New Breed of First Responder Helps Solve America's Health Care Crisis

by Francis P. Koster, Ed.D.

Some of the most costly healthcare delivered in the United States starts with a call to 911. This triggers a expensive ambulance run, which usually results in an expensive emergency room visit. After recovery, the patient goes home. And often starts the cycle over again with another call to 911. 

One role model worthy of learning from in this arena is MedStar, a public utility model ambulance system serving 15 towns in the Dallas/Ft. Worth Texas area. ⁱ They have figured out how reduce the number of calls to 911, how to respond to them quicker, how to have a higher trained ambulance crew and how to improve patient care - all the while reducing total healthcare cost. 

Here are a few of the techniques they use. 

They matched the fleet to the need - MedStar examined how often calls for help came in, and from where. They found out that the majority of the calls came during two peak times of the day - but that historic staffing schedules had the same number of trained people standing by in ambulance garages 24 hours a day. By making the shifts 12 hours, instead of the previous 24 hours, and overlapping the shifts, they were able to have 50% more crews standing by during the peak call time.ⁱⁱ This resulted in two things - faster response times, and much lower payroll, because they did not have to pay excess staff during the quiet times. 

They also moved the "on-duty" ambulances depending on the time of day, placing them where the history indicated calls would come from at that time, instead of having them sit in a garage or fire station. Think of it as defensive football...if you know a pass is coming, you deploy your defense against it. Again, shorter response times. 

Dealing with "Frequent Riders" - MedStar did an analysis of who called for the ambulance, and for what, and found that 21 of their most frequent callers resulted in nearly 1,000 ambulance calls in one year.ⁱⁱⁱ These "frequent riders" amounted to $1.1 million in ambulance charges and nearly $2.5 million in emergency room charges..^iv Reducing the number of calls from "frequent riders" for the entire Ft. Worth area would save a lot of healthcare time and money, and the patient would be healthier. And taxes could decline. 

Armed with this list of "frequent flyers", MedStar assigned a paramedic on "light duty" due to injury to make what amounts to house calls to check up on the patients. These "house calls" uncovered a lot of circumstances which would have resulted in further calls for help if not addressed. As a result of this kind of intervention, the use of the ambulance service by these callers declined by 51%^v 

Another technique that helped was to simply review with the "frequent riders" the cost of the ambulance and hospital. Many of these folks often had no idea of the cost, and some changed their behavior when educated. 

MedStar did research on their assumptions to check them out - and found some surprises. Research demonstrated that "running cold" (no lights or sirens) instead of screaming down the road actually did not increase the time from the first call to the arrival at the hospital, but did allow for the EMT crew to tend to the patient better (putting in needles, and so forth) , because neither the patient nor the EMT were thrown from side to side when brakes were applied or abrupt turns occurred. The patient actually arrived in better shape without sirens being used! ^vi 

During their research the ambulance service noted that they had a high percentage of calls to large gatherings where mature guests suffered heart attacks, and medical people were among the guests, but the event hall had no defibrillator. MedStar allows party planners to request the loan of a defibrillator from their website to have it on hand at the party^vii, thus raising the chances of a heart attack victims survival.

 And they made getting training easier - when the crews were on call, but not busy, they were given access to training via electronic distance learning, which they were able to login to while waiting for a run. During time passing with no emergency, the crews were in school. 

The system, which started covering solely Fort Worth and grew as other area cities recognized the value of joining a regional system, now numbers 55 ambulances and 325 employees - with over 200 fully licensed, highly trained EMTs and Paramedics, with a very large number of these holding advanced certification due to the "training while waiting" plan. 

With all the discussion about saving Medicare, you don't need to be a futurist to see that unless something is sensible is done to improve our healthcare non-system, we will either bankrupt our country, or deny millions healthcare. It does not need to be that way. You can help bring about change by helping community leadership study successful models already in place elsewhere that improve the health of our people while lowering costs to private business and taxpayers. And if you don't like this model, suggest another - but don't just sit there. Working together, and learning from one another, we can fix the problems facing our country.