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Fire and Community Health?

We hear it all the time: Our EMS resources are stretched to the limit. Our medical calls for service are over 80% of our call volume. We're running the wheels off our engines and medical squads.

We respond to many of the same people almost every day and many times for nonemergent minor medical conditions; we know these patients on a first-name basis: Mrs. Smith is having another seizure … Mr. Jones is having another diabetic problem.

So, we respond, treat them and transport them. The emergency department discharges them. They go home and have the same problem a few days later. We respond again.

This cycle goes on day after day, shift after shift. Can anything be done?

Yes. As leaders in the fire and EMS community, we must identify the underlying factors that precipitate repeat and constant calls for medical service. When we boil down the many facets, it's clear there are common denominators that fire/EMS can and should address. These include a lack of access and capacity for primary care, appropriate entry points into the healthcare system and meaningful preventative health measures.

Fire/EMS and Primary Care

With a combination of a large uninsured population and shortages of family practitioners, internal medicine and other primary care providers, many people feel forced to receive primary care through emergency rooms and EMS.

Colorado Springs has a population of about 450,000, and 90,000 are effectively uninsured; the underinsured would represent a much larger number. Our safety-net system of care consists primarily of charity clinics operated from donations. The functional capacity of these safety net measures is about 65,000; the difference between the 90,000 and 65,000 is the need that's often placed on EMS's doorstep.

Solving this disparity requires unprecedented community health collaboration, which should include fire/EMS. Why the fire department, one may ask.

First, we're in a unique position to triangulate communication between many health resources.

Second, because we're physically distributed throughout the community, our stations can act as mini-clinics targeted to community areas that are more susceptible to lower socioeconomic and larger uninsured populations.

Finally, we're very apt at relocating and moving resources in a dynamic environment (mobile clinics) and, most importantly, we employ skilled and experienced medically trained personnel.

We believe we have the ability to be part of a healthcare team that can help provide primary care in a coordinated fashion with medical providers to manage acute and chronic illnesses in neighborhoods with the greatest needs. Chronic disease management, wound care, point-of-care lab draws and immunizations are just a few ways we may be able to help. People are already calling our number, and we want to deliver the best service we can in the most cost-effective way possible.

Appropriate Entry Points to Healthcare

EMS is unique in the healthcare continuum in that it's one of the few areas in which the patient drives the ship. A community-wide change is in order.

In emergencies, we want community members accessing EMS, but when their condition is nonemergent, we want them to have a more appropriate access point. This isn't just about driving down call volume or becoming more efficient; it's really about getting the best care for our patients whenever possible, but seeing a different doctor, continually cycling in and out of the emergency room, doesn't provide the same care as being in a patient-centered medical home.

The healthcare industry as a whole is changing from a fee-for-service model to a value-of-service model. Resulting coordinated-care teams have recognized what we've all known intuitively: a very small number of people are using a very disproportionate amount of services.

Our goal is to create "hot spotter" teams. They would include an integrated team of healthcare providers and case managers working in tandem. This highly skilled workforce offers a unique opportunity to expand their training to community paramedicine in addition to their environmental knowledge and skill sets.

Through this type of program, residents could receive basic point-of-care health and home-care services at low or no cost. The idea is to work within an integrated team to get primary, preventive and environmental care to those who need it most and to cut down on expensive emergency responses, transports and emergency room visits.

There are several challenges to implement a community paramedic program and it requires a great deal of collaboration and coordination among the healthcare community and governmental policy makers.

Meaningful Health Preventative Measures

Fire/EMS represents tremendous challenges. In most systems, medical alarms represent a significant percentage of call types and, subsequently, additional resources must be allocated to continue to provide excellent services to our community.

One essential component of this model is that, as firefighters and EMS providers, we're accustomed to behaving as a reactionary force: When Mrs. Smith has chest pain, we respond; when Mr. Jones has a seizure because he ran out of medication two days ago, we respond.

Throughout this cycle, we rarely thing about healthcare and the events that led up to the medical event.

As an industry, the fire service as a whole has done a tremendous job in the areas of fire engineering, prevention, loss and injury—so much so that we have seen a steady decrease in fire service calls; the increase comes from low-acuity medical calls. The healthcare industry hasn't been as successful with preventative measures; we believe we can bring some of our proven skills and resources to the fight, which can make a long-term impact.

For example, we've partnered with the healthcare community and local grocery stores to stage health checks that include blood pressure and blood sugar monitoring. Every third Saturday of the month, we park apparatus in front of several grocery stores in targeted areas of our city. The fire team is joined with a clinical team from a safety-net organization to provide basic wellness and health literacy and get people plugged into primary care.

Some of the stores actually provide dieticians and create healthy meal plans to support this effort. We're able to go where the patient population needs us the most and talk about health and wellness. This approach won't make a significant change tomorrow, but we hope to reap the rewards a decade from now.

Moving from reactive to proactive is a challenge in the culture of our workforce. Our budgets are stretched thin and our workforce has decreased, so ask why take these measures?

We could argue this has the potential to decrease our call volume and save dollars, but the truth is that this is the right thing to do for our patients, our community and our organization. It will set us on the right course for the future.

If you recognize some of these challenges in your community and want to try something different or innovative but hesitate to do so, I encourage you to develop your vision and collaborate with others in the healthcare community. Don't reinvent the wheel (we have and will continue to borrow from the best practices of others), communicate your vision and be prepared for resistance but be persistent.

The future of fire service and EMS delivery is changing. We believe the small steps we take today will be recognized in the future as historical markers of when we came to a crossroads that changed the landscape of our profession. What will the fire/EMS and community health look like in your department?

Tommy Smith is deputy chief of support services for the Colorado Springs (Colo.) Fire Department.

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