By Bella Biondini
Anchorage Daily News
ANCHORAGE, Alaska — Jennifer Pierce rapped on the mobile home’s front door. The man who ushered her inside had called 911 for his brother the night prior for a suspected stroke. Pierce, a mental health clinician with the Anchorage Fire Department, had returned on Wednesday to check on the family left behind.
A woman in her 90s sat in a rocking chair in the living room with a blanket in her lap. Pierce kneeled down to address her: Who had been doing the cooking? Had she seen a primary care doctor recently? Was her breathing machine cleaned regularly?
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Pierce leads a one-year pilot project within the fire department called Community, Outreach, Referral and Education, or CORE. The two-person crew, consisting of a licensed mental health provider and a paramedic, works to reduce repeat 911 calls and connect vulnerable residents to health care and substance use treatment services.
“They’re kind of getting stuck in the system,” Pierce said. “They’re going to the emergency room because something’s being missed.”
The team has already experienced success by meeting community members’ needs at home rather than in the hospital and will soon expand the program in March. In the first two weeks, Pierce said she had received more than 20 referrals for the pilot project.
The CORE team’s daily appointment list is based on referrals from emergency medical services crew members who have become too familiar with frequent 911 callers, some who ring as often as three times a month, Pierce said. The callers often have complex needs. Instead of a bed in the emergency room, these residents often need extra help scheduling or making it to medical appointments or accessing a higher level of care, such as assisted living. Others, while not in immediate crisis, need additional mental health resources.
Many people call 911 because they don’t know what to do and it’s their “last line of defense,” said Joshua Browning, Pierce’s paramedic partner on the CORE team.
On Wednesday morning, Browning spent four hours sitting in a primary care office with a resident who had been bouncing in and out of emergency rooms and would need hernia surgery. By 2 p.m., the pair drove to their third home visit, an older adult suffering from chronic chest pains.
Pilot program relaunched
Over the past decade, 911 call volumes in Anchorage have climbed.
This includes a number of incidents paramedics and firefighters felt they were not the right resource or lacked proper training for, said Michael Riley, one of the original founders of CORE. Yet, for many years, no other options were available, he said.
The municipality originally launched the CORE program in 2018 to fill in gaps that had become visible when some residents, unsure of how to utilize the medical system, called 911 for transport and not necessarily an emergency, Riley said. The department also received thousands of calls for mental health crises, prompting the creation of the Mobile Crisis Team in 2021.
CORE dissolved in 2021 after running out of grant money, and AFD’s focus shifted to funding the Mobile Crisis Team. CORE kicked off again this month with a $175,000 grant from the state, but its absence over the past few years has been palpable, Riley said.
Non-emergency or “low acuity” calls put pressure on emergency rooms, as well as the capacity of a fire department already under strain. “Basic life support” calls between 2014 and 2024 have risen by nearly 40%, Fire Chief Douglas Schrage said during a Public Health and Safety Committee meeting in November.
Low-acuity calls make up a larger share of the overall call volume, he said, part of a trend across the country where residents choose to call 911 instead of going to a physician or a hospital themselves. Contributing factors may be that fewer people have insurance or gaps exist in the “continuums of care available in the community,” Schrage said.
Prior to existence of programs like CORE and the Mobile Crisis Team, callers had two options when ambulances and firetrucks arrived: go to the hospital or stay home. As the needs of the community changed, members of the fire department wanted to find different ways to meet them, said Pierce, who manages both of AFD’s programs. The Mobile Crisis Team, although one of the busiest rigs in the city according to Browning, was only part of the answer.
Advocating across Alaska
The CORE program is part of Alaska’s growing web of “mobile integrated health,” or MIH, programs, present in Anchorage, as well as communities such as Juneau and Ketchikan.
The programs address the gaps that occur between an emergency and subsequent follow-up with a doctor, said Juneau MIH Program Director Josh Jubb. These breaks in the system have always existed for patients but have gotten larger for a “menagerie of reasons,” from the cost of and one’s ability to obtain health insurance to mental health disorders and substance use, he said.
“There’s just a lapse, that pathway doesn’t work for many, many people,” Jubb said.
The Anchorage pilot project has provided an opportunity to “look behind the curtain” at a disjointed health care system that is often challenging for people to navigate, regardless of their age or health, Browning said.
Tuesday through Friday, Pierce’s office at the Anchorage Fire Training Center in Airport Heights is typically empty. She works out of a gray Ford Explorer, a computer balanced in her lap in between at-home visits where health care options are discussed in living rooms and at kitchen tables.
At residents’ homes, Pierce said she looks for clues that may help prevent the next 911 call.
Through the first iteration of CORE, she worked with a woman in 2020 who struggled to manage her diabetes and mental health. While she claimed to take her medications, when Pierce visited she found the woman’s blood sugar was extremely high and her medications were scattered across a cluttered house in places difficult to find.
“You could just see the struggle when we’re there in the home,” Pierce said. “Then we could advocate for her.”
In March, the CORE team will begin accepting opioid response referrals. When EMS responds to an overdose, first responders typically administer the drug naloxone, often referred to by the brand name Narcan. While it can save someone’s life, it also sends them into withdrawals.
With the new program, members of the CORE team will have the option to administer a medication called buprenorphine. It offers relief from withdrawal symptoms that increase the chances a person keeps using instead of seeking help, said Josh Engle , crisis services program manager at True North Recovery in Wasilla. It’s one of the local providers the CORE program could hand off a patient to.
“That window of opportunity you have with somebody that’s struggling with substance use is very small,” Engle said. “With this type of program, you potentially have the ability to make (it) a little bigger.”
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