Chronic Community Needs Continue to Increase

Fire-rescue crews of the Renton Regional Fire Authority (RRFA) in Renton, Washington were getting burned out. 

“Data should drive our needs and training, and the data is showing a sharp increase mostly with chronic community needs in the past five years,” says Chuck DeSmith, deputy chief for the RRFA EMS, Health and Safety Division.

“We have a broken health system where emergency rooms are just packed,” he adds. “They have to take people, but they're overworked and nurses are stressed because everyone's just walking in. We’re sending people there who really don’t need to go.”

DeSmith notes that in the past five years, the big three calls for service have been mental health emergencies, substance use disorder, and complications of being homeless, such as wound care, hypothermic/hyperthermic, and malnutrition.

In the past three years, his agency has noted a dramatic rise in non-accidental scenes of violence, such as gun and knife injuries, as well as assaults.

“This data prompted more training with safety, Personal Protective Equipment, police/fire interaction, gunshot wound care, and whole blood field transfusions with medics,” DeSmith says.

“Instead of adding more training for the big three needs to our EMTs, we put our efforts into our CARES team response.”

The FD Cares Unit

The Fire Department Assistance, Referrals, and Education Services (FD CARES) program is a mobile integrated health unit in which registered nurses and social workers work with firefighters and EMTs to address underlying physical and behavioral health and social needs of repeat 911 callers.

The smaller, specialized unit includes a registered nurse and social worker who address low-acuity calls for services that are nonemergent in nature and do not typically require a fire engine, aid unit, or emergency response by firefighters.

An FD CARES unit can spend more time with individual patients and can make proactive and follow-up visits to ensure long-term successful patient outcomes.

The branding on the truck is different, as are the uniforms. The FD CARES unit is a red pickup truck that has different branding and carries fall-prevention equipment and lift devices. The crew wears different uniforms. It is dispatched to a scene when someone calls 911.

The dispatcher utilizes criteria-based guidelines to treat it as a non-emergency call, although sometimes it does result in transport to ER. The FD CARES team stays on site as long as needed to determine the type of help needed and provides follow-up to ensure the patient’s needs were met.

FD CARES is supported by the Washington State Nurses Association with work scope oversight from the UW Valley Medical emergency department. Crews have learned firefighter lingo and practices in order to work in sync with them. As part of the fire department, the FD CARES crew members also have become IAFF members.

In 2022, the FD CARES program extended services to the Renton Police Department and the City of Renton to co-respond with police to help vulnerable community members obtain needed resources.

FD CARES joins RRFA in servicing the greater Renton and Fairwood community covering 37 square miles and a population of more than 139,000 residents.  FFRA has seven stations and four aid units fully staffed 24/7 with EMTs. The agency contracts with King County Medic One for paramedics.

Compassion fatigue, burnout, early retirement, PTSI/PTSD, and suicides are among the ways treating some of the chronic injuries have affected the RRFA’s EMTs and paramedics.

“This is happening in staggering numbers,” DeSmith notes. “We as firefighters/paramedics are hired, trained, and equipped for acute and emergent injuries. They truly do not have the skill set for chronic needs.”

A Rapid Incease in Calls

Not only that, but the call volume has increased.

DeSmith says he recalls a time when fire-rescue stations were like a home away from home, a second family.

“We cooked meals together, laughed, and really bonded,” he says. “But now we’ve had two stations shot at while the crews were inside. We've had locked gates and barbed wire because of theft break-ins. We've had people sleeping in the bushes outside – a lot of homeless folks.

“Fire stations are being shot at. We used to be the good guys out there. Everyone loves firefighters. You couldn't go to Starbucks without somebody trying to pay for your drink. Now we’re just somebody else in uniform.”

DeSmith describes a street racing incident where about 100 people were doing donuts in the middle of a four-lane road.

“They were mad that the fire truck was trying to get through and you could hear shots fired,” he says. “Luckily, no one was hit. I think they fired them into the air. It was total disrespect for someone needing emergency help. So I want people to not just look downstream but look upstream at what is causing this to our firefighters who are rescuing us because we can do some good out there. It feels like we’re not making a difference.”

Those who enter the EMS world want to help other people in their emergencies, despite their own life challenges and emergencies, DeSmith points out.

“Sometimes we put our life on the line,” he adds. “Any call on the freeway could be our last because you're trusting horrible intoxicated drivers or texters. We’re willing to help you and actually risk our life. That takes a special person. So we need to feel like we are making a difference or we die a little every day.”

DeSmith notes that “all of the leaders are surviving the day with their heads down. I keep thinking, ‘Who’s got their heads up?’ I’ve been at this 35 years and I’ve never seen this before. I’m worried about all these wonderful people we're hiring that have this idea of what they're going to do in the fire service and EMS.  We’ve got to protect our emergency workers.  We can't control who calls 911 for what. What we can control is who actually responds to this.”

In FD CARES crews doing their job, it paves the way for fire-rescue workers to get back to doing the for which they signed up. It’s also another way to cut unnecessary spending.

Money is being saved through RRFA’s participation in ‘treat and refer’ – a Medicaid program through which the agency is paid every time it successfully navigates a 911 call away from an emergency room.

“We also have Ground Emergency Medical Transport – GEMT – so when we decide to triage and somebody needs to go in, we're usually cheaper than a lot of private ambulances. That will help us pay for Medicaid patients that we transport,” says DeSmith.

“We have four full-time aid units. I’m a big fan of door-to-door care.  I don't like passing them off to a private. I want our EMTs to own their decision that this patient does need to go to the hospital or they don't need medics. So that makes us better culturally as EMTs. Opiate settlements are another way money comes in. There is a lot of state funding. We have a county-wide EMS levy that supports our work.”

With FD Cares being a relatively new program, it is going to take some time to determine its success as the pool of cases on the streets keeps growing, DeSmith notes.

“We had shut down all the mental health institutions, which we're starting to build again,” he adds. “There’s hope on the horizon, but it's going to take time – I’d say about five years before we start seeing some real improvement.”