By Suzanne Hoholik
The Columbus Dispatch
COLUMBUS, Ohio — Paramedics often tell stories of emergency calls that are far from emergencies — a man can’t sleep, a woman is nauseated or a baby won’t eat.
As jobless rates and the ranks of the uninsured rise, paramedics have become primary health providers to many people. Cash-strapped cities are trying to find ways to weed out nonemergency calls.
Some have paramedics hand out taxi vouchers to people who need a ride to health clinics, not emergency rooms. Others have created a triage system for 911 calls and better screenings once paramedics arrive at a house or apartment.
The Columbus Division of Fire answered 107,351 calls for medical help in 2007, 13 percent more than in 2006. Paramedics say that many of the people who called should have been seen by a family physician, not an emergency-room doctor.
Jack Reall, president of the Columbus firefighters union, said he supports not transporting every patient to an emergency department.
“Until we have the ability to actually triage and make the determination on when we should transport and when we shouldn’t, our workload isn’t going to ease,” Reall said. “You need to give the responsibility and authority back to the paramedics in the field to decide when they should transport.”
Cincinnati city officials say they might add a nurse to their 911 call center as a way to triage calls before paramedics are dispatched.
The city’s emergency medical service has been so inundated with 911 calls that during a 26-day period last year, 73 people who called for a medic were told none was available.
“When the ambulances are driving people to the hospital who don’t feel well or need a prescription refilled or have a child with a toothache, that overwhelms the system,” Cincinnati Councilman Jeff Berding said.
Currently, he said, the motto in the city’s EMS is “You call, we haul.”
Berding said a nurse could direct some people to clinics and urgent-care centers. Those who need a ride could be taken in a van instead of an ambulance.
Which calls would go to a nurse, he said, would be based on a strict protocol approved by the department’s medical director.
Several other cities, including Richmond, Va., Houston and San Francisco, have similar triage systems in place for 911 medical calls.
Columbus has no plans to change things. If you call 911 with a medical emergency, paramedics are dispatched. If you want to go to a hospital, you go in an ambulance.
“There has been no discussion of anything like this occurring here,” said Dr. David Keseg, medical director for the Columbus Division of Fire. “But I’m always open to new ideas to make things more efficient.”
Keseg said he questions whether a nurse could accurately triage a person over the phone and wonders about liability risks if an ambulance is not sent.
“A lawsuit could negate any savings,” he said.
Cincinnati is studying the policy in Richmond, which spent 18 months testing phone triage before implementing its program.
“We were cautious about the liability, and our attorneys and medical director were intimately involved to make sure this is safe,” said Jerry Overton, chief executive of the Richmond Ambulance Authority.
“We determined it was and turned it on.”
A task force studying the idea in Cincinnati plans to present its findings to the City Council in the spring, Berding said. He hopes for a vote by summer.