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HOW TO STOP ABUSE A County’s Experience Dan Lynch, EMS Director

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Presentation on theme: "HOW TO STOP ABUSE A County’s Experience Dan Lynch, EMS Director"— Presentation transcript:

1 HOW TO STOP 9-1-1 ABUSE A County’s Experience Dan Lynch, EMS Director
Central California EMS Agency

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

3 FULL 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 County There are other programs in the State.

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

“Ignorance is Bliss” “What you don’t know won’t hurt you” WRONG!!

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

7 “Fresno, we have a problem!”
DISCOVERY Frequency of Use People % Once 49478 75.9% 2-3 11438 17.5% 4-5 2351 3.6% 6-10 1392 2.1% 11-20 399 Less than 1% 21-30 97 31-40 30 41-50 11 51-75 18 76-100 6 3 185 1 196 329 471 LOOKING AT THE DATA (aka: UH OH!) “Fresno, we have a problem!” Pre-hospital calls only

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 FREE GRRRR! This is a nightmare

9 DISCOVERY Identified “Target Audience”
Created a list of “Top 50” Abusers

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

11 DISCOVERY Identify the abuser. Look at the underlying problem.


13 Goal: HOW DO WE SOLVE THIS? Help them out of the system
NOT shut them out of the system Denying service is the last resort

14 Odd Jobs

15 Hospitals Social Services
SOLUTIONS 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 SOLUTIONS – Set Back Multi-Disciplinary Task Force
No interest from other participants Excuses.... News Media Intervention Exposed the crisis and abuse Public and political outcry Back on track

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

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

19 EMS ABUSE POLICY 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 1st, 2nd, 3rd Notice and Suspension Order Provides an appeals process Appeal panel Direction for Field Personnel CCEMSA Policy #570

20 EMS ABUSE POLICY Field Direction Sit-up/stand/walk = No Transport
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) We are not transporting you to the hospital.” Sit-up/stand/walk = No Transport

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

22 RESULTS 1991 calls / year Savings: $1,771,990 Dept Engaged 8 16%
1st notice 7 14% 2nd notice 4 8% 3rd notice 3 6% Suspended 1 2% Dead 5 10% Active 22 44% 50 100% 1991 calls / year Savings: $1,771,990

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

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 Challenges 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 Case Study #1 – “Cesar” 43 y/o male Substance abuser – alcohol
Heavy user of the system: Defiant – “I can use the ambulance whenever I want” 2008 2009 2010 2011 2012 2013 27 179 471 710 247 33

27 Suspension of Transport- April 6, 2012
Case Study #1 – “Cesar” Number of Responses Suspension of Transport- April 6, 2012

28 Case Study #1 – “Cesar” Number of Responses YIKES!!

29 Case Study #2 – “Richard”
31 y/o male Substance abuser – alcohol & drugs Heavy user of the system: 2008 2009 2010 2011 2012 2013 6 1 24 170 5

30 Case Study #2 – “Richard”
Suspension Order Second Notice Third Notice First Notice Number of Responses Homeless Services Engaged Mental Health Engaged

31 The 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!!)

32 CONTACT INFORMATION Dan Lynch Phone: (559) Abuse Policy: EMS Policy #570 Website: me for samples of notices or suspension orders

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