Vol Squad Drives Alternative Response in N.J.

Anyone who has worked in EMS knows about the “frequent fliers.” These are the folks for whom your unit or system gets frequent calls. Perhaps it’s a homeless person who doesn’t have access to medications; maybe it’s a “emotionally disturbed person” struggling with mental illness; maybe it’s a case of repeated domestic violence, elder abuse, or substance abuse.

What do all these calls have in common? They often less represent the emergency in emergency medical services and more often chronic issues to which an EMS response or hospital transport are temporary fixes instead of solutions for definitive, long-term care.

South Orange is a suburban/quasi-urban town in Essex County, N.J. It is incredibly diverse in both the background and socioeconomic status of its residents. With a population of 17,000, South Orange is also the home of Seton Hall University and its additional 11,000 students. South Orange’s EMS is provided by the all-volunteer South Orange Rescue Squad and its 30 EMTs (and, during weekdays, by a unit from the RWJBarnabas Health system).

South Orange, like many communities, is no stranger to high utilizers. Recently its leaders decided to do something to improve the situation. Through a partnership between the village of South Orange, Essex County, Seton Hall University, the South Orange Rescue Squad, and the South Orange Police Department, the Community Care and Justice Program was launched in October 2021.

Community Care and Justice Program

Composed of two social workers and professors from Seton Hall and three interns from Seton Hall, Rutgers University, and New York University, the Community Care and Justice Program (CC&J) has a mission to serve and protect the vulnerable and underserved in the area through an engagement protocol and providing social service resources. Says its mission statement:

CC&J is premised on a wide body of research that establishes viable alternatives to certain aspects of law enforcement, as well as public health and safety. It is focused on introducing these alternatives and augmenting the status quo with methods that stress the overall health and wellness of the community—including the use of social workers and community teams to engage with residents who may be experiencing mental health crises, substance misuse, homelessness, domestic violence, or racial inequities.

Those are among the issues with which the CC&J program interfaces: homelessness, elder abuse, hoarding, sexual assault, domestic violence, substance abuse, and mental health.

CC&J Protocol

When a South Orange Rescue Squad or South Orange Police unit encounters a person with these issues who is either a repeat patient or appears in need of additional social services, they follow an established protocol.

The patient is assessed and screened for medical issues and then transported, if needed, to an appropriate emergency department. During the encounter the EMS crew obtains written consent from the patient or their guardian to share their information with and be contacted by CC&J social workers. The patient is told about CC&J and that it is a free program that can connect them with resources. The ePCR has a script EMTs read, and if the patient agrees, it has a HIPAA release they sign.

Once that’s complete, after the call the EMTs complete a HIPAA-compliant electronic CC&J referral form where they include a narrative of the encounter, the initial reason for their dispatch, and if the patient is a repeat patient. After receiving that referral, CC&J contacts the patient to meet with them either in their home, at another public location, or over the phone, depending on the patient’s desires and situation. At that time they perform a social intake and connect the patient to social services resources, mental health resources, and other needed longer-term interventions.

More Than a Band-Aid

In an interview with the local website Tap Into SOMA, South Orange EMS Chief Victor Rothstein was excited about the partnership.

“The rescue squad is very excited to be a part of this outreach,” said Rothstein. “What EMS offers patients is essentially a Band-Aid fix in most cases, a stabilization of acute illness and injury until we can get the patient to a hospital. Although our EMTs are considered among the most capable in the region, many times patients need longer-term assistance we…cannot provide. In fact, frequently we get called to individuals who don’t actually need medical attention per se but still need some form of professional help or access to resources. In these cases the social workers the CC&J program provides will make more of a difference than any ambulance or hospital could.

“We have been hoping for a program like this for a long time, and the Community Care & Justice outreach team will help make major progress in ensuring the residents of South Orange can survive and thrive in some difficult situations.”

Deputy EMS Chief Annie Carman concurred: “This program…should see an increased quality of life for some of our more vulnerable and chronic patients, save emergency resources for those who might need them more, reduce using emergency responses to help solve more chronic issues, and, most important, get people the specific social services resources they need.”

Professor Kristin Miller of Seton Hall is director of the CC&J program. In this role she works with clinicians and students to coordinate social work, mental health, and substance misuse services to local residents. As part of her duties, per the university, Miller will also “design policy and programming for the wellness outreach initiative as well as a strategic calendar of community wellness training and a mental health resource guide. She will provide supervision to staff and volunteers and outreach and case management support to community members while working with police and EMS to leverage research and strategize prevention.”

Resources

Ricciardelli M. Social Work Professor to Lead Community Outreach and Wellness in South Orange. Seton Hall University, 9 Aug 2021; www.shu.edu/arts-sciences/news/social-work-professor-to-lead-community-outreach-in-so.cfm.

Smith F. South Orange Cops and EMTs Now Sending Referrals to Social Work Outreach Team. Tap Into SOMA, 22 Oct 2021; www.tapinto.net/towns/soma/sections/health-and-wellness/articles/south-orange-cops-and-emts-now-sending-referrals-to-social-work-outreach-team.

Barry Bachenheimer, EdD, NREMT/FF, has been involved in EMS and the fire service for over 35 years. A career educator, he is a member and training officer for the South Orange (N.J.) Rescue Squad.