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Emerging models for serving growing population of low-acuity patients

EMS medical directors discuss integrated health care programs to serve frequent 911 callers at Gathering of Eagles


The Houston ETHAN project uses telemedicine to connect paramedics with low-acuity patients to emergency physicians.

Photo by Greg Friese

DALLAS — New tactics, to serve a growing population of patients with non-emergency health care needs, were discussed by medical directors at the 2016 Gathering of Eagles XVIII EMS State of the Science program.

David Pearse, MD, medical director for the city of Houston, opened the discussion with a description of a telemedicine program to redirect patients to appropriate resources for unscheduled health care. In its first year, Houston’s ETHAN program has served 3,473 patients. The ETHAN physician and EMS crew agreed the patient did not need transport to the emergency department 82 percent of the time.

Nursing care, integrated into the Los Angles Fire 911 system, was described by Mark Eckstein, MD, medical director for the city of Los Angeles and Fionna Moore, MD medical director and CEO for London Ambulance Service. The top 40 EMS users in Los Angeles accounted for more than 2,000 EMS incidents in 2015. Eckstein described a 12-month pilot project using a nurse practitioner unit for those frequent and low-acuity callers.

Moore described a UK NHS program to improve care of frail, geriatric fall patients and to manage patients at home with the goals of saving money and reducing hospital admissions. Patients accessed a nurse and a LAS paramedic response to recent fall through a self-referral community hub, a post-emergency department visit, and 999 emergency call.

Art Yancey, MD, Grady EMS (Atlanta) medical director described three types of patients — frequent callers, real-time 911 callers with low-acuity problems, and discharged patients at risk of unscheduled return to the hospital within 30 days — in an integrated health care project. In its first months, the program is showing some early successes connecting frequent callers to appropriate health care and social service resources.

Memorable quotes on the emerging programs

“Paramedics and firefighters are doing a really good job screening patients (for ETHAN).”
David Pearse, MD

“A lot of what we do is ‘MS’ which is medical services and we also do a lot of public health.”
Marc Eckstein, MD

“In addition to saving money the program was very popular with patients.”
Fiona Moore, MD

Key takeaways on interventions for low-acuity patient populations
Here are key takeaways for medical directors and field providers from the three presentations.

  • The early adopter paramedics in the ETHAN project have been crucial in championing the program to increase utilization of the telemedicine physician consultation by other paramedics.
  • ER-level care to treat low-acuity patients can be brought to the field using a mid-level provider like a nurse practitioner.
  • Frequent users are likely to have a constellation of environmental, physiological, psychological and substance abuse problems. A single intervention isn’t going to solve the needs of all users.

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Greg Friese, MS, NRP, is the Lexipol Editorial Director, leading the efforts of the editorial team on Police1, FireRescue1, Corrections1 and EMS1. Greg served as the EMS1 editor-in-chief for five years. He has a bachelor’s degree from the University of Wisconsin-Madison and a master’s degree from the University of Idaho. He is an educator, author, national registry paramedic since 2005, and a long-distance runner. Greg was a 2010 recipient of the EMS 10 Award for innovation. He is also a three-time Jesse H. Neal award winner, the most prestigious award in specialized journalism, and the 2018 and 2020 Eddie Award winner for best Column/Blog. Connect with Greg on LinkedIn.