Outreach program to help 911 'frequent flyers'

Community Paramedicine will send paramedics to visit frequent 911 callers to assess why they call so often


By Meghan Hurley
The Ottawa Citizen

OTTAWA, Canada — An Ottawa paramedic sits in a 65-year-old schizophrenic man’s almost bare living room, trying to convince him to bathe.

The man, a Hungarian, is afraid to get into his tub and has too much pride to accept the help of a personal care worker.

In the past, he would have turned to the one place he knew he would find help. He’d call 911.

"He has hearing problems, language problems, mental illness," says paramedic Tracey Suprunchuk. "He’s really falling through the cracks, but when the medics go in there, we’re used to just emergencies — we only have so much time to deal with someone."

So the Ottawa Paramedic Service came up with a solution and have launched a $1.3-million, provincially funded pilot project aimed at reducing paramedic costs and easing the strain on the 911 system. If successful, the program will also reduce emergency room wait times and help connect patients with the social services they need, reducing their dependency on 911.

Of the nearly 117,000 calls to 911 that Ottawa paramedics handled last year, 2,500 came from just 176 frequent callers, vulnerable people, such as the Hungarian man, who call 911 for non-emergency services.

The program, which began Sept. 4, is expected to cut that number in half. That will save the paramedic service $400,000 a year, says Jocelyne Marciano, a paramedic commander in charge of the initiative.

"Of course, it’s like when you go on a diet. The first 20 pounds are easy to lose, but it’s the last 10 pounds," Marciano says. "We anticipate that at the beginning we’ll see a lot of positive outcome, but it’s in the last stretch that it will be hard to reach it."

The Ottawa Paramedic Service Community Paramedicine program consists of three paramedics who spend time in the homes of Ottawa’s frequent 911 callers to connect them with social services.

"Community paramedicine is more progressive and more proactive," Marciano says. "We want to assist the people in staying at home."

The paramedics first assess the frequent caller’s medical needs, identify any other concerns and connect them with the appropriate services.

The only things the 65-year-old schizophrenic man had in his home to eat when Suprunchuk visited was a loaf of bread and two cans of food. He doesn’t use his oven because he can’t afford the hydro. And he doesn’t have the money to take the bus to the food bank, forcing him to balance groceries on his bike all year round.

The man also has a hearing problem, sleeps on a mattress on the floor and needs help with his language skills.

With each visit, Suprunchuk addresses more of these concerns.

"You get to go full circle with them," Suprunchuk says. "The interventions that we make on a short basis creates a huge difference in their lives. It’s pretty powerful."

It wasn’t until Suprunchuk was halfway through another home visit that she realized she knew the client, a homeless woman who frequently called 911.

Suprunchuk and her colleagues dealt with the woman many times, but she was often intoxicated and aggressive.

During the visit, the woman told Suprunchuk that she had secured an apartment, stopped drinking, started to see a counsellor and was cooking healthy meals.

"She said to me she’s no longer eating out of cans and drinking Listerine," Suprunchuk says. "That’s just really touching to see how that worked for her."

Although the woman got help before Suprunchuk went to visit her, seeing how the right social services transformed her life made the paramedic realize the new program’s potential.

Going into a client’s home to identify their needs before referring them to the appropriate social services and following up is far more effective than responding to a 911 call at their home, she says.

But the more intimate dealings with clients brings a heavier emotional impact for Suprunchuk.

"It’s a little harder to turn it off at the end of the day," she says. "Some people you go to visit, they don’t really know what we’re all about or why they were referred, but by the end of the visit they’re just hugging you and they don’t want to let go."

The Ottawa Paramedic Service began to develop the program almost two years ago. They based it on one in Fort Worth, Texas, and modified it to fit Ottawa’s needs.

Gary Wingrove, a former paramedic and chair of the International Roundtable on Community Paramedicine, says Medstar EMS in Fort Worth identified 21 people who called 911 800 times in one year.

Medstar EMS began their Community Health Program in July of 2009 for the same reason as Ottawa: to reduce the number of 911 calls and to get patients the social services they need.

Wingrove said Medstar EMS saw a 58-per-cent reduction in the 911 calls made by the 21 frequent callers after the program was launched.

Since the program’s inception, it has saved more than $7.4 million in emergency room charges and $1.6 million in paramedic charges.

Medstar EMS also discovered that the number of hours patients spent in emergency room beds was reduced by 14,334 hours.

Republished with permission from the Ottawa Citizen

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