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Fire-based EMS Programs Driving the Bus

Although the term community paramedicine is becoming well known in the U.S. fire service, in Arizona we have added the word integrated to show the intent of our programs. Semantics aside, there are many examples of fire-based EMS community integrated paramedicine (CIP) programs in Arizona. All are driven by far-sighted fire service leaders, looking to create better service models for the communities we serve.

Programs include urban models, such as Mesa Fire and Medical and Chandler Fire Health & Medical (CFHM). Under Chief Harry Beck, Mesa is using two-person transitional-response vehicles, addressing behavioral health issues and other unmet needs. The Chandler program targets frequent flyers who are low acuity and fit into a treat-and-refer program, taking them to alternative destinations and avoiding the ED.

Serving smaller areas (pop 50,000), Buckeye Fire Medical & Rescue and Lake Havasu City Fire Departments have also started programs. Buckeye’s program is a bridge from the hospital to primary care. Lake Havasu City Fire, working with their hospital, focuses on seeing patients with COPD and CHF. Though still collecting data, Chief Dennis Mueller reports that trends point to a reduction in patients with COPD and CHF calling 911 and even an increase in moral as firefighters who get involved in the program see a value of using their skills and knowledge in a more proactive manner.

We also have examples of progressive public-private partnerships. Approximately 100 miles north of Phoenix, a collaborative effort is underway between private, for-profit Verde Valley Ambulance Company (VVA) and several fire districts, including Clarksdale, Rim Rock, Camp Verde, Verde Valley and Sedona Fire. These fire-based EMS agencies have partnered with VVA to improve outcomes, using a cooperative community paramedicine model.

In southern Arizona, the Yuma Fire Department is in the planning stage with community stakeholders to start a pilot. Just south of Yuma, the San Luis and Somerton Fire Departments are partnering with the Regional Center for Border Health in an effort to use firefighter-CIPs in an integrated effort to improve patient outcomes and lower overall healthcare costs.

Golder Ranch Fire District, serving a large population in and around the beautiful town of Oro Valley just north of Tucson, has a CIP program focused on cutting readmissions. It’s showing great promise after its initial year of operation.

The much larger Tucson Fire Department has just recently started the Tucson Collaborative Community Care (TC3) Program. TC3’s goals are to connect those in need with community resources so they ultimately improve their overall health and become thriving, contributing community members.

Not having enough room to name all the fire agencies in Arizona that are involved in CIP projects, my last reference will be my very own Rio Rico Medical & Fire District, located 15 miles north of the Arizona-Mexico border. Our program, started in January 2014, focuses on high-utilization uses of 911 suffering with chronic diseases. We correspondingly conduct home-safety inspections so as to mitigate falls. Two great partners have been the Arizona Poison & Drug Information Center whose 24x7x365 mission helps us with the medications management element of our program and Southeastern Arizona Area Health Education Center who is our partner in healthcare training and outreach.

The common link between these programs is the passion we all have for serving our communities. This very important intangible provides the vision to look beyond our internal organizations and engage community stakeholders to work together to achieve the triple aim of healthcare reform.

Our programs let us look at the root cause of why people are frequently calling 911 in a low-stress setting. And unlike the frantic atmosphere of an emergency, a home visit by our CIP teams actually allows the time for us to get to know our patients. If we have time to find out their motivation triggers, we can improve their health outcomes.

Fortuitously, we all have support from both the Arizona Fire Chief’s and Arizona Fire District’s Associations. Creating a network to share successes and challenges has been crucial to the overall success of our programs. An additional key was crafting a strong working relationship with Labor at all levels. The Professional Fire Fighters of Arizona have proven to be a great partner and has strengthened the statewide effort. Together, we realize the downstream implications of the ACA for the overall healthcare delivery system and the potential of fire-based EMS to be a major player in integrated healthcare.

In Arizona, we have all worked hard to ensure that the programs and pilots have been built to meet the need of the local community. While CIP is a deft slant on providing our clients with the most appropriated level of care, it also connects them to the right healthcare resources.

As we move into the integration of fire-based EMS programs in our communities and engage our stakeholders in conversations concerning improving the overall health of our population, this new paradigm will become the new normal as paramedics became the new normal starting in 1969.

We have another program underway in our state, which may be the linkage we need to obtain reimbursement for fire-based EMS to fund CIP programs in the future. This effort took shape after discussions between Arizona Health Care Cost Containment System (AHCCS), the Arizona Department of Health Services and the Chandler Fire Health and Medical Department (CFHM).

Chandler Fire presented strong evidence to support a treat-and-refer option for our field units on a 911 call and save the system money. Upon reviewing data from CFHM, AHCCS has worked with CMS to develop codes for payment. Arizona EMS CIP providers hope to start receiving reimbursement for this program beginning in October 2016.

Proactive measures are necessary to start up a program like CIP, which is outside the box of traditional thinking. It all starts with fire chiefs and agency representatives getting up and out of their offices and meeting the communities they serve. Conversations can start in earnest when fire officers come to the table with the knowledge that comes with assessing your community needs, understanding local available healthcare resources and knowing barriers to accessing those resources.

In a recent article, a respected fire chief suggested the fire service wait to implement community integrated paramedicine or mobile integrated healthcare (MIH) until the “right bus” comes along. To me and most of the fire chiefs in Arizona, we respectively disagree with that suggestion. Each CIP-MIH 911 program must be designed to meet the specific needs of your community. Therefore, there is no single “right bus.”

In fact, we feel the fire service should be driving the “bus of innovation,” which will continue to make the fire service relevant and a contributing member who helps design the EMS delivery system of tomorrow instead of waiting at the bus stop.

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