I am an ex volunteer/paid firefighter and, like many things it gets in the blood. Although not active, on occasion I still look at "industry" news. Today I came across this interesting article about how a fire department is dealing with the changes in responses.
Currently approximately 60 to 80 percent of all calls to a fire department are for medical emergencies. Often these victims (approximately 40% in Mesa) don't need to be transported to a hospital, or are transported and end up waiting long hours to be seen or have problems with transportation home from the hospitial. This number will likely get higher as the population gets older and there are less fires due to improved prevention education and improved fire suppression systems. Forward looking fire departments are looking for different ways to address this situation, in part due to costs for the department. Traditional response is a large engine, possibly a squad (smaller response unit) and either a department ran or private ambulance responding to the incident. Some areas will send two fire engines because one has paramedic certified firefighters on it and the other own (which may be closer) doesn't.
Forward looking departments are changing this model. Many are training their dispatchers to ask questions to quickly ascertain if only a department ambulance and/ or 2 person squad (think of the old television show Emergency! with Squad 51) to the scene with possibly a private ambulance.
Mesa's creative solution
Calling their new unit and response model the "Transitional Response Vehicle", this unit is staffed by a captain and firefighter (both paramedics), and a physicians assistant or nurse practitioner from a participating hospital. This unit is an “"emergent care units on wheels,” capable of doing some rudimentary testing and prescribing medication right on the spot."
The unit will also do minor treatments if needed:
The advantages or such a model are huge, (Mesa Fire and Medical Department Chief) Beck said, noting that thousands of dollars and hundreds of staffing hours were saved recently when police responded to a suicidal woman who had lacerated her wrist and was bleeding.
Beck said one of Mesa’s emergent care units responded, stitched up the woman’s arm, prescribed some medication on the scene and rather than transporting the woman to the hospital, she remained in police custody and was taken to a mental health facility. And it all happened in under two hours.
By contrast Dr. Smith said under the old model, the woman would have been transported to the hospital with a police escort and remain under police watch for three to five days while a mental health facility was found. And, the City of Mesa would have been on the hook for the woman’s care for the duration at a significant cost, Smith said.
(Bold emphasis mine on the new name of the department).
The response unit operates under the dictate of "when in doubt transport", but the chief and local hospitals are hoping for a 40% reduction in emergency room use. This will be an improvement considering how many people use the emergency room as an urgent care (even with ACA).
Chief Beck also outlined some other advantages this unit provides:
Beck said the way to make this model work is to collect lots and lots of data to show the savings and to prove better outcomes for the patients. Hospital will help underwrite and pay for the services provided by the fire department under this model because they see the huge savings.
Dr. Gary A. Smith, Mesa’s medical director said hospitals will reimburse costs for follow up care in the home because it helps keep people out of the hospital because they’re not taking their medication, or not following orders.
Beck added that the service fire departments provide can also help prevent injury and illness. Firefighters for years have been in the prevention business and it just makes sense to expand that service into helping prevent hospitalization and medical emergencies.
Fire departments have been the place to go when private citizens need help for hundreds of years. With the changing demographics of our society, it is only that they alter their mission in order to survive in the new economy. This expansion will provide more reasons to prevent "cost savings" politicians from attempting to axe or "privatize" a department.