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Quick Look: Dallas Fire-Rescue launches mobile integrated health care program

Dallas Fire-Rescue and area hospitals are also discussing plans to expand the program to include additional in-home services

Updated February 2015

Dallas Fire-Rescue is launching a new program that will initially target frequent 911 callers by offering home visits from firefighter-paramedics, who will conduct in-depth evaluations and offer assistance accessing a variety of health and social services. Calling it the Mobile Community Healthcare Program, Dallas Fire-Rescue and area hospitals are also discussing plans to expand the program to include additional in-home services, such as post-hospital discharge follow-up for trauma patients or those with heart failure and asthma.

“I’m really fired up for the potential of what this can do,” says Assistant Chief Norman Seals, who oversees the department’s EMS bureau.

Dallas Fire-Rescue—one of the nation’s first large metropolitan fire departments to embrace the mobile integrated healthcare concept—has the support of the Dallas City Council, which allocated about $600,000 for fiscal 2013–2014 to cover salaries of five firefighter-paramedics to take on the mobile healthcare role. The budget will also cover their equipment, including five SUVs to traverse the 380-square-mile coverage area.

The firefighter-paramedics selected for the new role were carefully selected for their “patient advocate mindset,” Seals says. They participated in three weeks of mobile healthcare training at Fort Worth-based MedStar Mobile HealthCare, an industry leader in the new delivery strategy.

Back in Dallas, they received additional training from community partners in patient navigation skills and the types of social and mental health services available. “If we go into a patient’s home, we’ll do a medical assessment. We might also see that they don’t have enough food, or they need some basic repairs, or they need to have someone visit with them because they’re lonely or depressed, or they have other mental health issues,” Seals says. “We can bring appropriate community resources to bear to help that patient’s full life situation. As an EMS agency, we’re the hub to help that patient to access those resources.”

In January, firefighter-paramedics received an additional three weeks of training at a long-term care clinic at Parkland Health & Hospital System, Dallas’s county hospital, to learn more about chronic conditions such as heart failure, COPD and end-stage renal disease. “We wanted to get them more education on the full continuum of healthcare,” Seals says.

The initial phase of the program, launched in early February, will target 254 frequent users which an analysis of billing records shows received services (either transport or treat no transport) at least 12 times in fiscal 2012–13. Frequent users who agree to enroll in the Mobile Community Healthcare Program will receive a home visit, medication review and help assessing mental health, healthcare and social services resources.

“When the chief put me over EMS … I wanted to go out and see what was happening in the industry as a whole, outside of our borders, in fire-based EMS but also in the rest of the ambulance industry,” Seals says. “I read everything I could get my hands on. I kept hearing about this concept of mobile healthcare and saw a great deal of value in it.”

New York Times story sheds unwanted attention on EMS

In a story that hurts in more ways than one, a Dec. 4, 2013, New York Times story told the tale of a 23-year-old La Jolla, Calif., woman with three broken teeth who was transported by ambulance to the emergency department and received a bill for $1,772. “We only drove 9 miles and it was a non-life-threatening injury,” she told the newspaper. “I needed absolutely no emergency treatment.”

The story—“Think the E.R. is Expensive? Look at How Much It Costs to Get There”—went on to detail the fragmentation of the EMS industry, the rising costs to Medicare of ambulance transport ($6 billion, up from $2 billion in 2002), and a recent Office of the Inspector General report noting that Medicare ambulance services were “vulnerable to abuse and fraud.”

What the story didn’t mention is the fact that ambulance transports account for about 1% of the total Medicare budget; nor did the reporter talk to anyone who works for an ambulance company. Yet the story garnered 661 comments, many of them complaining about ambulance bills.

Read the story, if you can bear it, at tinyurl.com/m9ws5vd. It’s an interesting window into how the public views EMS and may be helpful to you when you’re educating public officials and your community about what EMS has to offer.

REMSA'S Nurse Help Line goes live

The Regional Emergency Medical Services Authority (REMSA) nurse help line recently started taking callers. Staffed 24/7 by six R.N.s and one nurse manager, the help line, located in the REMSA medical communications center, is funded by a Centers for Medicare & Medicaid (CMS) Innovation Center grant.

REMSA, based in Reno, Nev., was one of three agencies nationwide awarded a combined $13.3 million in grants to fund innovative programs in community paramedicine. Other recipients were the Upper San Juan Health Service District in Pagosa Springs, Colo., and the Prosser Public Hospital District, which serves a rural area in Washington state.

A trial run of the nurse’s line started in September 2013. Community outreach and an advertising campaign to get the word out—including radio, TV, internet ads and direct mail—began Oct. 30. “The volume is continuing to grow,” says Brenda Stafford, REMSA’s Healthcare Innovation Award project director, who declined to give specifics.

Members of the community can dial the nurse’s line directly; some non-urgent 911 calls (a subset of Omega calls) will also be transferred to a nurse. Both dispatchers and nurses are EMD- (Emergency Medical Dispatcher) certified by the International Academies of Emergency Dispatch (IAED); the communications center also uses the Pro-QA software to triage calls, while nurses have additional training in the IAED’s Emergency Communication Nurse System. A few calls have been transferred from the nurses to 911, Stafford says.

REMSA’s nurses will do a patient assessment, offer advice on how soon to seek care and the appropriate level of care, and assist patients in identifying and arranging care, including accessing community resources such as primary care doctors, clinics, medical health services or public assistance programs.

Read more about the REMSA nurse help line at remsa-cf.com/. For more about the IAED’s Emergency Communication Nurse System, go here

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