Calif. Fire Department Launches MIH-CP Pilot Program

The Marin Independent Journal, Novato, Calif.

The San Rafael Fire Department is testing a new strategy for responding to non-emergency 911 calls, which officials say are a frequent problem that puts a drain on resources.

Under the 90-day pilot program, which launched this month, a new team consisting of a nurse practitioner and a social services worker responds to certain 911 calls for medical issues that dispatchers suspect might not necessitate an ambulance ride to a hospital.

In many cases, those non-emergency calls come from “chronic” 911 users, according to fire officials. Some have mental illnesses or substance abuse issues, while other frequent callers have ongoing medical problems and lack proper care.

A fire engine and an ambulance, both staffed with medics, also responds, as is customary for 911 medical calls. But the so-called “DirectConnect” team arrives in a separate vehicle and, if appropriate, takes the lead in providing care for the caller.

“The goal is to look for some alternative ways of delivering medical care and services to high users of 911 and emergency medical services,” said San Rafael fire Battalion Chief Matt Windrem.

The DirectConnect team, he said, “could potentially provide some care that paramedics wouldn’t be able to provide that could prevent a trip to the emergency room.”

The pilot program is a partnership between San Rafael and the county public health department. The DirectConnect team is on call during limited hours—four days per week for six hours each day—while officials assess the effectiveness of the program.

“The public health benefit here is that we’re aligning people’s needs with the resources we have,” said Dr. Matt Willis, the county’s public health officer. “We have resources outside the emergency department, we just need to get people connected to them.”

About 11% of 911 calls for medical issues in San Rafael came from people who had called four or more times within six months, according to a recent health department review of dispatch records for the city. One person called 17 times during a six-month period that ended in January, which was the highest number of repeat calls. Three people called 10 times, which was the next-highest number.

“When we look at the data, we see that, for a significant portion of 911 medical callers, an ambulance ride and a trip to the emergency room are not the best way to met their needs,” Willis said. “It’s a real win for us if we’re able to protect the resources of those ambulances and emergency room beds for people who are actually experiencing real medical emergencies.”