Right Response

EMS initiative breaking down barriers to health care options

By Michael Waddell

For many people in the Mid-South with barriers to getting to the appropriate health care professionals, sometimes a 911 call has seemed like their only option. That’s all changing now thanks to a new collaborative effort between the Memphis Fire Department’s Emergency Medical Services (EMS) and local health care organizations, area hospitals, nonprofits and philanthropists.

The innovative partnership is resulting in national attention for Memphis as a trend-setter as one of the first major cities in the country to adopt similar changes.

Over the past several years, the number of EMS calls received by the Memphis Fire Department has increased significantly.

“A couple of years ago the Memphis Fire Department determined that the non-emergency calls were really bogging down the system,” said Justin Entzminger, director of Innovate Memphis. “Last year alone, out of approximately 130,000 ambulance runs, about 25,000 or more were non-emergencies.”

John David Williamson, left, and Rebecca Luckey take a call at a local child care facility. The Emergency Medical Services team cuts down ambulance use by responding to non-emergency calls. EMS has two Rapid Assessment Decision and Redirection (RADAR) cars that respond to calls in the area.  (Daily News/Houston Cofield)

So Innovate Memphis partnered with Memphis Fire and EMS to develop solutions. An IBM Smarter Cities Challenge grant for $500,000 of in-kind technical assistance resulted in a deep study of the issues and recommendations.

“From there, the EMS department has led with piloting the recommendations that they feel are the best and most impactful for Memphis, and we provide support,” Entzminger said.

A result was the formation of a steering committee chaired by Memphis Mayor Jim Strickland and Memphis Fire director Gina Sweat that includes CEOs from the major local hospital systems, major nonprofit primary care groups, insurers, the public health department and philanthropic organizations.

“Now since we’re working as a group, we can all operate with the same goal towards the same mission: trying to improve public health care for the entire area,” said EMS division chief Andrew Hart.

One of the first things realized was there was no one quick fix. The first pilot program addresses the “high utilizer” group, identified as people who call 911 for EMS services more than four times per week.

“We identified more than 350 people who were over-utilizing the system,” Sweat said. “Many of them had a variety of health care needs that were not being met by just a trip to the emergency room, and that was creating a revolving-door effect.”

A second pilot program involves placing nurses into the dispatch system. Five nurses have been hired and are in the process of being training right now, and the pilot starts next month.

“They will be able to further triage the calls to gain a more in-depth medical history for that person while freeing up our operators to handle more 911 calls as they come in so that we can continue to answer them in a timely fashion,” Sweat said.

Rebecca Luckey, left, and John David Williamson process paperwork after responding to a non-emergency call in South Memphis. The two work for Emergency Medical Services to help cut down on ambulance use by responding to “alpha” calls. (Daily News/Houston Cofield)

Dispatchers, who are all already certified through the Emergency Medical Dispatch system, will receive additional training for working with the nurses.

Adding to the problems under the previous system, in Memphis last year just 35 ambulances responded to the 130,000 calls, resulting sometimes in a shortage for the people that needed them most. Adding more ambulances to combat the issue was not a viable solution.

“Continually throwing money at a problem that has never seemed to fix it was no longer a good answer,” Sweat said. “If we can trim the non-emergency calls off the system, we have enough ambulances to service the city.”

A variety of Memphis-area health care providers and nonprofits are assisting with financial and staffing support for the new collaborative, including Baptist Memorial Health Care Corp., Christ Community Healthcare, Innovate Memphis, Methodist Le Bonheur Healthcare, Regional One Health, Resurrection Health, Saint Francis Hospital and others.

Dr. Steven Euler from Resurrection Health directs the physician support for the Rapid Assessment Decision and Redirection (RADAR) project and is one of the physicians who rides out with paramedics on non-emergency calls. Once on-site, they conduct a medical screening to determine the appropriate care needed.

“If it truly isn’t an emergency, we can get them plugged in with their primary care doctor, or if they don’t have one we can help get them established with a primary care provider who can then monitor their long-term care,” he said.

Resurrection Health has three clinics located around the city in medically underserved areas, including in Whitehaven, Frayser and at American Way and Getwell.

The RADAR teams respond to nearly 10 calls daily, and since the pilot program launched in April they have provided non-emergency support to more than 500 local residents and have been able to redirect 66 percent of those calls.

Examples of non-emergency calls that EMS regularly receives includes sore throats, stomach aches, rashes, joint pains, tooth aches, and even simply the need to get medications refilled.

Providing transportation to and from doctor appointments is also a primary goal of the new collaborative.

“Often times people are calling 911 because they don’t have a way to get to their doctor’s office, and they know just based on prior experience that if they call 911 an ambulance will come and take them to the emergency room where they can get treated by a provider,” Euler said.

The doctors are riding along now as part of the pilot’s proof of concept, but the ultimate goal will be a telemedicine piece where the doctors will be available remotely through a central base.

Liability risks are always a concern given the nature of working with people with medical conditions. However, the EMD system used in Memphis is internationally accredited and has been operating since the 1970s, with years of research to back it up.

“So if the dispatchers say a call is non-emergent, then 99.99 percent of the time that person could sit home for 24 hours and have no adverse impact,” Hart said. “That’s why we have doctors riding along now instead of going straight into the telemedicine piece.

“We’re being very conservative with these changes because our first priority is always protecting the safety of our citizens.”