King County Emergency Medical Services has begun a pilot program with Eastside Fire and Rescue aimed at keeping trained emergency responders and their rigs free to help people with serious medical emergencies. That means a nonemergency call might be handled by a Community Medical Technician driving a lightly equipped Ford Escape hybrid.
When a King County resident calls 911 with a medical problem, the system quickly dispatches an aid car or a fire engine, stocked with expensive lifesaving equipment and emergency medical technicians or highly trained paramedics.
Sometimes, though, there isn’t any real medical emergency — the call is from someone who has fallen and can’t get up, someone with a drug- or alcohol-related problem, a patient who needs a new tank of oxygen or someone without insurance who needs primary-care help.
With emergency calls increasing significantly and budgets tightening, King County Emergency Medical Services has just begun a pilot program with Eastside Fire and Rescue aimed at keeping trained emergency responders and their rigs free to help people with heart attacks and other serious medical emergencies.
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If you’re in Eastside Fire and Rescue’s 190-square-mile area, and you call 911 with a problem that clearly doesn’t need emergency medical care and transport, don’t be surprised to see a lighter response: a social-services-savvy responder driving a lightly equipped Ford Escape hybrid.
“We want that fully trained, experienced crew to be available to strokes, heart attacks, allergic reactions, car accidents,” and not out of pocket because someone needs help slip-proofing their home or dealing with an inebriated relative, said Eastside’s Deputy Chief Greg Tryon.
Instead of the typical crew — three or four emergency medical technicians (EMTs) or paramedics trained in complex lifesaving techniques — the lone person in the Ford heading to a nonemergency call will be a new type of responder: the Community Medical Technician (CMT), a firefighter/EMT who has received extra training to be able to refer patients to social-service assistance and other community resources.
“We’re trying to figure out how best to meet the needs of our community,” Tryon said.
Dr. Mickey Eisenberg, medical director of King County Emergency Medical Services (EMS) of Public Health — Seattle and King County, said that while his division hasn’t tracked numbers, “it seems so obvious to us” that if a crew is responding to a nonemergency call, it’s likely to be delayed in responding to a second call.
Just about a year ago, he recalled, a South End crew tied up with a “very trivial” situation was delayed in responding to a house fire. By the time the crew got there, the whole house was in flames.
At Eastside, about 800 calls a year — about 10 percent of the total — are for situations that clearly are not emergencies, but from patients requesting assistance for minor medical conditions or situations that need social-service assistance, not medical stabilization and transport to an emergency room, Tryon said.
Eisenberg said the volume of calls to 911 in King County is increasing faster than population growth. That likely isn’t only the result of an increasing proportion of older residents, but also from a lack of access to primary-care mental-health help and cutbacks in other social-service safety-net programs.
“There is no question that services like EMS, like hospital emergency departments, serve as a community safety net,” he said. “Anybody can get help any time.”
Eastside sees that frequently, Tryon said. With the loss of insurance coverage, he said, “sometimes people resort to using 911 as the first level of care.”
A few years ago, to help address the problem, Eastside contracted with a nurse response line so it can refer patients who call with worries about minor medical issues or nonemergency medication issues.
People know they can always call the fire department for help no matter what, Tryon said.
But, he added, “We’ve got very expensive rigs, very well-trained firefighter/EMTs. We’ve created this very good, very timely emergency medical response system — that’s now being used for things it wasn’t designed for.”
The trial is funded by EMS, including the CMT, who is an added responder for Eastside for the rest of the year while the pilot program is underway.
Although EMS response is free to patients, they do get billed if the responders have to transport them somewhere, Tryon said. But they’ve never wanted to bill patients for simply calling.
“I don’t want someone not to call 911 because ‘Oh God, I’m going to get a bill,’ ” he said, when the problem could be a heart attack.
The pilot project, which started last month and will continue until the end of the year, is modeled after one in Oregon, Tryon said. An earlier, slightly different trial in Kent and South King County had good feedback from both firefighters and patients, he said.
Eisenberg, at EMS, said the first trial was very cautious, simply reducing the number of EMTs sent out when a call was deemed to be a nonemergency and studying how accurately dispatchers could identify the nonemergency calls.
“There was lots of uncharted territory,” Eisenberg said. “It took showing it was safe and effective. You’ve got to be pretty cautious when people are reporting emergencies.”
For now, Tryon said, Eastside will still dispatch aid cars from the closest fire station in the first minute after a call comes in; after the dispatcher gathers more information, the aid car may be recalled and the call turned over to the CMT unit if it’s a nonemergency. Eventually, Tryon said, they expect to be able to eliminate the first dispatch.
While everyone is cautious in this first rollout, Eisenberg predicts the new system will provide better care for county residents and use resources more efficiently. “Everybody could win in this process,” he said. “If it works, it will be obvious to everybody.”
Carol M. Ostrom: 206-464-2249 or firstname.lastname@example.org.
On Twitter @costrom.