Calif. county turns to health care on wheels to alleviate ER crowding
The goal behind the motion is to find a way to alleviate crowded emergency rooms, while also steering patients with mental health needs into more focused care
By Susan Abram
LOS ANGELES — Health care units on wheels may become more common across Los Angeles County if officials can prove they are better for patients, help alleviate crowded emergency departments, and are more cost-effective, according to a motion passed Tuesday by the Board of Supervisors.
The goal behind the motion, introduced by Supervisor Kathryn Barger, is to find a way to alleviate crowded emergency rooms, while also steering patients with mental health needs into more focused care. Her colleagues agreed, allowing the county staff to look into if mobile health units can be implemented.
“Our safety net has become increasingly stretched,” Barger wrote in her motion. “Growths in paramedic units and Emergency Department beds have not been able to keep up with the rising demand for their services. Our paramedic units are ever busier, and our Emergency Departments function at or above their capacity on most days, as evidenced by ambulances forced to wait to offload their patients. Our safety net is so full that it lacks surge capacity, and even a predictable rise in volume from a flu season coming a month early is enough to imperil our system and community health.”
Tuesday’s vote followed a series of discussions by the Board this month on how to expand the role of paramedics to take homeless people with mental health care needs to urgent care centers that can provide specific care, instead of emergency rooms.
Los Angeles County fire Chief Deputy David Richardson Jr., who oversees emergency operations, told the board at the Jan. 9 weekly public meeting that the volume of 911 calls was up significantly and the department expected to field more than 400,000 calls for emergency medical services in 2018.
“The 911 system becomes the default healthcare provider,” Richardson said during the meeting.
Dr. Clayton Kazan, the fire department’s medical director, said changes are needed to relieve pressure on the EMS system.
“We need to look at changing the whole model of healthcare delivery,” Kazan told the board.
Kazan said a “urgent care (center ) on wheels,” is a concept the county is testing in the Antelope Valley.
The Board noted the Los Angeles Fire Department was able to establish a mobile unit to take people to a Sobering Center in downtown LA’s Skid Row area.
But in general, paramedics don’t currently have the freedom to drop someone who is drunk or high at a sobering center. Once they respond to a medical emergency, they are required by state law to head to an emergency room, sometimes waiting for hours before they can get back to work answering calls.
Kazan also said earlier this month that emergency rooms aren’t well equipped to deal with substance abuse, and that personnel can offer little beyond stabilizing the patient and then sending them back out on the street to repeat the process.
“We have folks that come in and out of the emergency department probably every other day,” Kazan told the Board.
Last week, the voted unanimously to support state Assembly Bill 1795, which would expand the role of paramedics to allow them to take patients to sobering centers and mental health urgent care units.
A report on the feasibility of mobile health units is due back to the Board in 90 days.
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