Five Questions With: Andres Mercado, MIH Officer, Santa Fe (N.M.) Fire Department

Following a 2014 survey that indicated about 3 percent of the city's 9-1-1 callers were using 18 percent of the emergency response resources each year—including one man who averaged one ambulance ride every five days—the Santa Fe (N.M.) Fire Department developed the mobile health office in early 2016 in collaboration with the Christus St. Vincent Regional Medical Center and the Southwest CARE Center.

Through the service, paramedics and technicians visit the homes of the top 9-1-1 callers, most of whom have unaddressed chronic illnesses.

The MIH program is the subject of a new documentary titled Frequent Caller, scheduled for release in late 2019.

EMS World spoke with paramedic Andres Mercado, who was named MIH officer for the program earlier this year, to learn more.

EMS World: Can you briefly describe the origination of the Santa Fe MIH project and your involvement with it?

Mercado: Under Chief Erik Litzenberg, the Santa Fe Fire Department (a single-tier EMS-based fire department) has stayed on the cutting edge of emergency response and prevention. Our Wildland Urban Interface program keeps our residents and our watershed safe from one of the greatest fire risks in our community. So when MIH-CP was discussed in Santa Fe, Chief Litzenberg saw it as a common-sense approach to accomplish our mission of protecting life safety. I was reassigned from shift work to a 40-hour work week to conduct research on the subject. Informed by industry leaders at MedStar, the Colorado Springs Fire Department, San Diego Fire and Rescue, McKinney Fire Department and others, I undertook the mission of creating the Mobile Integrated Health Office (MIHO), which now has one full-time administrator (myself), two full-time paramedics, one full-time EMT, one full-time social worker, a part-time physician and a part-time pharmacist. The team runs a high-utilizer program, an opioid outreach program, a firefighter referral program and a dual role 9-1-1+CP SUV program.
 
What challenges did you encounter while getting the MIH program operational?

Change management has been the biggest challenge to the program. Firefighters love tradition and some in the department felt these new programs were "mission creep." Progress has been made through improved messaging, and we are committed to being solidly anchored in our mission (to protect life safety through emergency response and prevention) and being data-driven. We have overwhelming support from our medical and social service community, managed care organizations, elected officials and, most importantly, from community members.
 
How did the documentary “Frequent Caller” happen and what was it like to be involved in the project?

Our group was alerted that the department would be hosting a film crew that would be filming about the intersection of healthcare and public safety. The Free Voice Media team has proven to be professional, sensitive and flexible as we are limited in how we can operate owing to HIPAA rules. Plato said that storytellers rule the world. There is something powerful about being able to tell a story well, and the story of the opportunity to improve our healthcare and public safety systems simultaneously is, in my view, important. This is an exciting time for the fire service and EMS, and I hope our story helps bring attention to the amazing work industry leaders throughout our country are doing right now.

What advice would you have for other departments looking to establish a similar initiative in their cities?

Don’t follow the money; follow your mission. Ask yourself, are you here to save lives? If the answer is “yes," the next question should be, “what is killing and injuring people in my community?” If it is opioids, serious mental illness, mismanaged medical conditions, confusing prescription regimens, etc., focus on that. If it's kids falling in swimming pools or seniors suffering falls, focus on that. This is true community risk reduction. Also, every leader I spoke with warned that if you are not failing at some things, you are not trying hard enough. People’s lives depend on it. Look at your data and partner with interested parties to make your community safer.
 
What do you hope attendees of your community paramedicine talk at EMS World Expo will come away with?

I will be presenting on two panels:
·         Urban CP Panel: I hope that attendees will come away feeling confident to speak with their chief, city manager, mayor and elected officials about why this work is necessary if we (fire service/EMS) are to accomplish our mission. With this conviction, the conversation about funding changes dramatically. If you come to this session, remember to read your department/agency mission statement prior to the session!

·         Unique Approaches to the Opioid Epidemic: We will be sharing our process and approach. Seven people will die from opiate overdose in the U.S. during this one-hour session. It's imperative that we have an all-hands-on-deck approach to this epidemic. We hope that attendees will come away confident that they can start up an opiate outreach program in their community almost immediately. The two most important ingredients are reaching out to local partners and a desire to be part of the solution.