Ariz. Chief Examines Changes in Fire-Based EMS

SAN DIEGO – The face of the fire service is changing and emergency medical service is becoming the staple of fire departments nationwide and those who aren’t in the game will suffer the consequences.

Those are words shared by Harry Beck, chief of the Mesa (Ariz.) Fire and Medical Department. Mesa is so serious about providing quality EMS care to its residents, the department changed its name to include medical.

“We got so much praise for doing that it was incredible,” Beck told an overflow crowd at Firehouse World conference in San Diego. “Eighty percent of what we do in Mesa are EMS runs. Our city councilors were pleased that we finally accepted it.”

And the change for Mesa was far more than a cosmetic name change, Beck explained in a presentation he gave titled “Transitional Response Vehicles: The Mesa (Ariz.) Fire Department Model.” Dr. Gary A. Smith, Mesa’s medical director, was a co-presenter for the class. The presentation was part of the Mobile Integrated Healthcare Summit Fire Service Update that was offered during the Firehouse World conference.

Beck explained that he recognized that something different needed to happen to survive how health care is being delivered now and in the future. He said 60 percent of emergency 911 medical calls resulted in transport to the hospital, but 40 percent didn’t need transport. Yet, Mesa would send four highly skilled people to every call, reducing the number of available units for the more severe calls.

The solution for Mesa was to create two units that were staffed by a captain paramedic and a firefighter and send them on low acuity calls that had already been prescreened and determined during the initial call intake.

“I didn’t ask permission to do it,” Beck said. “I just did it because we all knew our hospitals are overcrowded and patients weren’t getting the care they needed.”

After the fact, Beck said the media was invited to take a look at the new model and the department spun it as a brilliant, innovative move that would soon be the model.

And it worked and the concept is a model that is being replicated in many places around the country.

“There are a lot of patients that didn’t need to go to the hospital, sit around in a waiting room for hours waiting to get the care they needed and then having to deal with transportation issues to get home,” Beck said.

The model was so successful Mesa partnered with a local hospital to get nurse practitioners and physician assistants to pair up with firefighters on “emergent care units on wheels,” capable of doing some rudimentary testing and prescribing medication right on the spot, Beck said.

The advantages or such a model are huge, Beck said, noting that thousands of dollars and hundreds of staffing hours were saved recently when police responded to a suicidal woman who had lacerated her wrist and was bleeding.

Beck said one of Mesa’s emergent care units responded, stitched up the woman’s arm, prescribed some medication on the scene and rather than transporting the woman to the hospital, she remained in police custody and was taken to a mental health facility. And it all happened in under two hours.

By contrast Dr. Smith said under the old model, the woman would have been transported to the hospital with a police escort and remain under police watch for three to five days while a mental health facility was found. And, the City of Mesa would have been on the hook for the woman’s care for the duration at a significant cost, Smith said.

Smith said it’s time to do something with different with health care when it costs 18 percent of the gross domestic product to provide it.

When the partnership with the local hospital first occurred, Smith said he would often get calls from the nurse practitioner about whether a patient needed transport.

“My response was always when in doubt, transport,” Smith said. “It’s that simple. And we’re only looking for 40 percent reduction.”

There is always a risk when dealing with medical calls, but the risk of not transporting a person who might need it, is just not worth it Smith said. Nevertheless, he acknowledges there is some risk to the Mesa model, but he believes the net result and the overall improvement is worth it.

“Sometimes you have to be willing to take a risk for the betterment of the system,” Smith said.

Beck said that like firefighting, sometimes things just need to be done.

“Go do what firefighters do to solve the problem and ask for forgiveness later,” said Beck who comes from a 100-year line of firefighters.

Beck said the way to make this model work is to collect lots and lots of data to show the savings and to prove better outcomes for the patients. Hospital will help underwrite and pay for the services provided by the fire department under this model because they see the huge savings.

Smith said hospitals will reimburse costs for follow up care in the home because it helps keep people out of the hospital because they’re not taking their medication, or not following orders.

Beck added that the service fire departments provide can also help prevent injury and illness. Firefighters for years have been in the prevention business and it just makes sense to expand that service into helping prevent hospitalization and medical emergencies. And, it won’t hurt to tack a smoke detector up at the same time, he said.

“The fire service has to do this,” Beck said. We know what happened those who abandoned it in the past,” Beck said. “This is our future. It is our present.”