SACRAMENTO COUNTY, Calif. — People want and expect a fast response when they call 911, but dispatchers are fielding a growing number of non-emergency calls, which take resources away from more urgent calls.
The Sacramento Metropolitan Fire District (Sacramento Metro Fire) is part of a pilot project that targets frequent callers, and it’s making a difference.
“If everybody's going to the emergency room for everything, it overloads that resource,” said Sacramento Metropolitan Fire Battalion Chief Scott Perryman.
He’s also a physician assistant and oversees a pilot program that helps people who frequently call 911 with non-emergency issues. It’s called Mobile Integrated Health (MIH).
“Sacramento County is one of the first in the Northern California area,” Perryman said. “What it is, is a nurse practitioner or physician assistant paired up with one of our paramedics. We get a chance to deal with high 911 utilizers. We also get a chance to deal with low-acuity 911 issues: medication refills, simple sutures.”
That’s because a physician assistant or nurse practitioner is allowed to do more for a patient, medically, than a paramedic.
“We're able to treat and release them in the field so they don't have to go to the emergency room, wait there for hours, overloading those resources there in the emergency room,” he said. “It allows our ambulances and our engines to be ready for that next emergent call: those strokes and heart attacks, cardiac arrest.”
As for how and when the MIH team jumps into action, Perryman said dispatchers treat all 911 calls as an emergency.
“We send our fire engine and we send our ambulance. They get there, and if it's determined that it meets our scope, then they give us a call,” he said.
Sacramento Metro Fire’s MIH program consists of a two-person team working Monday through Friday and includes firefighter paramedic Josh Katz and physician assistant Adrienne Mathis.
“We're not a replacement for 911. We're not a replacement for primary care,” Katz said. “We should be viewed, instead, as a bridge to help patients access the care that is available or perhaps that they need but can't get in a reasonable amount of time.”
What Katz and Mathis can do is treat and clear someone in the field, avoiding an ambulance trip and ER visit.
“Helping people navigate our very confusing healthcare system and having more time to sit down with them, because the ER is not always the right place for that,” Mathis said. “We can do multiple visits and kind of get them connected with resources or physical therapy, something to help them live the life that they actually want to live and stay out of the hospital.”
The MIH team has the flexibility to not only easily deploy anywhere within Sacramento Metro Fire’s jurisdiction but also spend quality time with a patient. They arrive on the scene in their red SUV and often find the reason the person is calling 911 so frequently, which is a problem they can solve.
“The top 25 on our list were responsible for over 1,500 calls a year — just those 25 people,” Katz said. “We were able to meet and treat quite a few of them and reduce that number down… Some of these patients are calling 97 times a year... And when we met with her and —(she) immediately stopped calling, and she actually hasn't called since.”
For example, they also recalled a situation where a man with a cognitive disability had two different kinds of insulin for managing his diabetes. He kept needing to call 911 for complications related to his diabetes. When the MIH team stepped in and spent time with him, they learned he is also colorblind — and that one type of insulin had purple labeling and the other had grey and he couldn’t tell the difference between the two, so he was taking the wrong insulin, which resulted in frequent ER visits. They were able to solve that problem and therefore eliminate his recurring issue.
After launching the MIH team about two years ago, Perryman said Sacramento Metro Fire saw a 43% decrease in frequent 911 callers.
The team serves people in the unhoused community, people overdosing on opioids and people with mental health issues. They also serve elderly, home-bound seniors, like the couple in their 70s who left a "thank you" voicemail for the MIH team after Mathis and Katz taught her to operate the lift her husband uses and care for a sore on his back.
“This is a great service for people that are bed-bound, in a lot of trouble. I'm recuperating, myself, from kidney cancer. My husband's got cancer, and he's got this horrible thing on his back,” the woman said, adding that the MIH team has “been beyond fabulous. I can't say enough about these people. I hope you continue with this. This is the best service we've ever had.”
Money for Sacramento Metro Fire’s MIH team runs out on November 30. It’s funded through Sacramento County Public Health, which gets annual dollars from the Centers for Disease Control and Prevention. A county spokesperson tells ABC10 they expect another year of funding to come through.
Perryman said the county has been supportive of the program and is seeing positive results.
In its first year, the MIH Program saved the county and health insurance companies more than $1 million, Perryman said. The two-person team responded to nearly 200 calls last year and has already more than doubled that so far this year.
“Sacramento is leading the way in Northern California, and we're happy to serve the community,” Perryman said.
His long-term goal is to find a permanent source of funding.
“We’re looking at every resource because my fire chief is very clear: we’re not in it to make money," Perryman said. "If we get more and more funds, we’ll simply open up a second unit and a third unit… It’s about providing more services to the community.”
The majority of patients have some form of health insurance, he said — often Medi-Cal, Medicare, Kaiser Permanente or Anthem Blue Cross of California. That’s why he’s asking the insurance companies to jointly fund this program, saying they’ll more than get that money back in the cost-savings his team provides.
“The cost of equipping and employing two people in this position is far more efficient of a resource use than even another ambulance would be because that's still only one patient at a time, tied to the wall time at a hospital, tied to the employees working on that, the hiring, the training, the staffing, all of it,” Katz said. “This is so much more agile and easily deployable.”
“It's the right thing to do for the patient because they're getting the care they need. It's the right thing to do for the health system because health care is expensive. If we can reduce that cost, oh man, it's a win,” Perryman said.
The successes come on both the large and small scales.
“Solving small issues that patients have, like getting access to getting prescriptions filled. Finding transportation to and from doctor's offices or even other stuff like food or housing or any other resources that we can connect them with, makes a big difference,” Katz said.
But could this be seen as rewarding people who are using 911 for their non-emergency needs?
“It could very easily be looked at as we're giving special care or special treatment to our highest utilizers, like the squeaky wheel gets the grease,” Katz said. “But in reality, those patients are going to tie up resources either way and we can either be reactive or proactive. And that's what this program is, is proactive. From an EMS perspective, fire department’s perspective, we can't reduce the amount of calls that we receive; we can only change the outcome for the patient based on the care we provide.”
As for why there are more and more people calling 911 with non-emergency needs, Perryman said it's a variety of reasons at play. He added that Sacramento Metro Fire is seeing call volume going up every year. Issues include the opioid crisis and overdoses, the expanding homeless crisis, COVID-19, a shortage of primary care providers, challenges with the healthcare system and its complexities and the number of vulnerable, low-income people in the community.
So will patients helped by MIH continue using 911 for non-emergency needs? Perryman said a study done with the city of Los Angeles’ MIH program shows patients are not calling 911 more, since the MIH teams are treating them, solving recurring problems and reconnecting them to their primary care providers.
“It's no secret that obtaining health care at any level can be very difficult. I think we hear one of our most common complaints from patients is that, ‘I tried. I tried calling my doctor and I can't get an appointment for six weeks.’ OK, that's a bummer, right? This person is doing everything they should be doing but still not accessing care appropriately,” Katz said. “That's where we can step in and make that difference and prevent them from becoming a high utilizer down the line.”
There are MIH programs at fire departments across the country, including in Dallas, Memphis, Salt Lake City and Los Angeles. Sacramento Metro Fire collaborates with those departments and says they’re seeing similar positive results.
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