Innovation in Emergency Medical Response

Here is an interesting article about innovation in 9-1-1 response. Sue Hoyt, our former Chairman for many years and former President of the Emergency Nurses Association, brought it to my attention.

Right now, when someone calls 9-1-1 and says they need emergency medical help, we often under resource (do nothing), and more often over resource (send an ambulance), when the situation calls for something in between. The English emergency medical response system began experimenting with using their 1-1-2 (their 9-1-1) system as a gateway to a range of medical services several years ago, using nurses as triage experts. Richmond EMS, led by Jerry Overton, was the first in the US to try it. Now Louisville, Ky and COMCARE member Priority Dispatch are trying it there.

With budgets tightening, and technology making it easy to pull in expert resources, we can expect more pressure for more informed response.


February 22, 2009
Lexington Herald-Leader

Louisville looks to ease emergency room backlogs


Officials in Louisville are looking at a new screening system for 911 calls as a way to reduce overcrowding in emergency rooms and limit ambulance runs.

Metro EMS recently received a $50,000 grant to look into how best to filter out lower priority calls that don't require an ambulance.

Dr. Neal Richmond, director of Metro EMS, said hundreds of ambulances are sent out each year in Louisville to respond to ailments that might not require one. Those calls are taxing the city's emergency response system.
Many of them go to 911 operators either because the patients making the calls have limited health insurance or they have no doctor or one who is unavailable.

"If there's an alternate way to handle 911 calls and get people the care they need, we're all about that," said Debbie Fox with MetroSafe Communications. "It's very innovative."

If the system is enacted, The Courier-Journal reported that 911 calls deemed low priority would be rerouted to a registered nurse, who would determine what care is needed. That could range from recommending treatment at home or making an appointment for the patient to visit a doctor or clinic.

This month, EMS officials talked about potential new software with doctors, nurses, hospital administrators, emergency dispatchers, social service agencies and others.

Greg Scott with Priority Dispatch, the company that developed the software, said only Richmond, Va., has incorporated it fully in the United States. A few other American cities have tried it, and the system is prominent in Britain.

Implementation won't happen overnight. It will take a significant network of resources, including requirements for medical providers to keep appointments open and assistance from transportation companies in providing taxi vouchers or bus rides.

"It's a vast effort," Richmond said.

Steve Heilman, a doctor with Norton Healthcare, said he expects the program could help reduce hospital crowding but warns it will take some education for the public to catch on.

"Community perception is going to be a very difficult area to address,"
he said. "People call 911 expecting to get an ambulance."