Calif. county explores new ways to reduce EMS response times and non-emergency calls
Kern EMS Program Manager Jeff Fariss said the county and Hall Ambulance will implement several changes such as call sorting
By John Donegan
The Bakersfield Californian
KERN COUNTY, Calif. —The look and shape of calling 911 in Kern County is changing, and officials say it’s for the better.
On Tuesday, the county Board of Supervisors received the mandatory 2022 Ground Ambulance Report, which maps out the health of the county’s ambulance services, measured in response times, customer anecdotes about service and ambulance offload times, among other metrics.
The report cited 20,000 more 911 calls in 2022 and a continued staffing shortage. Despite the excess in emergency dials, the amount of calls that resulted in a trip to the hospital dropped by 10%. Officials explain this is an unfortunate trend in which false-alarm calls are made by patients that put paramedic crews out of action for hours.
Kern EMS Program Manager Jeff Fariss said that in his time he’s seen callouts by someone suffering from “athlete’s foot, or toe pain.” Other common examples can include a patient who forgot to take medication or who has an empty inhaler.
“There are many times a day when people call 911 for very minor injuries or illnesses that could and should be treated by calling their personal physician, insurance nurse line or visiting an urgent care,” said Mark Corum, a spokesman for Hall Ambulance. “People call 911 because they think it will get them seen more quickly. But when we get to the hospital, the hospital sends them to the waiting room for a very long wait.”
These types of calls waste valuable time and resources, Fariss continued, and demoralize paramedic crews who crisscross the county answering frivolous calls. The result is that it still takes too long for patients with real emergencies to get into the hospital.
In response, Hall Ambulance — which provides services to 96% of Kern residents — and county health officials are implementing a number of new policies and programs to weed out nonemergency calls and improve response times.
The review is separate from the price increases the county approved in April for ambulance service. That process raised new baseline rates for Hall Ambulance’s Basic Life Support — operated by a paramedic instead of an EMT — by $497.63 to $2,912.12. Advanced Life Support services were increased by $561.47 to reach $3,285.76.
“Everybody’s bill will change,” Kern Public Health Services Director Brynn Carrigan said at the time. “Depending on what the payer source is, they’ll either pay part of it, all of it (or) none of it. But everybody that uses the ambulance will see an increase on their bill.”
On Monday, paramedic crews across Kern were briefed — and then quizzed — on a Direct to Triage system, which sorts incoming patients based on their “clinical severity” instead of sending them all to the emergency room, which can lead to time-consuming offload times.
It’s a common sorting system used in various forms across the country, as many hospitals facing similar staffing shortages have limited resources to handle patients.
“For the most part, it’s all positive,” Fariss said of the response. “Nobody likes change — change is always scary because it represents the unknown. But for the most part, it’s all positive.”
Fariss explained that this is one of the largest policy overhauls in Kern’s history, and it only starts at the new triage system. The county also introduced this year a tele911 system — the first in the state — where EMS crews at the scene connect physicians to people over video call, where those who call 911 can be diagnosed quicker. Since its start in July 2022, officials said they’ve tele-called 798 patients. Only 211, or 26%, needed an ambulance.
“Often, they’re people who cannot get an appointment to see their doctor, so they call 911,” Corum said.
Since February, Hall Ambulance has been five cars deep into its new Fly Car program, whereby paramedics, who ride separately from the ambulance, only stay with the patient if necessary. Otherwise, they give instructions to the EMTs on hand and go to the next call.
Two trials in November and December proved a success, officials said, resulting in a 64% faster turnaround rate, a difference of 46 minutes.
“If the patient does not need a paramedic, they can leave the scene and go back into service that much quicker,” Corum said. “We have several paramedics who now work the (Fly Car Program) as their regular shift by choice.”
The county is also tracking people who misuse the 911 system and allows officers to send them three cease-and-desist orders before putting them on a no-ambulance list. The county has a three-strikes rule that, following the final strike, bans that “user” from calling an ambulance.
Dozens of cease-and-desist orders have been filed this year, Fariss said. EMS staff decide once they arrive whether a patient is allowed transport.
“We will still always respond to a 911 call,” Fariss said. “It would just fall on the provider to decide, not the patient.”