On March 27, 2008, the Fire and Emergency Medical Services Department (FEMS) initiated the “Street Calls” Program, designed to perform mobile outreach and intervention for high-volume individual users of 911 services, including the homeless, mentally ill, and chronic public inebriates.  The Street Calls Program is staffed by FEMS paramedics paired with social workers and clinicians from other DC government agencies.

 

FEMS has updated the"Make the Right Call" campaign and is partnering with the Office of Unified Communications to distribute material to all District households on the proper use of 911 and 311.

 

The Department’s Clinical Quality Program Manager has completed training in EMD-Q™ (Emergency Medical Dispatch Quality Assurance) in preparation for implementation of AQUA™ (Advanced Quality Assurance) for the Medical Priority Dispatch System (MPDS™). The Department has requested resources to assist the Office of Unified Communications with quality assurance for the call-taking and dispatch process. These resources are included in Mayor Fenty’s Fiscal Year 2008 EMS Enhancement funding proposal, currently pending approval by the Council.

 

 

A new Closure/Diversion policy was issued on June 12, 2008. This policy* was developed with the active participation and endorsement of the hospital working group formed under Recommendation 5 (f).

 

Since the Task Force issued this recommendation, F&EMS has partnered with the Department of Health (DOH) to identify outpatient primary care medical facilities to serve as delivery points for patients with non-emergent conditions.  At this time, however, there are very few facilities in the District that F&EMS can immediately bring non-emergent patients to when responding to a 911 call that may not necessarily merit transport to an emergency room.  In the absence of such destinations, it is not yet feasible to implement the procedure called for by this recommendation, although doing so remains the long-term goal of F&EMS. 

 

In the meantime, Mayor Fenty is taking immediate steps to fulfill the need for more non-emergency delivery points in the District.  Using the Community Health Care Financing Fund, and guided by the RAND report recommendations, DOH will provide capital development grants for the construction of new or expanded facilities to increase primary, urgent, and emergency care capacity.  These grants are slated to be released in the fall of 2008, with eventual award, design, and construction to be completed over the course of two to four years.  During the course of this development, F&EMS and DOH will coordinate an appropriate protocol for the transfer of non-emergent patients to newly developed urgent care facilities.  DOH is also developing community-based interventions and grants to educate and link residents to existing medical homes to reduce – on the front end – unnecessary calls to 911 and use of emergency transportation services.

Through the Emergency Care Reform Initiative - a city-wide planning process for reducing avoidable hospitalizations, preventable Emergency Department visits, and unnecessary EMS transports – F&EMS and DOH are developing options for non-emergent, urgent transportation for residents seeking non-emergency medical care. This includes looking at existing infrastructure, such as the Medicaid non-emergency transportation program, as well as novel mechanisms and vehicles that can link residents with appropriate, cost-effective transportation to outpatient treatment.

 

F&EMS and DOH have analyzed EMS transport data to review trends in non-emergent use, identifying particular facilities and situations to prioritize for alternative transport mechanisms.  In particular, nursing homes represent a disproportionate share of potentially avoidable EMS and emergency room visits.  To that end, DOH is in the process of developing a pilot program to enhance the quality of care in area nursing homes with the aim of reducing both the use of and the need for EMS transports and emergency room visits.  DOH and F&EMS will assist nursing homes in securing appropriate alterative mechanisms of transports for residents with non-emergent health care visits or needs.

 

F&EMS and DOH are also reviewing opportunities for other facilities with potentially avoidable EMS transports and emergency room visits, including homeless shelters and group homes, to identify similar alternatives for urgent but non-emergent transportation to health care facilities.

 

The implementation of a protocol to refuse transport of patients who call 911 for assistance is contingent on the District’s ongoing efforts to develop alternative transportation options and non-emergent delivery points.  While F&EMS agrees with the goal of this recommendation – to reduce misuse of 911 and ambulance transports – it is the Department’s position that this issue is best addressed by connecting patients to appropriate medical homes and enhancing the District’s primary, urgent and emergency care capacity.