while others have a multitude of chronic ailments, often coupled with mental health or social services needs. Not only do those patients take up an inordinate amount of EMS resources, but they cause hospitals to have to repeat tests and labwork that may have already been done elsewhere. “By taking them back to the same facility, that facility will have all of their pertinent medical information, their history, and may have talked with the primary care doctor,” Hadley adds.
The idea for the protocol came after Hadley and his team analyzed the habits of their top 50 911 callers. They noted that many frequent users would go to multiple hospitals, sometimes even on the same day. With the support of Sedgwick County EMS Medical Director Sabina Braithwaite, M.D., they got the OK from the Medical Society of Sedgwick County, which oversees EMS protocols and includes representatives from area hospitals, to implement the policy last summer. Responders can tell from the electronic patient care report if the patient has been transported recently.
Initially, when EMS providers informed patients that they would have to return to the same hospital, some patients resisted. “Many of them weren’t happy about it,” Hadley says. If the patient couldn’t be persuaded, medics would contact Braithwaite, who would explain the policy to the patient over the radio.
Braithwaite was called several times a month during the first few months. But a year after implementation, many patients seem to have accepted the policy and challenge it less often. “Crews are also more adept at explaining it,” Hadley says.
Sedgwick County EMS hasn’t yet studied whether the policy has led to a decrease in transports for frequent users, but Hadley says there have been individual successes. One man, for example, called 911 a dozen times in January and February, complaining of abdominal pain and other problems. He’d get mad at EMS crews and hospital staff and call Hadley’s office daily to complain. “He would always want to go to a different hospital,” Hadley says. “He didn’t like what the other hospital was doing for him. He didn’t believe they were taking his condition seriously. They weren’t doing the right tests. He didn’t think the hospital or our crews were being nice to him.” Eventually, Hadley and the hospital got the man connected with mental health and social services. In March, EMS transported him only once.
Fostering partnerships between hospital EDs and EMS benefits both, Hadley says. “It’s where EMS has a real opportunity to be an integral part of reducing overall health costs and, most importantly, getting patients the right resources they need at the time,” he says. “For a long time, we were not looked at like a healthcare partner; we were paid to transport people to the hospital. But I believe there is an opportunity to improve communication with the hospitals, so that we can help them help us.”
LAFD increases ambulance staffing
The Los Angeles Fire Department is reassigning some firefighter-EMTs from fire apparatus to ambulances in order to boost their fleet of BLS ambulances.
The LAFD is made up of “task forces,” which include 10 firefighters who staff three vehicles (a ladder truck, a pump and a fire engine), and “light forces” (a pump and a fire engine) staffed by six firefighters.
Starting in May, the LAFD began reassigning one firefighter per shift from task forces at stations with low call volumes to ambulances at stations with higher call volumes. The LAFD is also moving one firefighter per shift from light force fire trucks at stations with heavy call volumes to ambulances at the same station. The move will remove one firefighter from 22 trucks while boosting the department’s fleet of non-paramedic ambulances by about one-third, to 45, says Capt. Jamie Moore, LAFD public information officer. Los Angeles Fire Chief Brian Cummings announced the staffing change at a Los Angeles City Council public safety committee meeting in May.
More than 80 percent of LAFD responses are medical, and many of those can be handled by a BLS team, the department says. “Moving these medically trained firefighters from the fire trucks to open these 11 Basic Life Support ambulances will increase the availability of LAFD’s resources and increase the department’s ability to properly serve the public,” Cummings said in a statement.
The plan is opposed by the firefighters union. On its website, United Firefighters of Los Angeles City (International Association of Firefighters Local 112) calls the plan “dangerous and unacceptable.”
The Los Angeles Times website has a link to the new staffing plan. Visit documents.latimes.com/draft-lafd-ambulance-plan/.
Free Guide to Preventing the Spread of Infections in EMS Available
The Association for Professionals in Infection Control and Epidemiology is offering a guide for EMS in preventing the spread of infectious diseases such as Staphylococcus aureus (MRSA).
“The major goal of this guide is to increase awareness, educate, and provide guidance to EMS system responders who are at risk for occupational exposure to blood, other potentially infectious materials, infectious diseases, and bioterrorism,” write the authors, led by Janet Woodside, R.N., an EMS program manager for Portland Fire and Rescue. “Standard EMS training curriculum contains information on infection prevention. However, EMS needs more integration with other community IPs [infection preventionists, health care professionals who have special training in infection prevention] and more efficient communication networks for information sharing.”
The 86-page “Guide to Infection Prevention in Emergency Medical Services” includes:
- Infection prevention standards, regulations and best practices in patient and EMS system responder safety
- Instructions, examples and tools to conduct surveillance and risk assessments
- Forms and templates for infection prevention education, training and compliance monitoring
- Emergency, disaster and bioterrorism preparedness information
The authors point out that proper hand-washing, proper use of personal protective equipment, and thoroughly disinfecting equipment and ambulances are key ways of preventing the spread of infections. But exposures happen. And when there is one, EMS agencies should have a written plan outlining work restriction guidelines, policies and procedures. Likewise, EMS agencies should ensure that all EMS responders are properly immunized.
The guide includes information on who should be immunized, along with contraindications. Download the guide at here.
