Presentation on theme: "HOW TO STOP ABUSE A County’s Experience Dan Lynch, EMS Director"— Presentation transcript:
1HOW TO STOP 9-1-1 ABUSE A County’s Experience Dan Lynch, EMS Director Central California EMS Agency
2OBJECTIVESUnderstand the importance of identifying frequent users in the EMS systemAcknowledge the impact and cost that frequent users have on the EMS systemRecognize tools and methods to reduce ambulance use by frequent usersRecognize challenges of dealing with frequent users in your system
3FULL DISCLOSURE I am Not an Expert in Ambulance Abuse I don’t have all of the answers – I have a lot of opinions.I know about Fresno County.Solutions will be different from County to CountyThere are other programs in the State.
4FRESNO COUNTY Central California Agricultural Center of the World Pop 976,000Pre-hospital Calls2012 – 165,916
5THE VALUE OF NOT KNOWING “Ignorance is Bliss”“What you don’t know won’t hurt you”WRONG!!
6DISCOVERING THE PROBLEM Hearing chatter from the fieldCalls from ambulance crews and hospitals“Two guys using the ambulance”“Cesar”“Lonzel”2010 – 471 transports2010 – 329 transports
7“Fresno, we have a problem!” DISCOVERYFrequencyof UsePeople%Once4947875.9%2-31143817.5%4-523513.6%6-1013922.1%11-20399Less than 1%21-309731-403041-501151-751876-100631851196329471LOOKING AT THE DATA(aka: UH OH!)“Fresno, we have a problem!”Pre-hospital calls only
85 STAGES of GRIEF DENIAL ANGER BARGAINING DEPRESSION ACCEPTANCE Who do they think they are!?!How can this be happening?There is No Way this data is correct…or we can put you on a bus to Nevada for FREEGRRRR!This is a nightmare
9DISCOVERY Identified “Target Audience” Created a list of “Top 50” Abusers
15Hospitals Social Services SOLUTIONSCreate a Multi-DisciplinaryTask Force“The Group”Create Policy for EMS PersonnelAt some point, we will have to deny serviceTopic: Frequent UserEMSMental HealthSocial ServicesHomeless ServicesHospitals Social ServicesLaw Enforcement
16SOLUTIONS – Set Back Multi-Disciplinary Task Force No interest from other participantsExcuses....News Media InterventionExposed the crisis and abusePublic and political outcryBack on track
17The Process Identified Frequent User Are they in the “System”? YesAre they in the “System”?NoDetermine Responsible AgencyYesCan they be referred?(or refuse)NoMental HealthSocial ServicesHomeless ServicesLaw EnforcementEMS Agency Abuse PolicyEngage personKeep “The Group” advised of abusersFollow-upEngage person
18Identified Frequent User EMS ABUSE POLICYIdentified Frequent User(not in system or refusing services)Group Notified*Letter – 1st Notice30 daysGroup Notified*Letter – 2nd Notice30 daysGroup Notified*Letter – 3rd (final) Notice10 daysEMS Medical DirectorOrder of Suspension of Ambulance ServicesGroup Notified*Hand-delivered or Certified MailLetters include reference information on where to obtain care or services.
19EMS ABUSE POLICY Defines an Abuser Twelve or more responses within a 90-day periodThe count does not include calls for 5150 transports.Provides a description of the process1st, 2nd, 3rd Notice and Suspension OrderProvides an appeals processAppeal panelDirection for Field PersonnelCCEMSA Policy #570
20EMS ABUSE POLICY Field Direction Sit-up/stand/walk = No Transport V. AMBULANCE PROVIDER RESPONSIBILITYA. Upon contact with an EMS abuser, who is specifically determined to be an abuser by the EMS MedicalDirector, 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 centercriteria, 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 thefollowing:“You have been identified as abusing the ambulance system. The EMS Medical Director hassuspended ambulance transport for you. You need to consider alternative transportation. If youfeel this is in error, you can contact the EMS Agency at (559)We are not transporting you to the hospital.”Sit-up/stand/walk = No Transport
21EMS ABUSE PROCESS IMPLEMENTED - March 2012 RESULTSJanuary 1, 2011 to December 31, 2012Number of ResponsesWeeksEMS ABUSE PROCESS IMPLEMENTED - March 2012
23RESULTS “Top 50” from 2008 to 2013 2011 – Out of Control 2013 Goal of 1140
24*** WARNING *** 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 2012Watch List of 22 people – “Nip it in the bud!”Need to feel immediate resistance.
25Challenges Law Enforcement Keeping other agencies / departments involvedDo not overwhelmKeep number of abusers manageableConsistencyKeep engaged with abuserIf you give them slack, they will take it.Everyone is treated the sameInteresting reactionsSmall Fire DeptPhysician Group
26Case Study #1 – “Cesar” 43 y/o male Substance abuser – alcohol Heavy user of the system:Defiant – “I can use the ambulance whenever I want”2008200920102011201220132717947171024733
27Suspension of Transport- April 6, 2012 Case Study #1 – “Cesar”Number of ResponsesSuspension of Transport- April 6, 2012
28Case Study #1 – “Cesar”Number of ResponsesYIKES!!
29Case Study #2 – “Richard” 31 y/o maleSubstance abuser – alcohol & drugsHeavy user of the system:20082009201020112012201361241705
30Case Study #2 – “Richard” Suspension OrderSecond NoticeThird NoticeFirst NoticeNumber of ResponsesHomeless Services EngagedMental Health Engaged
31The Short Version 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!!)
32CONTACT INFORMATIONDan LynchPhone: (559)Abuse Policy: EMS Policy #570Website: ccemsa.orgme for samples of notices or suspension orders