‘Community Medical Technicians’ Responding to 911 Calls in King County Pilot
In Seattle–King County, calls to 911 are answered using a tiered system. Depending on the severity and urgency of the call, dispatchers traditionally have sent either paramedics or EMTs, or they could transfer calls to a nurse’s line. But Mickey Eisenberg, M.D., medical director of King County Emergency Medical Services, saw the need for a third level of response, one that would cover non-life-threatening calls that the nurse determined should be dealt with in person.
In March, fire departments in two King County communities—Woodinville Fire and Rescue in Woodinville and Eastside Fire and Rescue in Issaquah—launched a year-long pilot program in partnership with King County EMS in which a new breed of responder—community medical technicians, or CMTs—will be dispatched in non-life-threatening situations. CMTs are EMTs with additional training that allows them to do home assessments and connect patients with resources other than the emergency department, such as fall prevention programs, housing assistance, and drug and alcohol services. CMTs will travel in an SUV and carry defibrillators and other medical supplies in case the patient needs treatment on scene.
The goal of the pilot is to avoid costly and unnecessary trips to the ED and to offer patients the type of help they really need, Eisenberg says. (The pilot only involves firefighter-EMTs and not paramedics because in Seattle–King County, medics aren’t involved with lower-urgency calls. Paramedics currently respond to about 30 percent of calls in the region, according to Eisenberg.)
Years of studying dispatch records has illustrated the types of calls that rarely require transport to the ED or result in upgrades at the scene, Eisenberg says. Examples include a senior who has fallen and can’t get up but is otherwise not injured; abdominal pain that should be checked out but doesn’t have the hallmarks of an immediately life-threatening situation; an intoxicated patient; or a minor car crash.
“It makes sense to change the EMS system into a graded response, instead of a full-on response to every call where you send a fire engine with three or four guys and gals and two vehicles,” Eisenberg says. Seattle–King County already uses a taxi voucher system for patients who lack transportation but aren’t in serious distress.
Eisenberg estimates that CMTs will respond to about 1,000 calls during the pilot. During that time, his team will measure effectiveness, with an eye toward rolling it out to the rest of the county if it works. To measure performance, Eisenberg’s team will make follow-ups calls with all patients to determine outcome and whether they felt they got the care they needed. “We do believe if we can connect the person to the right agency, we will have fulfilled a major part of our mission,” he says. And yet, he adds, the fire departments he’s working with are taxpayer supported and aren’t dependent on billing for transports for revenue, so it’s possible a CMT response wouldn’t work in other communities.
More From King County: Sheriffs Get AEDs
In partnership with King County Emergency Medical Services, more than 50 King County sheriff’s cruisers will soon be equipped with automated external defibrillators. If deputies arrive first to the scene of a cardiac arrest, they can start resuscitation and defibrillation until EMS responders take over.
“Training and equipping sheriff’s deputies with external defibrillators is a great service for all residents in King County and will definitely save lives,” says Mickey Eisenberg, M.D., medical director of King County Emergency Medical Services, which is providing the training. “Rapid defibrillation can literally snatch a life from the jaws of death.”
Report Recommending Unifying Travis County Fire, EMS Stirs Controversy
Late last year, a study paid for by the Travis County Commissioners Court recommended unifying several emergency services districts outside the city of Austin, Texas, into a single, county-managed fire and rescue department. The report also said the county should consider altering the agreement between the county and the city of Austin to provide EMS, including possibly starting a county EMS service or renegotiating the agreement to give the county more control over EMS. (A commissioners court is the governing body of each of Texas’ counties, similar to a board of county commissioners.)
Currently, Austin–Travis County Emergency Medical Services serves residents of Austin and Travis County, while fire service in the county is provided by 13 independent fire districts.
Though the report was not made public, its contents were reported by the Austin American-Statesman. The conclusions immediately stoked controversy among EMS and fire employee associations and community members, according to EMS Director Ernie Rodriguez.
After the report came to light, a series of discussions with commissioners led them to decide to continue to support Austin–Travis County Emergency Medical Services. Of the annual $43 million budget, the county contributes about $11 million, according to the Austin American-Statesman, citing the report.
“When the county looked at our performance as a unified region-wide system, they decided the best thing to do was to continue to support that system, to continue the agreement with the city and to begin to address areas of weakness,” Rodriguez says.
The study noted the “high quality of care” EMS provides but said ambulance response times in the county are longer than in the city—although it does not examine why, according to the newspaper. Rodriguez says he’s working with county officials to improve the interlocal agreement to make sure the system is adequately funded, improve service and determine how best to measure performance.
As for the fire districts, “the study finds that the system needs to be united instead of having independent fire districts all over the county, all delivering different levels and quality of service,” Rodriguez says.
Unification remains under discussion, he adds. “How you unify an assortment of providers scattered throughout the county into one organization or one effort is probably the most difficult thing the study recommends we do,” he says.
“The county is keeping its eyes wide open and exploring all of its options,” Rodriguez adds. “They’ve got the different fire departments doing self assessments, figuring out what the needs are and where we have gaps in coverage.”
At least one fire chief supports unification. Jim Linardos, chief of Lake Travis Fire Rescue, told the newspaper he supports the idea of his and other emergency service districts merging. “If you were to start over today, you wouldn’t have it set up the way we have it set up,” Linardos told the newspaper.
