Columbus and Cleveland have changed the way they respond to 911 medical calls in an effort to save time, emergency resources and money. Last week, Cleveland EMS stopped taking 911 callers to the hospital for low-priority complaints, including headaches, broken toenails and boils. The city announced that paramedics will respond first to high-priority calls, including chest pains and difficulty breathing. If they have time, squads will go on low-priority calls.
The change was made to help plug a $23 million gap in the city budget. In Columbus, EMS officials are addressing an increase in the number of people who call 911 from one hospital in hopes of having an emergency squad take them to another. Paramedics often arrive and learn that hospital staff members don’t know that the patient wants to move. Now, “they’ll dispatch EMS and then reverse back to the hospital and give medical staff an opportunity to … try to rectify the situation,” said Prairie Township Fire Chief Stephen M. Feustel.
Not everyone is happy with the change in Cleveland. “I’m not a big fan of it, because we don’t know what we’re going into until we get there,” said Stephen G. Palek, president of the Cleveland EMS union. “Someone could say ‘leg pain,’ and he could have four bullets in his leg.” But, Palek said, handling nonemergency calls added to the burden of EMS, which recently laid off six paramedics, won’t fill seven vacant positions and reduced the number of squads on the streets from 18 to 15. “Quite frankly, our guys are getting killed,” Palek said. “They can barely get someone off the cot before they have to go out. They’re begging for five minutes to go to the bathroom, for God’s sake.”
Cleveland received 80,000 EMS calls last year and took 64,000 people to hospitals. City leaders expect the new policy to eliminate 2,500 or more transports this year. Low-priority calls such as hemorrhoids or someone needing a prescription filled will be referred to clinics near the caller’s home. Second-tier calls, such as flulike symptoms, will go into a queue, and the person will be called back every 20 minutes. Cleveland EMS Commissioner Ed Eckart said the longest call on hold was two hours and 45 minutes, and that person eventually was taken to a hospital. He said the new policy requires a lot of public education and monitoring in case people claim to have chest pains when they don’t. “If that becomes an issue, we’re going to have to take corrective action like ticketing for a false alarm,” Eckart said.
In the first week of the new policy, he said, paramedics did not respond to 12 to 14 calls and 90 percent of those people went to a local clinic. Columbus, which has 32 medic units, still responds to every 911 medical call. Even with a tight budget, city officials say they have no plans to change that policy. “I think the liability outweighs the saving of money,” Battalion Chief David Whiting said of Cleveland’s policy. “You’re dealing with saving people’s lives. You can’t put a price on saving somebody’s life.”
As far as 911 calls made from central Ohio hospitals, patients say they want to be transferred because they are unhappy with the wait or the care they are receiving. The problem isn’t widespread, but it is increasing, officials say. “Just because you’re dissatisfied with the hospital doesn’t mean you should be calling 911,” Feustel said. “It’s a very small number, but it only takes one very irate person to create a mess.” It was enough for the Central Ohio Trauma System to create guidelines directing dispatchers to call hospital officials to let them know paramedics are on the way. “If they do respond for some reason, our staff would want to know so we could intervene with the patient and address the concerns that prompted the call,” said Elizabeth O’Connor Seely, executive director of Ohio State University Hospital East. There’s a process to transfer patients that involves having doctors and nurses from both hospitals talk to one another about the patient’s condition and the medical care already given. “We have to think they’re better off under a physician’s care, not in a (squad),” said Madison Township Fire Chief Clifford L. Mason. “We have a lot of medications in the back of a medic, but we’re not a hospital.” shoholik@dispatch.com
