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Calif. city sees success with first 911 overhaul

Pilot program in El Cajon diverted some 911 calls to nurses for the appropriate level of care


El Cajon, CA - January 31: At Heartland Communications (Central Dispatch) on Tuesday, Jan. 31, 2023 in El Cajon, CA., Communications Supervisor Amy Strand, offered advice to Matthew Ruperty as he was processing an emergency call from the public.

Nelvin C. Cepeda / The San Diego Union-Tribune

By Lauren J. Mapp
The San Diego Union-Tribune

EL CAJON, Calif. — Heartland Fire & Rescue launched a pilot program in 2023 to make its emergency medical system more efficient by diverting some 911 calls to nurses.

Through the El Cajon Community Care program, callers not in life-threatening situations can choose to be transferred to an American Medical Response nurse navigator, who helps them access the appropriate level of medical care.

“You might have hurt your knee going down the stairs, and instead of sending a firetruck, an ambulance and five fire personnel, you might instruct the patient to go to the emergency room, go to the urgent care,” Mayor Bill Wells said.

On Thursday, more than a year after its launch, Heartland Fire gave a progress report on the success of the program, which is the first of its kind in California.

During its first year, the program directed 581 residents to the correct care for their situation.

Global Medical Response, the parent company of AMR, reports that 208 callers — or 36 percent — did not require emergency medical services. Of those, 120 were treated with nurse advice only and 30 were treated with a visit from a mobile urgent care unit or telemedicine, and 58 were directed to an alternative health care destination, such as urgent care.

An additional 212 callers required an urgent Basic Life Support response and 138 required a not-time-sensitive response from non-911 units.

“We see this program really being a very positive, additional tool that we have in our quiver or in our toolbox to be able to help out callers and provide them with the most appropriate level of care,” said Bent Koch, Heartland fire chief.

Among the callers who chose to connect with a nurse navigator, 138 callers needed a non-urgent response from a Basic Life Support ambulance. An additional 23 people whose conditions initially seemed less serious but changed during the call were deemed emergencies and received a traditional, 911 Advanced Life Support response.

Global Medical Response reports that the program makes emergency operations more efficient and frees up ambulances to address more urgent calls.

The vast majority of cases served by nurse navigators — 96 percent — did not require rapid response from a fire engine and/or police car. The program also saved 611 unit hours (a unit is the team) in ambulance capacity and $573,000 in avoided emergency care costs.

That frees up the city’s ambulances to attend to more urgent medical emergencies, which is helpful given sometime long turnover times when dropping off patients at an emergency room.

“We actually had a case last year where there’s an ambulance that was waiting for a bed for over six hours,” Koch said. “That means while they’re on scene, if another call comes in, they’re not available for the next call.”

Now that the pilot program is in its second year, American Medical Response is looking at ways to broaden the program both in El Cajon and elsewhere in the county, said Paul Forney, AMR regional director for San Diego and Imperial counties.

“Our intent, now that we have a year of data to substantiate our methodology and our approach to clinical care, is to expand the number of patients that would be eligible in subsequent years of the program,” Forney said.

While Wells lauded the program and its effect on making the emergency medical system more efficient, he said it was a little surprising that more people didn’t take advantage of the program. He said that because it’s still relatively new, he thinks people don’t trust or understand how it works yet.

Eventually, once more cities in the county are on board, Wells said a community-wide campaign might help educate residents about the program’s benefits, similar to campaigns that encouraged the public to call 911 when faced with an emergency.

“I think as time goes by, and they’ve had more experience with it and they’ve talked to other people who’ve had experience with it, they’ll start to accept it more, and I think it’s gonna be more of a staple,” Wells said.

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