07-01-2005, 04:45 PM #1
Volusia County Preventive Care Program
News Journal On line
Proposal aims to head off avoidable 911 calls
Preventative care program could reduce ER visits
By JAMES MILLER
Last update: May 31, 2005
An elderly diabetic living alone forgets to eat dinner when she takes her insulin.
Hours later, she wakes up on the verge of insulin shock and calls 911. Within minutes, paramedics are at her door. Soon, she's in an ambulance on the way to the hospital.
It's a common scene, according to Volusia County medical officials: an expensive and avoidable emergency room visit. They have a plan they think could help.
Under a new proposal, city and county firefighter paramedics could provide preventive care -- like checking in to see whether a forgetful diabetic is taking her medicine and eating her meals. Expensive medical costs could be avoided. Paramedics could get needed patient care training, and their departments might even bring in some cash, county officials said.
"The core is that we've got a whole army of health care providers who are extremely well-trained, talented, young and aggressive," said Dr. John Shedd, the county's medical director. "They've got the time, and they know their municipalities and the citizens who would benefit most from this better than anybody."
But some fire chiefs, while they like the idea, aren't convinced the voluntary program will be cost- or time-effective, and an official with county's largest hospital isn't sure about the need.
Under the "Community Health Program," city and county fire and medical officials would use 911 call logs and response records to try to figure out who they could help.
If the assistance is wanted, paramedics might drop by a diabetic's home to do a blood sugar check on the way back from another call; drop in on a homebound patient to make sure he's taking his medicines correctly; perform a cardiac test on someone who recently had heart surgery; or check a home for hazards that could cause an elderly person to fall.
Along the way, they could help reduce tie-ups in crowded emergency rooms and cut down on unnecessary medical expenses that can eat up tax dollars and cost almost everyone money, Shedd said."It comes out of necessity and need," he said.
Shedd, who is also the emergency room director for Florida Hospital Ormond-Memorial, said 911 dispatchers take about 65,000 emergency medical calls a year countywide, with about 40,000 leading to ambulance transports. While "every one of those calls is considered an emergency by the person who makes it," he said about 20 to 25 percent are actual medical emergencies.
Many of the others could be handled differently, he said.
At the same time, county Emergency Medical Services Director Matt Zavadsky said the program would provide useful additional patient care experience for paramedics.
He said Shedd's numbers reflect data from emergency response logs.
Shedd and Zavadsky drew up the plan after talks with local fire chiefs months ago. They've presented it to some city managers and the County Council also has gotten a preview. For county fire services to participate, the council would have to endorse a formal proposal. City commissioners would have to do the same for city fire departments.
Participation would be entirely voluntary and departments could chose to participate in whatever capacity suits their needs, but fire chiefs interviewed this week gave a mixed report. And John E. Evans, a spokesman for Halifax Medical Center, said officials there aren't seeing the need.
Evans said a reporter's call last week was the first hospital officials had heard of the plan. While he said he couldn't speak for any other hospital, he thought Shedd's estimate of the problem "would probably come as a surprise to our emergency department folks."
Costs were on the mind of Ormond Beach Fire Chief Barry Baker.
Zavadsky said he thinks the consensus is most costs would be limited, and two managed care organizations also have expressed interest in contracting home-care services, but Baker said he didn't think any reimbursements would be enough.
He also said he thought many patients would reject the additional care and questioned whether his paramedics would have the time based on their other duties, which he thought emergency medical officials were underestimating.
In Port Orange, Fire Chief Tom Weber said it's a "tremendous" idea, but the city will have to see what a study committee makes of it before deciding if or how much to participate.
"I could say, 'Hey great idea, just do it,' and then find out what the impact is," Weber said. "I want to find out what the impact is first."
For his part, Port Orange EMS chief and 23-year veteran Russell Rafferty hopes it works out. He thinks the program would benefit his paramedics as well as the community.
He pointed out that after the city amped up its flu shot program in the early '90s, Port Orange paramedics responded to fewer general emergency calls. He thinks that could happen again.
"I like it," he said. "It's more grassroots, back to the community and more like neighbors -- not just the fire station down the road."
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The comments, opinions, and positions expressed here are mine. They are expressed respectfully, in the spirit of safety and progress. They do not reflect the opinions or positions of my employer or my department.
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