911 non-emergencies a growing problem nationwide
By Karen Auge
The Denver Post
DENVER — The 911 call came in as "ankle pain."
So Denver paramedics headed out onto frozen streets and brought Debra Neaves to the hospital.
With that trip, those emergency providers became makeshift patches in the frayed health care safety net, providing services they were never intended to provide — at enormous cost to health systems, taxpayers and everybody with health insurance.
Sitting in a wheelchair inside Denver Health Medical Center's emergency room, Neaves teared up as she recited a list of the health problems that tumble through her life: diabetes, sleep apnea, high cholesterol, a crushed ankle. A doctor visit was weeks away, and the pain was worse every day. On this morning, "I stepped out of bed, and it was just so bad, I couldn't walk."
Neaves is on Medicaid, the taxpayer-funded medical coverage that in Colorado assists poor children and disabled adults. The program provides transportation, but Neaves said, "You need three days' notice for a taxi to take you to a doctor."
So she called 911.
Paramedics and emergency medical technicians here and around the country say a substantial number of emergency calls aren't emergencies at all but medical situations best handled in a doctor's office.
"It's a problem, and it's getting worse," said Jerry Johnston, who just ended his term as president of the National Association of Emergency Medical Technicians and is an Iowa EMT.
It's costly — an average ambulance call is $300 to $400 — and it's potentially dangerous, Johnston said.
"It becomes frustrating because we could be tied up taking someone to the emergency department who, A, doesn't need to go to the hospital and, B, doesn't need an ambulance," and in the meantime, there is a pileup on a highway and no available paramedics.
He's not talking about the goofball 911 calls that occasionally make news: the woman who needs advice on how to cook her turkey; the guy who wants to know whether it will snow tomorrow. Those calls may be irritating, but they are easily dispensed with.
The non-emergency medical calls are another matter. Some of these calls are from people gaming the system, such as a woman well-known to Fort Worth, Texas, EMTs, who gets drunk every Friday and then calls 911 and asks to be taken to the hospital a few yards from her apartment.
Then there are those who are just plain impatient, said Dr. David Ross, medical director of Colorado Springs AMR, which is that city's ambulance provider. "There are a small percentage of patients who will use the ambulance systems to try and get bumped up on the be-seen list" in the emergency room, Ross said.
But many non-emergency calls are made out of frustration, said Dr. Christopher Colwell, interim director of emergency medicine at Denver Health and medical director of the paramedic division. "They have nowhere else to go," he said. "They deal and deal and deal until it reaches a stage where they can't deal anymore, and they can't go anywhere else."
Duty to respond
Even if they could see a doctor, the chronically ill and the poor often have no way to get there, Colwell said. "It often boils down to, do they need treatment or do they need a ride?"
Often, it's a ride they cannot pay for. Denver Health gets paid for about 28 percent of ambulance rides, which is one reason the paramedic division lost $1.6 million last year.
There are no solid numbers on non-emergency medical calls to 911, mainly because nobody tracks them.
Anecdotally, emergency providers agree that non-emergencies constitute a substantial amount of an EMT's or paramedic's workday.
One gauge is that of the 84,837 emergency calls to Denver paramedics last year, about 30 percent didn't result in anyone being taken to a hospital.
In Colorado Springs, it is roughly 28 percent, Ross said.
There are a couple of reasons why an ambulance will go out and not come back to a hospital with a patient, said Dee Martinez, Denver Health spokeswoman.
The first is that people refuse ambulance transportation.
"The other is that we get on a scene and determine there is no need to transport," she said.
Sometimes, that might seem obvious from the moment a dispatcher picks up the call. But emergency systems have a duty to respond, said Johnston. "If you're a system that responds to 911 calls, you must respond to every call."
That's why the woman in Fort Worth is so well-known to EMTs there.
And she is one reason emergency providers in that city devised a novel program that they say saves money and better serves those who need care.
"We identified our 21 most frequent fliers and then looked to see whether there is anything in common among them," said Matt Zavadsky, assistant director of operations for Fort Worth's paramedics.
Turned out, there was.
Many had chronic health problems, others had mental-health problems and some just wanted someone to talk to.
So, the city of about 720,000 created "community health paramedics" who are specially trained to respond to non-
emergency medical calls and regularly visit patients to check blood sugar, blood pressure, etc.
"We wanted to make our frequent fliers healthier and decompress the system to make more ambulances available for other types of calls," Zavadsky said.
The results exceeded everybody's expectations, he said.
"We reduced 911 calls by 52 percent and saved our system $560,000 in the first six months," he said.
Paramedics in western Eagle County are working on a similar program to address unique health care problems facing people in rural areas.
Christopher Montera, chief of western Eagle County's ambulance district, and Anne Robinson of the county health department want to deliver health care to people in their homes, through something they are calling the community paramedic pilot program.
As Montera and Robinson envision it, paramedics would visit patients regularly after they've been released from the hospital. The result, they hope, would be fewer people needing to go back to the hospital.
The program could save everyone - hospitals, taxpayers, insurance companies — in the long run, he said.
A common thread ties what Montera is trying to accomplish to the issue that drives overuse of 911 in cities: access to health care.
"In health care reform, we need to have this discussion, and we're not," Johnston said.
In the meantime, people with upset stomachs, low blood sugar and nausea will continue calling 911. And paramedics will respond.
"We tend to be the safety net within the safety net," said James Azuero, assistant communications chief for Denver's paramedic division. "If you call 911, someone will answer, and if you want, someone will show up," he said.
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