"My prescription ran out and I want an ambulance to take me to the hospital to get it refilled." "What is your address, sir? We are sending an ambulance."
How many times a day does that happen in the United States? How many times have you been on a call similar to this one? Unfortunately, there are too many stories similar to this.
Each one of us has horror stories of someone who abused the 911 system for an ambulance trip to the hospital that could have been easily accomplished with some vehicle other than an ambulance. Some of the more bizarre stories I have heard over the years include a man who had chest pain for 18 years and then became concerned when the chest pains stopped one night. Only then did he call for an ambulance. Another one involved a woman who needed diapers for her baby and thought she could get them at the emergency room free. Still another involved a woman who could not open a medicine bottle - she did not want to disturb her sleeping husband on the couch, so she called for an ambulance to open the medicine bottle.
Paramedics and firefighters have their own vocabulary to describe such situations. Some include "positive samsonite signs," which is a situation involving an emergency response and when you arrive the person is standing at the curb with a suitcase. Another saying is "frequent flier," which is someone who frequently uses the ambulance for no true emergencies. Finally, some contend that EMT actually means "Expensive Mobile Taxi."
Unfortunately, 911 has become the entry point for many people to the health care system who do not have a primary physician. It is too easy - push three buttons on your telephone and someone drives you to a doctor, and you do not need any cash in your pocket.
One fire department that has done something about 911 abuse is the Lakewood Fire Department in Washington state. The Lakewood Fire Department has approximately 100 career firefighters, covering 22 square miles and a population of 60,000, responding to about 7,300 calls annually from four stations with a fifth one being built. The department does advanced life support (ALS) transport with basic life support (BLS) transport handled by a private provider.
The innovative program was the brainchild of Paramedic/Firefighter Jay Sumerlin, who has been with the department for 18 years. As Sumerlin describes it, he works on an engine company in a low income area of the city. Since the department dispatches an engine company to all EMS runs, Sumerlin would frequently see citizens who abused the 911 system.
In Washington state, the Department of Health and Social Services (DHSS) issues coupons for a variety of uses, including ambulance transport to the hospital. Many of the 911 abusers would use the coupons as a method for going to the emergency room for medical treatment since many did not have a primary physician.
With the call load increasing, Sumerlin saw a need to address the issue. Sumerlin approached Chief of Operations Ken Sharp with an idea of using a taxi to transport such patients to the hospital, a doctor's office, etc. Sharp told Sumerlin to put together a pilot program, which he quickly set about doing. Within a short period, Sumerlin had a contract signed with a local taxi company. Additionally, protocols were put in place where the paramedic or the EMT on the engine would assess the patient and if they deemed the patient could go by private vehicle or taxi, they would contact medical control with their findings. Only the physician at medical control would have the authority to permit a patient to go by taxi.
After medical control authorizes the taxi ride, the engine company fills out a taxi voucher for the patient, a taxi is called, and the engine company exits the scene.
At first, the program was financed by sending a bill to the patient. Shortly thereafter, the Franciscan Foundation and International Association of Fire Fighters (IAFF) Local 1488 contributed money to the Lakewood Life and Safety Charity Fund, a non-profit corporation, to pay for the taxi vouchers. Since then, local businesses and other groups have contributed to the fund. Because it is a non-profit corporation, they can write off the donations on their taxes.
Citizens do not have the option of calling directly for a taxi. When 911 is called, dispatchers using a Criteria Based Dispatching (CBD) program determine the nature of the call and send the correct and appropriate response. It is only after an assessment has been conducted of the patient and medical control is contacted, that the taxi program is activated.
The taxi program is not strictly limited to transporting patients to emergency rooms. In the past, the program has been used for transporting patients to a detox unit, a doctor's office or a pharmacy. The program has even been used for people whose cars were destroyed in fires and who did not have a way to get home, or for parents whose child was in cardiac arrest and who were too distressed to drive their personal car to the hospital.
The program has been operational for about one year and has been completely successful. There have been no adverse events, since if even if there is a question concerning the patient's condition, an ambulance is used for transportation to the hospital. Not only has it been successful operationally, but also financially. In the first year, the department has seen a savings of over $26,000, with only $414 in taxi vouchers given out.
With the increased demand for EMS services and emergency rooms diverting patients away because of overloading, kudos to the Lakewood Fire Department for thinking outside the box and devising an innovative method for dealing with 911 abuse.
Gary Ludwig, MS, EMT-P, a Firehouse® contributing editor, serves as the Chief of Special Operations for Jefferson County, MO. He retired as chief paramedic from the St. Louis Fire Department after serving the City of St. Louis for 24 years. Ludwig has trained and lectured internationally and nationally on fire and EMS topics. He also operates The Ludwig Group, a professional consulting firm. He can be reached at 314-752-1240 or via www.garyludwig.com.
