Cincinnati Fire hopes new program cuts nonemergency 911 runs, addresses callers' health issues

Officials: Community paramedicine helps seniors

CINCINNATI – When Cincinnati Fire Chief Richard Braun talks about problems that people cause by flooding 911 with nonemergency calls, he naturally tells a story about a nearly 100-year-old grandmother.

His grandmother.

Braun said she used to call medics at 3 a.m.

"She wanted somebody to talk to. They would get there and nothing would be wrong with her,” Braun told WCPO this week. “They would take her to the hospital. My dad would have to go get her then and the hospital would call in. And Dad got tired of going to the hospital at 3 or 4 in the morning, so Grandma got put in the nursing home.

“At about 98 years old, I asked her how she was doing and she told me, ‘I called 911 too many times.’ She knew exactly what she was doing, and if there was community paramedicine, the medics conceivably could have put her on to doctors that deal with that kind of situation.”

Cincinnati Fire Chief Richard Braun

That comes to mind now because Braun’s department and the City of Cincinnati are launching one of the first community paramedicine programs in Ohio.

Community paramedicine is a proactive program that allows paramedics and emergency medical technicians to provide routine healthcare, instead of just emergency services. Local officials also expect to be able to cut down on expensive, resource-draining false alarms to 911 while answering the needs of repeat callers.

When a 911 call comes in and the dispatcher asks, “What’s your emergency?,” the answers can be frightening. Or they can seem frivolous.

Not everybody is calling to report a fire or a crash or someone choking. Those less urgent calls are wasting time that could be spent on more immediate concerns. They're also costing taxpayers.

For example, sometimes new parents will call about minor cuts because they panic. Elderly people will call 911 because of minor colds.

Nearly 20 percent of calls for the Cincinnati Fire Department are not emergencies, Braun said. Given that his department responded to 80,000 calls last year, emergency staff made 16,000 nonemergency runs in 2016. And that means those first responders aren't available to answer real emergencies.

A new pilot program in the city aims to cut down on the number of nonemergency 911 calls. The proactive program is called community paramedicine and it is one of the first of its kind in Ohio. There is no set start date for the program because it is still in development. 

Many of those nonemergency calls are from repeat callers, Braun said. Often, it’s the elderly or people with problems that require other attention.

Some of those issues include "mental health, isolation or obesity,"  City Council member PG Sittenfeld said.

PG Sittenfeld, Cincinnati City Council member

"As I was told when I came on, it may not be an emergency to me, but it's an emergency to the person who called us," Braun said.

"Runs will come in, and we know the people by name. It's 'so and so,' and it's part of the culture,” he said. "It can be frustrating at times when you go back to the same house time and time again, and you want to help these people, but our medics just didn’t have the means to do it."

Community paramedicine, Braun said, "allows our medics to conceivably go into homes, help people on a nonemergency basis … We can help them get connected with the right agencies to call and that can be very helpful."

Normally, an ambulance and a fire truck would respond to a home and leave. But community paramedicine would allow nonemergency workers to follow up with callers without tying up resources. 

"You and I, we have our personal physicians we go to. Well, some people don't have that. So, it's kind of like fire prevention," Braun said. "Fires have gone down over the year because our fire prevention has done such a great job. It would be the same thing with community paramedicine. We get them out on the street and into the community and then the 911 runs start going down because it's being taken down because it's been taken care of on a preventative basis." 

Sittenfeld said one of the goals is “to increase the overall health of the community, especially our senior population.”

"Some of the heaviest users of our emergency response system do tend to be seniors,” Sittenfeld said. “So we want to make sure they have the support they need to really address the problem, not just serve a short-term fix." 

It goes hand-in-hand with other plans to promote seniors’ well-being, he said.

Monroe Fire Chief John Centers believes in community paramedicine, which has been successful in other states where they only need a local medical director's approval to greenlight the program. Ohio fire departments have to go to the state Emergency Medical Services board for approval, and that takes time. 

Monroe Fire Chief John Centers

Last year, Center’s department became the first in Ohio to try creating a paramedicine program.

"It's pretty simple stuff when you look at it from the outside,” Centers said. "Our risk survey found that our elderly community was in the highest need of additional resources. You may have other jurisdictions where it’s heroin or it’s infant mortality rates.”

The Department of Homeland Security awarded Monroe a $1 million grant, which allowed Centers to hire six additional firefighter/paramedics. 

Monroe’s program is funded for two years and covers salaries, benefits and more. Council plans to support the program beyond that, and Monroe Fire Department officials hope to have a permanent full-time medic dedicated to this soon. The six current paramedics provided through the grant are part time and will leave the department after two years when the grant expires.

Cincinnati didn’t get a federal grant, so city officials had to come up with their own funding plan to get the program off the ground.

“We've been out to communities and to hospitals looking for funding to make this a pilot project," Braun said.

Sittenfeld tasked the city administration with finding resources to execute the paramedicine program. Now, after a year of planning following approval from the state EMS board, the Cincinnati Fire Department is implementing its program.  

"Because we're structuring this as a pilot -- to be able to test it in a low-cost way -- it will not be a heavy investment at first. I mean, ultimately this will probably be a net cost saver," Sittenfeld said.

The first step is to find out what kind of help frequent 911 callers really need.

“They'll pick a pool of people that tend to be frequent high users of our emergency response system and they'll sort of inventory: What's this person's life and lifestyle? What are those resources? What are the supports? What are the helps that they really need?" Sittenfeld said.

Monroe follows up with patients once they leave the hospital. It’s part of the preventive medicine concept.

“Upon discharge they get a large stack of information about what to do when they get home, what their follow up is, what their appointments are. It’s a lot of information to absorb when you’re still kind of in the recovery process,” Centers said.

Bottom line: Community paramedicine will save resources and lives, Braun and Sittenfeld said.

"If we can keep those (emergency runs) steady, then we don't have to say we need more medics now because the runs have gone so high, it's overrunning our system. To put a medic unit in service is almost $2 million," Braun said.

Braun said the engines and medics take about 16 runs per day. And the department is nearing 100,000 runs per year. So if the program cuts down on the number of calls the department has to respond to, that would reduce the workload and save taxpayers' money.

“We're going to have a healthier, safer community,” Sittenfeld said. “We're going to have a more efficient fire department, and we save taxpayer dollars. It's a triple win."

FIND OUT MORE

Several community informational sessions about the paramedicine program are planned. The first will be:

When: 9 a.m. to noon, March 16

Where: Colerain Township government building, 4200 Springdale Road. 

Web editor Greg Noble contributed to this report.

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