angelic performances: the evolution of mobile integrated health...
TRANSCRIPT
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Angelic Performances: The Evolution of Mobile Integrated Health
in the City of Angles
Marc Eckstein, MD, MPH, FACEP, FAEMSMedical Director & EMS Bureau Commander
Los Angeles Fire Department
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Current challenges
u Must show value in healthcare
u Budgetary restrictions & reductions
u Rising call volumes & response times
u High percentage of low acuity calls
u EMS Super Usersu Increased ER “wall
time”
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>25,000 homeless in City of LA, with 10,000 of them in downtown area
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What is the LAFD doing to address these issues?
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Los Angeles Fire Department
Serves nation’s second largest city – pop > 4
million
One of the most diverse
cities in America
Large % of population with limited English
proficiency
Huge income disparity
95 paramedic ambulances
50 BLS ambulances
85 ALS engine companies
10 ALS truck companies
400,000 EMS incidents/year
> 85% are EMS
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Mobile Integrated Health Efforts
u EMS Advanced ProvidersuAdvanced Provider Response Unitsu SOBER Unitu TelemedicineuAlternative Destination Response Unit
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Mobile Integrated Health:Advanced Provider Response Units
uMissions:• Low acuity pts: treat and release• EMS Super-Users: referrals to SW• Mental health pts: transport to psych urgent care• Inebriates: transport to Sobering Center
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Public Private Partnerships
u Local healthcare organizations fund salary of EMS AP
u LAFD pays for paramedic
u Equipment through private donations
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SOBER Unit – SOBriety Emergency Response Unit
u NP + Case Manager + paramedicu Went into service on Nov 2017u Transport medically cleared
inebriates to free standing Sobering Center
u > 500 pts transported during first 12 months of pilot program
u 4 secondary transports to ER < 4 hrs
u All for alcohol withdrawalu No adverse outcomes
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Telemedicine at 911 Dispatch
Center
u Advanced Providers and MDs at dispatch using telemedicine
u Triage patients with units on scene
u Avoid unnecessary ambulance transports
u Clinic referrals
u Taxi cab transports
u Matches the patient's health care needs with the appropriate level of service
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Alternative Destination Response Unit
u State pilot program
u Paramedics with additional training may use Medical Screening Tool to clear select patients to be transported to:uMental Health Urgent Care CentersuSobering Centers
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Challenges/Opportunites
u Financial sustainability
u Recruitment and retention of EMS Advanced Providers
u CMMI Emergency Triage, Treat and Transport (ET3) Model
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There is no such thing as an
inappropriate request…
BUT THERE CAN BE AN INAPPROPRIATE
RESPONSE TO THAT REQUEST
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If your system is still under the “You call, we haul” mantra you need to reconsider…
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Thank you
LAFD Advanced Provider Response Units