Too many vulnerable people are trapped in crowded hospital emergency rooms who didn’t need to be there. The emergency room revolving door isn’t helping them, and it’s putting other critical patients at risk.
By Brian K. Rice
Brian K. Rice is president of the California Professional Firefighters, labor organization representing 30,000 front line firefighters, firstname.lastname@example.org. He wrote this commentary for CALmatters.
In 31 years as a firefighter and local union president, I’ve seen things on the job and heard stories told by my members that don’t easily go away.
Often, these experiences break your heart. Sometimes, they make you mad as hell.
A few years back, a 73-year-old woman called 911 to the Sacramento Metro Fire Department complaining of nausea and vomiting.
We transported her to the emergency room. She should have been seen quickly but the ER was packed with 120 other patients. Many of them would have been better served elsewhere.
So she waited and waited in the hallway of one of the capital city’s major hospitals, while Sac Metro paramedics attended to her. After more than an hour, she went into severe distress.
Our paramedics furiously delivered advanced life support on the spot. It wasn’t enough. She died on the gurney in the hospital corridor. She never made it to the ER doctor.
I’ve answered calls like the one from this woman, and have spent hours in hospital emergency rooms.
I’ve also answered calls from people who should not have been in the ER: chronic inebriates, severely mentally ill people and other vulnerable patients who would get better help at a sobering center, a substance abuse center or a mental health provider.
Police officers and sheriff’s deputies have the discretion to help guide these at-risk individuals to the right help. But by law, fire department paramedics who are trained, skilled medical personnel, cannot offer those better choices. It’s straight to the overcrowded, overstressed ER.
It’s frustrating, and it doesn’t always have to be that way.
In California, some fire agencies have found success with a promising care model for at-risk patients: community paramedicine.
As with community policing in law enforcement, community paramedics draw on local resources and their own knowledge and experience to guide patients to the help that will do them the most good.
Sometimes, it’s an alternative destination – a sobering center or a mental health care provider. In the city of Alameda, community paramedics are providing critical post-discharge care – bridging the gap to home health for many critical heart patients without any support system at home.
No patient is ever forced to an alternative destination.
Over the past several years, nearly two dozen community paramedicine pilot programs have been implemented in California, and by any measure, the projects have exceeded expectations.
According to a study by UC San Francisco’s Institute for Health Policy Studies, hospital readmissions have gone down in all but one of the 23 pilots to date. In some cases, the readmission rate dropped by as much as two-thirds.
Most importantly, community paramedics are, according to the report, “enhancing patients’ well-being.”
Every public safety agency in California should have the option to bring this creative, effective and humane model of emergency care. Legislation on Gov. Jerry Brown’s desk – Assembly Bill 3115 by Assemblyman Mike Gipson, a Democrat from Carson, would provide that flexibility.
AB 3115 would let local agencies establish their own community paramedic systems, with specific medical protocols, training standards and special licensing and oversight through local and state Emergency Medical Services agencies.
Emergency room physicians, firefighters, fire chiefs and mental health care providers – people on the front lines of our broken, cost-driven emergency response system – have embraced community paramedicine.
It’s not the magic bullet to end overcrowded ERs. But I’ve seen too many vulnerable people trapped in crowded emergency rooms who didn’t need to be there. The emergency room revolving door isn’t helping them, and it’s putting other critical patients at risk.