Within 10 minutes of receiving a 911 call that a 61-year-old man had passed out, a paramedic and a doctor pulled up outside J.K. Lewis Senior Center in a red SUV.

The health care duo checked the patient’s heart rate, blood pressure and temperature.

Last year, the man would have been taken by ambulance to the ER to receive treatment for his dehydration.

Memphis Fire is one of several agencies across the country that is rethinking 911 services for non-emergency calls like this and at the same time addressing health care needs of patients they are called to assist.

The city has the largest 911 EMS/ambulance service in the state. Last year, the fire department had 130,000 EMS calls and of that number 25,000, or about 1 in 5 were categorized as non-emergency.

“That doesn’t mean they are not urgent to the people who are calling, it means that 22 percent were non-life threatening. So we recognized those kinds of calls were tying up our resources, so we wanted to make sure we have the right resource available at the right time,” said Memphis Fire Department Director Gina Sweat.

In April, the fire department launched the “Right Response” a pilot program that pairs a doctor and a paramedic for non-emergency calls.

“We recognized that with our EMS system the call volume continued to increase year after year and city budgets don’t always increase in line with that need, so we recognized that if this continued it would be a point to where we wouldn’t be able to provide efficient service,” Sweat said.

‘The Right Response’
Memphis paramedic/firefighter Rebecca Luckey drives the rapid response SUV on a recent Tuesday morning as Dr. John David Williamson with Resurrection Health navigates through the 911 calls on a laptop.

Since 8 a.m., the two have been on three house calls. Sending an ambulance to those calls instead would have cost the patient $850 to go to the ER for non-life threatening illnesses.

After treating the patients, the two provide them with information about a primary care doctor if they need one, and most do. They also secure them a ride to a doctor’s office.

Since the “Right Response” program launched five months ago, the doctors and paramedics have responded to more than 600 calls. The pilot program costs roughly the price of two firefighter/paramedic salaries -which is about $55,000.

The fire department has partnered with Resurrection Health who provides doctors to ride with the paramedics on the calls. The Plough Foundation provided grants that bought the two SUV’s that are used on house calls.

Other health care organizations have provided staffing or funding for the initiative including the Assisi Foundation, Saint Francis Hospital, Baptist Memorial Healthcare, Regional One Health, Christ Community Healthcare, Methodist Le Bonheur Healthcare and Innovate Memphis.

“Right Response” is a pilot project now, but fire officials hope to make it permanent.

‘Can I speak with the nurse?’
This month, another phase of the project will launch and will have a nurse working at the 911 dispatch center to talk with residents and assess their health care needs.

“We realize those residents are calling us because they don’t know where else to turn,” said Sweat. “If it is not an emergency, residents can speak directly with the nurse.”

The community paramedicine or telemedicine concept is gaining momentum across the country, said Matt Zavadsky, president-elect of the National EMT Association.

Zavadsky said their data shows that 210 EMS systems in the United States have programs operating as “mobile integrated health” and they coordinate house calls and telemedicine through 911 systems, fire departments and local health departments.

Zavadsky, who is the chief strategic integration officer for MedStar Mobile Healthcare in Fort Worth, Texas said their mobile integrated health project started in 2009. It includes a nurse in the 911 center and an 11-person team of paramedics and a nurse case manager who manage the high utilizer group or HUGS – patients who frequently call 911 for non-emergencies.

“We have seen, with the high utilizer program, there is about a 55 percent reduction in 911 and emergency department use with the patients who enrolled in the program,” Zavadsky said. “With our nurse in our communication center, about 33 percent of the calls go to the nurse. They don’t even get an ambulance response because people will say “can I speak with the nurse?”

He added that the programs are helping patients avoid costly and time-consuming trips to the emergency room and helping improve their health care needs.

“Nationally, these programs are taking off primarily because of the economic incentives today for hospitals. Third-party payer insurance companies are really focusing on value,” Zavadsky said. “I will be the first to tell you, I have been in EMS for 37 years and there is more value in navigating someone through the health care system than just simply schlepping every person that calls 911 to the emergency room.”