New and Nontraditional Partners in Care

Policy: Many people call 9-1-1 with problems that are not medical or are beyond the capability of EMS to solve.

Strategy: Connecting callers to appropriate social services and other assistance, even outside the medical realm, can help meet their needs and stop or reduce their use of 9-1-1.

Vision: Reduced inappropriate use of 9-1-1 by citizens who can access other sources of assistance.

Let’s face it: Many of the people who call you need more help than you can provide. And it’s not just medical help. Some have dire psychological and behavioral problems; others abuse drugs or drink; some have practical needs they can’t get met any other way than by calling 9-1-1, however ill-suited it may be.

While it transcends the strict practice of medicine, there can be value for EMS systems in connecting such callers to resources that can better help them. By linking folks to partners from the social services and other outside realms, we can help provide lasting solutions to their nonemergency needs, thus preventing future 9-1-1 calls and hospital visits.

It’s not a new idea. Busy urban departments have employed such strategies for years to redirect heavy users who lack pressing EMS problems.

“I feel it’s worked for us,” says David Persse, MD, medical director for the Houston Fire Department, which initiated such a program more than five years ago. “That’s not because we’ve seen a decrease in our overall call volume; the denominator is just too big for that. I think it’s worked because I’ve actually had fire captains come to me and say, ‘Hey, we’re not hearing anymore from this guy we used to hear from all the time. Whatever you did worked; thank you very much.’ I think that’s about the best proof you’re going to get.”

Care Houston

Houston’s program, Care Houston, debuted citywide in 2007 after a successful trial in a neighborhood plagued by nonemergency calls. Now when the FD identifies a caller meeting program criteria (i.e., more than five calls in 90 days), it forwards their information to the city’s Health and Human Services Department. A health department staffer contacts them, and a representative visits their home to assess their needs and develop a service plan, with appropriate medical and social references.

Those references can include basics such as transportation services and lift assistance, but also extend to things like utility help and food sources.

“Every case is unique,” says Persse, also DHHS’ top public-health doc. “The Care Houston folks get pretty heavily involved with people to sort out what their issues are, and it’s everything you would imagine, from ‘I just don’t have transportation’ to ‘You mean I’m not supposed to call 9-1-1 for this?’”

Beyond medical matters, those transportation issues comprise some of Care Houston clients’ biggest needs.

“Some people just don’t have any way to get to their medical appointments,” says Algia Hickenbotham, who heads the program for the city DHHS. “Or maybe their wheelchair is just broken and they can’t get around their home. That may not be an emergency that requires a ride in an ambulance to a hospital, but it is an emergency for them.”

For folks who just need rides, Care Houston can provide help like cab vouchers or bus passes. It can refer people to METROLift, a public transit option for the elderly and disabled, or to private ambulance services. It also partners with local clinics and health centers to make appointments and get people to them. EMS providers can also arrange taxi transport directly for certain callers.

Beyond transportation, Care Houston connects clients to programs that can help with utilities or rent, or even to assisted-living arrangements if they can no longer function on their own. It can even help folks address root problems like obesity through nutritional programs.

And it’s been successful at reducing its callers’ burden on the 9-1-1 system: About 70% of them stop calling altogether after their targeted intervention, and others call less frequently.

Match Them Up

Even without a supportive local health department that can team with you, smaller EMS agencies can work directly to accomplish the same thing. At Colorado’s Pridemark Paramedic Services, they started over a decade ago. “We began to keep track of social services as resources we could contact after we got back to our stations,” recalls Thom Dick, then the service’s quality care coordinator, who now holds the same position for Platte Valley Ambulance in the same state.

Like in Texas, Colorado callers had lots of problems that weren’t just medical: chronic CHF patients living on high-sodium canned foods, for instance, because they couldn’t get anywhere to buy fresh, or just victims of economic downturn who couldn’t afford the basics. “Since I’ve moved to Colorado,” notes Dick, “I’ve found out what an emergency it can be when there’s a blizzard outside and you don’t have heat.”

Dick’s colleague Chris Hendricks developed a tool for scoring callers’ home environments, the Physical Environment Assessment Tool (see sidebar), that agencies can use to guide interventions. They’ll also need a list of willing partners who can help meet some of the needs crews find. In Platte Valley that includes adult and child protective services, housing and rent assistance, food sources, even builders who can install a grab rail or fix a broken step.

Not only are we in EMS uniquely situated to help people in this way, Dick notes, we’re often the only ones who are: We alone are invited into people’s homes at times of vulnerability. And as other local services get cut back, we may be their only avenue for help.

In both Houston and Colorado, businesses and other entities across the community have been willing to find ways to help when providers bring them people in need.

“People tend to want to assist once they know about the program and how beneficial it is,” says Hickenbotham. “When we link with those groups, it helps their business as well. They find it rewarding and useful, because a lot of clients just don’t know about their services.”

“We’ve found there are a lot of resources out there, if you can just match them up and find out what they can offer,” says Dick. “This kind of thing is what they’re in business for; they just don’t have connections to the right people sometimes. They really seem to appreciate our bringing folks to their attention.”

Sidebar: The Physical Environment Assessment Tool (PEAT Scale)

Dwelling (select all that apply)

- Enclosed shelter         2

- Electricity                 2

- Running water            2

- Temperature safe       2

Total                       (0-8)

Cleanliness (select one)

- Immaculate               4

- Clutter                     3

- Small bio. waste         2

- Large bio. waste        1

Total                       (1-4)

Social structure (select one)

- Lives with other(s)     12

- Lives alone                 9

- Verbal abuse/neglect    6

- Physical abuse/neglect 3

Total                       (3-12)

Hazards (select one)

- None                        12

- Possible                     9

- Probable                    6

- Certain                      3

Total                        (3-12)

Scoring: Add all four

7-16    Urgent intervention

17-27  Referral assistance

28-31  Less than optimal

31-36  Healthy

Sidebar: Tips for Forging Links in Your Community

• Know your local organizations, the services they can offer and who’s eligible. Make the list before you need it. Keep it updated; there can be turnover.

• Keep persisting when soliciting help; don’t take no for an answer. Even with for-profit entities, helping those in need can be good business and good PR.

• Know what insurance will cover. Homeowners’ policies frequently cover things like hail damage, for instance, though many homeowners don’t know that.

• People’s refrigerators are good barometers of their overall health and lives. Is fresh food visible, or are things spoiled and smelly? Elderly folks’ calendars are also revealing; they should show appointments, phone numbers, etc.