Ind. Firefighters to Launch Community Paramedicine Program

Mar. 25—The city's fire department will soon branch out into health care, insurance, transportation and social work so it can focus more on its true mission: fighting fires and responding to medical emergencies.

The department is launching a new "community paramedicine" program in which it will identify people who often call 911 for ambulance rides to the emergency room but don't have time-dependent medical emergencies.

Department firefighter/emergency medical technician Suzie Krill will visit these 911 "over-utilizers" in their homes, learn the reasons for their frequent ambulance trips, and work to link them with resources to avoid the calls in the future, said Andy Myer, assistant chief for EMS.

"Our goal isn't to make less 911 calls," Myer said. "Our goal is to have a healthier community. The upside to that is there's a savings involved, as far as billings and running the more expensive calls. We feel as though we can address these patients or these clients in a non-acute situation where it's safer for the responder, the client and the citizens of South Bend."

Some frequent 911 callers lack a primary care doctor, health insurance or even just transportation, or they might have health insurance but haven't yet learned how to use it.

"No matter what the disease state is, we want to coach them and get them to what we call a medical home," Myer said.

The department has reviewed a similar program in Raleigh-Durham, N.C., and sent Krill to study others in the Minneapolis-St. Paul, Minn. area and Tucson, Ariz., where she spent a week shadowing a team. Krill has built a 911 "over-utilizer" list locally, and hopes to start visiting patients within the next month.

The Tucson Fire Department calls its program Tucson Collaborative Community Care, or T-C3. Piloted from February 2016 through August 2017, and now permanent, the initiative has been a success so far, said Sharon McDonough, assistant chief for operations, training and emergency management at the Tucson Fire Department.

One measure of success is that the program identified 10 people who, combined, had made 352 calls to 911 before the program started. After the program had intervened in their lives, those 10 people had made just 24 calls to 911, a 93-percent reduction.

In another sign of success, response times to actual emergencies have not increased despite recent population growth in Tucson, because ambulances and firetrucks are being used more efficiently, McDonough said.

She acknowledged that it's a different role for firefighters, but said it's one that society is demanding they take on.

The Tucson department has partnered with three nonprofits—a health care provider, a council on aging (comparable to REAL Services in South Bend), and an accountable care organization—and health insurance providers.

It was unclear which local organizations will be involved in the South Bend Fire Department effort. Myer initially told The Tribune that it was important to have partner organizations on board before beginning to visit clients from the 911 over-utilizer list.

But when The Tribune asked him to identify some of those partners, Myer said the department would need to discover what kinds of resources clients need before creating concrete partnerships with organizations.

Karl Nichols, executive director of Community Wellness Partners, a nonprofit that works to improve minority health in St. Joseph and 11 other counties, said he would be willing to help any way he can.

Through his work with sheltering the homeless during cold weather over the past decade, Nichols said he's seen many firefighter EMTs arrive to a call and already know the patient by name because they've taken him to the ER so many times.

"I'm very supportive of that," Nichols said. "Anytime you can do a program that gets people connected to a primary care doctor, you're going to see great benefit from it."

Nichols said the demand for this service is so great that he hopes it won't overwhelm the fire department, distracting it from responding to real emergencies. But he said that doesn't seem to have been a problem in other cities where fire departments have started paramedicine programs.

Krill will handle the program on her own, devoting all 40 of her hours each week to the initiative.

"I just know from my experience working with Weather Amnesty, the number of calls I've made that did not need ER assistance," Nichols said. "If someone could have handled it right there, it just would have been so much less stress on everybody."

The Tucson department has a five-member team, but the city's population of about 500,000 is roughly five times as large as that of South Bend. McDonough said it's boosted morale across the entire fire department.

"We've had letter after letter and email after email from our troops, thanking us for what we're doing with this program because we've helped them," McDonough said. "They feel like somebody's doing something about these people who they haven't been trained, equipped or educated to really deal with. All they're trained to do is go and solve the emergency in the moment, where these people are just way more complex than that."