By Kim Hilsenbeck.
Emergency Medical Service (EMS) departments usually stand by and wait to help people who call 911. But repeat calls from the same patients prompted fire and EMS departments across the county to develop a new way of thinking about 911 service.
Buda Fire Department’s Assistant Chief Gary Langshaw discussed a relatively new concept, called a Community Outreach Program, where EMS reaches out to vulnerable populations, particularly the elderly and those with diabetes, to prevent problems and injuries and reduce the need to call 911 frequently.
Langshaw, who has been a firefighter and now an administrator for 20 years, estimated about 25 percent of medical emergency calls in Emergency Services District (ESD) 8 and ESD 2, served by the Buda Fire Department and EMS, do not require transport to a hospital. Many of those calls are from “frequent flyers” – individuals who routinely call 911 for the same issues.
Examples include persons with hypertension or diabetic patients who experience symptoms of low blood sugar, such as being disoriented and light-headed.
When diabetic patients call 911, Langshaw said his department doesn’t necessarily transport them to the hospital.
“We treat and release on scene and don’t transport to the hospital,” he said. “We get their blood sugar back up.”
But when those same patients call multiple times for the same thing, Langshaw said EMS may take them to hospital.
“Something is going on, either they don’t know how to take the medicine, or it’s not working properly,” he said.
Overall, the concept of healthcare and how EMS departments operate is changing, particularly under the new Affordable Care Act (ACA), Langshaw said.
How EMS services will operate in the future was the topic of “Answering the call for change,” an article in the magazine “Fire Fighter Quarterly.” The story author also acknowledged that the ACA is causing fire departments to change how they think about and deliver out-of-hospital care. At the same time, they must find ways to remain economically viable.
The concept of community outreach – in the magazine story referred to as Community Paramedicine – could change existing EMS systems by coordinating with other health care providers. For example, medics may operate a smaller paramedic vehicle that could transport patients to primary care providers, clinics and mental health facilities directly instead of only being able to take them to a hospital.
Dr. Rhett Reed, director of emergency service at Seton Medical Center Hays, agreed. He said the model for community paramedicine, while not quite up and running yet, may cause the current healthcare system to look quite different within 10-20 years.
The ACA law imposes penalties on hospitals for repeat patient visits within 30 days of a discharge. So hospitals are looking for community partners to avoid those repeats – and the penalties.
Buda Fire Department is setting the stage locally.
“We’re not there yet,” Langshaw said, regarding transporting patients to doctors directly. “That is the goal.”
One program within Buda’s community outreach model is called File of Life.
Langshaw said File of Life educates paramedics about certain patients who previously called 911.
“We fill out paperwork on the patient’s previous issues, medications and medical history,” he said. “We put that on the fridge or somewhere like a bulletin board.”
They also put a sticker in a front window with some very basic information.
Then when EMS arrive on scene in the future, particularly if the patient is alone and/or incoherent, paramedics identify the patient as having a file. This method of community paramedicine can save time and lives, Langshaw said.
But as with most everything related to healthcare, funding is an issue. The department has about $5,000 to spend on outreach.
How much would Langshaw like to have for the program?
“My ideal budget would be at least $100,000,” he said.
