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Dallas program reduces 911 frequent fliers

Through home visits to patients, in about a year the community paramedicine program has helped some go from calling 911 at least twice a month to not at all

By Tristan Hallman
The Dallas Morning News

DALLAS, Texas — The number of 911 calls in Dallas has swollen by more than 17 percent during the last five years, Dallas Fire-Rescue officials said Monday.

And while they say there is no cure for the increase, officials believe they have effectively treated a harmful symptom of the problem: EMS “frequent fliers” — people who call 911 several times a month for maladies real and imagined. Many of the callers are indigent and rely on the emergency services for their basic health care needs, such as managing their medications or diabetes-related problems, officials said.

Assistant Chief Norman Seals said the Mobile Community Healthcare Program, which treated its first patient a year ago, has successfully helped cut the amount of calls from some of those frequent fliers from more than two a month to almost none a month. Rather than simply responding to emergency calls, paramedics regularly visit the patients at their homes to teach them to care for themselves — and to use the 911 system properly.

“Oftentimes, these people have no other place to turn, and they turn to us,” Seals said during a meeting Monday of the City Council’s public safety committee. “We’ve been able to make a real difference in these people’s lives in a real substantive manner.”

The program has six paramedics but could add more by the end of the summer, Seals said. They have visited 73 patients in the first year of the program, and 32 are currently in it, he said. The average age of patients is 56. The youngest is 24. The oldest is 82. About 30 percent didn’t finish high school. About 42 percent live alone.

And, Seals said, “They are poor.” About 90 percent earn less than $13,000 a year. Almost all of them are on Medicare or Medicaid.

“This is a group of patients who haven’t really been fully understood in the city,” he said, adding that the patients are spread throughout the city and have a variety of health issues.

“We’ve had patients with cancer. We’ve had patients with oddball stuff,” Seals said. “Generally, it’s not just one — it’s two, three, four different kind of issues going on because they haven’t gotten the appropriate health care they need.”

He said 26 patients have “graduated” from the program, meaning they no longer need constant medical assistance. Those former frequent fliers were calling 911, on average, more than twice a month before they entered the program. They now average 0.28 emergency calls a month, according to fire officials.

Eventually, the officials hope to have area hospitals pay the fire department to make house calls to keep frequent fliers out of their emergency rooms. Seals said the city is negotiating with UT Southwestern University Hospital and Children’s Medical Center Dallas.

Dr. Marshal Isaacs, Dallas Fire-Rescue’s medical director, called the program “innovative.” It is patterned after a similar program by MedStar in Fort Worth, but officials say Dallas is the biggest city yet to try it. Isaacs implored City Council members to put their weight and city dollars behind the program.

Seals said the program has the potential “to morph into something a lot larger than it is” and reach even more patients.

Council member Jennifer Staubach Gates, who is a licensed nurse, said she was impressed.

“The larger we can expand this, the better,” she said.

Dallas Fire-Rescue has had a 17.5 percent increase in emergency calls since the 2009 fiscal year. During that time, fire calls had declined before shooting up again last year. Fire officials said they don’t see the number of emergency medical calls decreasing in a growing city.

Assistant Chief Daniel Salazar told committee members that the city is still in the market for a priority medical dispatch system to help deal with the enlarged call load.

Currently, Dallas Fire-Rescue responds to heart attacks and sprained ankles the same way: with lights and sirens blaring. The new dispatch software and training would allow the department to have tiered responses based on the emergency’s severity — much like a hospital emergency room.

Plano Fire-Rescue is using such a dispatch system. City leaders there have boasted that the program has saved them money and kept ambulances available for true emergencies.

Dallas council members hope their dispatch system will eventually produce similar results.

“It seems like a really good idea to triage these calls and send those ambulances where they are most needed,” council member Sandy Greyson said.


©2015 The Dallas Morning News