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A Countys Experience Dan Lynch, EMS Director Central California EMS Agency.

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Presentation on theme: "A Countys Experience Dan Lynch, EMS Director Central California EMS Agency."— Presentation transcript:

1 A Countys Experience Dan Lynch, EMS Director Central California EMS Agency

2 1. Understand the importance of identifying frequent users in the EMS system 2. Acknowledge the impact and cost that frequent users have on the EMS system 3. Recognize tools and methods to reduce ambulance use by frequent users 4. Recognize challenges of dealing with frequent users in your system

3 I am Not an Expert in Ambulance Abuse I dont have all of the answers – I have a lot of opinions. I know about Fresno County. Solutions will be different from County to County There are other programs in the State.

4 Central California Agricultural Center of the World Pop 976,000 Pre-hospital Calls 2012 – 165,916

5 Ignorance is Bliss What you dont know wont hurt you WRONG!!

6 Hearing chatter from the field Calls from ambulance crews and hospitals Two guys using the ambulance 2010 – 471 transports2010 – 329 transports Cesar Lonzel

7 LOOKING AT THE DATA (aka: UH OH!) Fresno, we have a problem! Frequency of UsePeople% Once4947875.9% 2-31143817.5% 4-523513.6% 6-1013922.1% 11-20399 Less than 1% 21-3097 31-4030 41-5011 51-7518 76-1006 101-1503 1851 1961 3291 4711 Pre-hospital calls only

8 DENIALANGERBARGAININGDEPRESSIONACCEPTANCE There is No Way this data is correct Who do they think they are!?! GRRRR! …or we can put you on a bus to Nevada for FREE How can this be happening? This is a nightmare

9 Identified Target Audience Created a list of Top 50 Abusers

10 Impact of Top 50 Abusers 4,367 responses Cost: $3,895,364 (year 2012 data)

11 1.Identify the abuser. 2.Look at the underlying problem.

12 IHSS 80%

13 Goal: Help them out of the system NOT shut them out of the system Denying service is the last resort


15 Create a Multi-Disciplinary Task Force The Group Create Policy for EMS Personnel At some point, we will have to deny service Topic: Frequent User EMS Mental Health Social Services Homeless Services Hospitals Social Services Law Enforcement

16 Multi-Disciplinary Task Force No interest from other participants Excuses.... News Media Intervention Exposed the crisis and abuse Public and political outcry Multi-Disciplinary Task Force Back on track

17 Identified Frequent User Are they in the System? Determine Responsible Agency Mental Health Social Services Homeless Services Engage person Follow-up Yes Can they be referred? (or refuse) Yes Law Enforcement EMS Agency Abuse Policy No Keep The Group advised of abusers Engage person No

18 Identified Frequent User (not in system or refusing services) *Letter – 1 st Notice *Letter – 2 nd Notice *Letter – 3 rd (final) Notice EMS Medical Director Order of Suspension of Ambulance Services 30 days 10 days *Hand-delivered or Certified Mail Letters include reference information on where to obtain care or services. Group Notified

19 Defines an Abuser Twelve or more responses within a 90-day period The count does not include calls for 5150 transports. Provides a description of the process 1 st, 2 nd, 3 rd Notice and Suspension Order Provides an appeals process Appeal panel Direction for Field Personnel CCEMSA Policy #570

20 Field Direction V. AMBULANCE PROVIDER RESPONSIBILITY A. Upon contact with an EMS abuser, who is specifically determined to be an abuser by the EMS Medical Director, the ambulance personnel will make an initial scene assessment upon arriving on scene. 1. If the patient is not ambulatory, cannot sit unassisted, meets 5150 criteria, meets trauma center criteria, or the paramedic recognizes a medical condition that requires immediate medical treatment, normal policies and procedures for patient assessment, treatment and transport shall be initiated. The EMS Medical Director may modify these criteria on a case-by-case basis. 2. If the patient does not meet the above criteria, the EMS crew will advise the individual of the following: You have been identified as abusing the ambulance system. The EMS Medical Director has suspended ambulance transport for you. You need to consider alternative transportation. If you feel this is in error, you can contact the EMS Agency at (559) 600-3387. We are not transporting you to the hospital. Sit-up/stand/walk = No Transport

21 January 1, 2011 to December 31, 2012 EMS ABUSE PROCESS IMPLEMENTED - March 2012 Number of Responses Weeks

22 Dept Engaged816% 1st notice714% 2nd notice48% 3rd notice36% Suspended12% Dead510% Active2244% 50100% 1991 calls / year Savings: $1,771,990

23 Top 50 from 2008 to 2013 2011 – Out of Control 2013 Goal of 1140

24 WATCH THE BACK DOOR! Others will be entering the system – not in the top 50 Person # 1 – 113 responses (Dec 19 and Mar 1) Person # 2 – 101 responses (Jan 4 to Mar 31) Person # 3 – 50 responses (Jan 2013) Person # 4 – 170 responses in 2012 Watch List of 22 people – Nip it in the bud! Need to feel immediate resistance.

25 Law Enforcement Keeping other agencies / departments involved Do not overwhelm Keep number of abusers manageable Consistency Keep engaged with abuser If you give them slack, they will take it. Everyone is treated the same Interesting reactions Small Fire Dept Physician Group

26 43 y/o male Substance abuser – alcohol Heavy user of the system: Defiant – I can use the ambulance whenever I want 200820092010201120122013 2717947171024733

27 Suspension of Transport- April 6, 2012 Number of Responses

28 YIKES!! Number of Responses

29 31 y/o male Substance abuser – alcohol & drugs Heavy user of the system: 200820092010201120122013 661241705

30 First Notice Second Notice Third Notice Suspension Order Homeless Services Engaged Mental Health Engaged Number of Responses

31 Admit you have a problem. Find out who your abusers are. Get help from the people that can do something. Also look at other programs in other counties. Create a process to engage. Stay consistent and constant. Keep EMS field personnel advised. (IMPORTANT!!)

32 Dan Lynch Phone: (559) 600-3387 Email: Abuse Policy: EMS Policy #570 Website: Email me for samples of notices or suspension orders

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