FDCARES: ONE FIRE DEPARTMENT’S CREATIVE APPROACH SOLVES MULTIPLE COMMUNITY NEEDS Mitch Snyder, a battalion chief at the Kent Fire Department (WA), understands that “EMS services are being forced to change. As we address the needs of our residents, we must work to reduce costs.” Medical calls make up more than 70% of the department’s responses1. The department has recognized that a large fraction of its medical calls are non-emergent in nature, while the health care system is moving away from supporting the transport-or-nothing approach. The department launched Fire Department Community Assistance, Referrals and Education Services (FDCARES) program to expand the services it provides to the community by offering fall prevention, care coordination, social services, patient navigation, readmission prevention, and low-acuity medical consults. These services are provided by a team of firefighter EMTs and registered nurses who respond to non-emergent calls with home visits. In one year, ED visits by Medicaid recipients decreased by 9.9% and ED visits by frequent utilizers decreased by 10.7%. 2 These services have made a positive impact on the department’s community, and FDCARES has shown that fire departments can stay at the forefront of innovation and offer more services that increase the value of care provided to the community. According to Snyder, “FDCARES is the next generation of Kent’s fire and emergency medical system. It is designed to maximize resources while saving tax dollars.” 1
they could survey homes for fall risks and train the elderly in disaster preparedness. EMS could be harnessed to screen, intervene and refer patients for food insecurity, vaccination status, elder and child abuse, and domestic violence. Indeed, in some communities, they are already utilized to administer flu and other vaccinations. Patient & Provider Safety Perhaps the area of most pressing need for innovation is in improving the safety of both patients and providers. The “Ambulance” hasn’t changed much in the last 30 years. Despite a few attempts, the ambulances commonly used in the United States are not designed for ongoing interaction between the provider and patient during transport. A great example is the fact that all of our ambulances are “left-handed,” meaning that the patients left side is oriented to the provider. European ambulances often allow for left or right sided patient care. Perhaps new technologies could be added so that as you approach an ambulance with a critically ill patient, the exterior lights turn on and the doors open automatically to allow for fewer interruptions in care. Accommodating children can also be a challenge on today’s ambulances. 28 Many resources, such as NASEMSO’s www.safeambulances.org, have been developed to aid providers and regulators in improving patient and provider safety, but more work is needed. Similarly, it will be incumbent upon regulators, providers and industry to continue to develop the types of equipment and safety systems that reduce error and preventable injury and death. We must also recognize that EMS is a demanding occupation, and providing mental health and suicide prevention should be central to discussions of provider safety. Innovations that support provider mental health are needed.
Mitch Snyder, “Fire Department Program Helps Prevent Illness and Injury,” EMSworld.com, last modified April 18, 2012, http://www.emsworld.com/article/10702385/fire-department- program-helps-prevent-illness-and-injury
28 “Working Group Best-Practice Recommendations for the Safe Transportation of Children in Emergency Ground Ambulances.” National Highway Traffic Safety Administration. Last modified September 2012. https://www.nhtsa.gov/staticfiles/nti/pdf/811677.pdf.
MOUNT SINAI HEALTH SYSTEM | UNIVERSITY OF CALIFORNIA, SAN DIEGO
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