Columbus Program Matches Patients With Appropriate Resource

EMS participates in social service referrals

In February, Dr. David Keseg, FACEP, joined EMS physicians from around the globe at the Gathering of Eagles conference in Dallas to share best practices, and discuss the latest relevant research and initiatives aimed at improving EMS. The medical director for the Columbus (Ohio) Division of Fire, Keseg presentation was titled, the Development and Perception of an EMS Social Service Referral Program in an Urban Fire-Based EMS System.

 

Columbus Division of Fire EMS is an all-ALS system. In 2009, the system logged a total of 110,398 EMS incidents. Taking into account the considerable limitations on EMS (training, resources, primary live-saving mission), Columbus sought a cost-effective solution for redirecting EMS patients who could be better served by social services.

 

Here, Keseg discusses the resulting Columbus Fire Department partnership with Public Health.

 

When was the EMS Social Service Referral Program implemented, and was it modeled after a program in another city?

 

It was started in 2006 and was really not patterned after any other program.

 

Can you estimate the number or % of calls coming into Columbus before the program was started that would be better served by a social service?

 

It was easily around 200 to 300 calls per year.

 

 

Have you established a definition of call types that would fall into this program?

 

Yes. They include:

  1. Improper use of EMS;
  2. Frequent calls to 9-1-1 about maintenance medical problems, such as needing breathing treatments, glucose checks, blood pressure checks, etc.
  3. Quality-of-life issues, including:
    • Physical/medical problems, such as falls;
    • Emotional problems, such as anxiety and loneliness;
    • Environmental problems, such as poor living con­ditions, hoarding behavior or too many animals in the home;
    • Social issues or family problems; and
    • Miscellaneous home situations that the medic may be concerned about.

(Note: See “2009 Referrals from EMS to Columbus Public Health” below.)

How did you forge the partnership with Columbus Public Health? Did they approach you, or vice versa? What services do they offer?

 

We approached them, and they were very amenable to working with us. They provide social service consults for the patients we refer to them. They also are able to link the patients with the most appropriate agency that might be able to help them.

 

Are you working with any other community organizations in addition to public health?

 

No.

 

How have patients responded? Were they open to the changes?

 

They’re usually very grateful to have the assistance, and most were open to receiving help.

 

Did you develop a specific training program for dispatchers and/or field providers?

 

We did a brief in-service training program with all of our firefighters, and then did a survey to see if they felt like they understood the program adequately. We were pleased to find out that most did understand the program and felt it was a benefit to them.

 

How have the field providers responded? Was there any resistance to the program?

 

Almost all of them felt like it was a great improvement and resource.

 

What are the challenges in working with Public Health and/or other government agencies or community organizations?

 

Communication is the biggest challenge, but we’re continually looking for ways to improve that area.

 

Has it cost the department anything?

 

Not a cent.

 

Can you put a figure on how much it has saved the department?

 

It’s difficult to say, because it’s almost impossible to calculate the cost of each EMS run. But suffice to say that the economic impact pales in comparison to the professional job satisfaction in getting patients the help that they really need. The patients benefit because they get the help they really need and don’t have to keep calling 9-1-1 for nothing. The department benefits because they are not tied up on nonemergency calls and then not available for the true emergencies.

 

The employee morale is improved because they feel that they have some recourse when they have a patient who may be inadvertently abusing the 9-1-1 system.

 

Are you working on any ways to improve the program?

 

We meet periodically with Columbus Public Health to go over our stats and discuss ways to improve on what we are currently doing. In addition, we continue to make sure our CFD personnel understand how the program works.

 

What’s your best advice for EMS systems considering a similar program?

 

Investigate what resources are in your backyard that might be accessed to help you procure the proper assistance for this set of patients and then see how you can partner with those entities to set up an effective program.

 

Dr. Keseg is happy to share the department’s SOP for “Social Service Concerns.” To request a copy, contact him via e-mail at DKeseg@Columbus.gov.

 

2009 Referrals from EMS to Columbus Public Health

Breakdown of 100 referrals:

  • 46%: Frequent callers
  • 33%: Caregiver problems
  • 30%: EMS medics just concerned about the individuals (elderly, alone, overwhelmed predominately)
  • 21%: Condition of the home environment
  • 5%: Obesity
  • 14%: Falls (new)
  • 9%: Mental health problems (new)
 

How EMS Links to Public

  1. EMS personnel notify their EMS supervisor about patients that meet the criteria for the Social Service Referral Program.
  2. The EMS Supervisor completes a Social Service Referral form and e-mails it to the Columbus Public Health — Neighborhood Health Services Social Work supervisor.
  3. Once referred, Columbus Public Health assigns the case to a social worker, who contacts patient. With the patient’s permission, the social worker makes a home visit and assists in trying to solve whatever the problem(s) may be.
  4. If a social worker makes a home visit, appropriate HIPAA documentation is obtained.
  5. Columbus Public Health sends acknowledgement referral to the Columbus Division of Fire Continuous Quality Improvement.

Delta Airlines Flight Flips Over on Landing at Toronto Pearson Airport

A Delta Airlines plane flipped upon arrival and ended up on its roof Monday, injuring 19 people including three who are in critical condition.
Man Killed Denver (CO)

Man Hit by 2 Cars, Killed in Crash on U.S. 36 North of Denver (CO)

A man who pulled over on the side of U.S. 36 and got out of his car Sunday morning died after being hit by two other cars,…