HomeMy WebLinkAboutRFA 2015-05-13 Item 3 - Fire Department CARES Executive SummaryExecutive Summary —
Over the last 30 years, the fire service has expanded the number of stations and personnel in order to
meet a 400 percent increase in the number of requests for Emergency Medical Services (EMS). The
expansion of fire -based emergency medical response has inextricably linked the fire service and the U.S.
health care system.
The U.S. healthcare system is currently under enormous public and congressional pressure to
reform due to the lack of access to services, the poor quality of care, and the high costs of care. Critics of
the US healthcare system cite fire -based EMS as an example of a public service that contributes to
America's over utilization of EMS and increasing national healthcare expenditures amounting to 18
percent of the Gross Domestic Product (GDP). Is this criticism of fire -based EMS valid?
Fire departments respond to a wide array of requests for medical service. The fire service is well
recognized for their capacity to respond rapidly to emergencies with quality care as demonstrated by
recent increases in cardiac arrest survival rates nationwide. However, a large proportion (estimated up to
40 %) of medical service requests are for non - emergent medical problems and a majority of these
requests are attributed to a subset of frequent users of EMS. Despite these facts, fire -based EMS
personnel, response times, and medical interventions are standardized for medical emergencies.
Consequently, 911 callers with non - emergent issues typically receive emergency- oriented care, which
often times results in the unnecessary transport of patients to an Emergency Department (ED) for more
definitive care. The National Quality Forum (NQF) estimates that this response model contributes to an
estimated $38 billion in wasted health care expenditures each year. Moreover, because fire -based EMS
and EDs are designed for the episodic treatment of emergent medical problems, clients with non -
emergent medical problems, who often have multiple chronic diseases and psychosocial issues,
experience poor quality outcomes, poor follow up care, and poor continuity of care. The result is
subsequent and repeated use of the EMS system. Why now should the fire service change their medical
response model?
The Patient Protection and Affordable Care Act (PPACA) is changing the landscape of the U.S.
health care system. Provisions in the PPACA are making insurance payers and hospitals accountable for
the quality and costs of EMS care, driving the adoption of healthcare delivery organizations and
innovative solutions that improve the value of EMS. The PPACA directly challenges the inefficiencies
of the fire service's "one -size -fits -all" response model. How can fire departments improve the value of
fire -based EMS?
Fire departments should adopt a new tier within their current response model that responds
directly to non - emergent medical and psychosocial problems and proactively contacts frequent callers of
911, frequent users of the ED, and patients at high -risk of hospital readmission. This Non - Emergency
Medical Service (NEMS) division should be fully integrated into the operations of fire departments.
The Kent Fire Department Regional Fire Authority (KFD /RFA) in Washington State has
developed a NEMS division, called FDCARES (Fire Department Community Assistance, Referral, and
Education Services). FDCARES is staffed 24 hours per day, 365 days per year with an Emergency
Medical Technician (EMT) and a Registered Nurse (RN), who are available to respond directly to 911
callers with non - emergent medical and psychosocial requests for service. Using a non - emergency
response vehicle, FDCARES staff responds to non - emergent callers within 20 minutes. FDCARES staff
delivers a wide range of services aimed at addressing clients' immediate and long -term medical and
psychosocial needs. These services include medical stabilization, care navigation and coordination,
transport to alternative care settings (e.g., urgent care, primary care, etc.), medication reconciliation,
patient education, referrals to social services, and injury and illness prevention. When not responding to
non - emergent 911 callers, FDCARES staff proactively contacts and delivers services to frequent 911
callers, frequent users of the ED, and individuals at high risk of hospital readmission.
Adopting and integrating FDCARES into a fire department's existing response model, improves
emergency unit reliability and response times, reduces over - utilization of EMS and the associated costs,
increases access to quality care, and improves outcomes for residents by ensuring that they receive the
right service, at the right time, in the right place, and in the right way.