Fire Chief Randy Bruegman and Paramedic Captain Dave Barry have been helping our collective efforts to increase the use of CRR concepts locally by sharing this example of their Community Care Response Unit (CCRU) and how it came about. It is a nontransport unit that is staffed with a paramedic and a nurse practitioner to respond to low acuity calls, providing assessment and care directly in the field. It is modeled after a pilot program in Mesa, Arizona, but also arose out of a realization that the Affordable Health Care Act provided Anaheim with an opportunity to partner with local hospitals to find better and less expensive ways to provide service.
Anaheim’s risk assessment, like many others, showed a very high incident rate for medical calls in the community, and the responders knew the numbers were only going to climb because of an aging population. They also had impetus to put the program together because of a report released in 2012 from the Orange County Grand Jury. This rather unique aspect of a grand jury is new to me but driven by state law in California. The civil, or “watchdog,” responsibilities of the grand jury include the examination of all aspects of county government, including special districts, to ensure the county is being governed honestly and efficiently and county monies are being handled appropriately.
|The CCRU is a nontransport unit that is staffed with a paramedic and a nurse practitioner to provide assessment and care directly in the field. (Photos by Anaheim Fire & Rescue.)|
|This model provides them with the opportunity to integrate ourselves into the broader public health arena, where they are viewed as an integral part of the overall medical system.|
The report helped provide the impetus for change in Anaheim, which Bruegman leveraged into support for the plan to implement a Mobile Integrated Healthcare Division.
The goal of the program was to increase advanced life support (ALS) availability, test mobile health care integration, create a hospital-fire-ambulance partnership, and reduce trips to the emergency room. The partnership was formed with the Kaiser Permanente of Orange County and CARE Ambulance service. They secured a private ambulance and equipped it so that they could (among other things) bandage, suture, clean wounds, prescribe certain medications, conduct blood analysis, and communicate directly with primary and urgent care facilities.
True to our model of CRR, their efforts include an evaluation component to demonstrate the results they have achieved. Between May 2015 and May 2017, they have documented a number of improvements that show the value of this program, including the following:
• 1,709 dispatches.
• Saw 554 patients.
• Ran on an average of 23 calls per month, 5.4 calls per week.
• 9.31 percent of the unit dispatches were for repeat calls.
• Top diagnoses were lacerations, anxiety, weakness, abdominal pain, and nausea.
• Procedures ranged from education to wound care and making appointments for patients at other facilities.
It is worth it to note that 5.78 percent of the patients they encountered were homeless. By now, readers can tell the people being dealt with are at least in part those who use the system extensively and often end up at the emergency room because they have no other healthcare options. So, starting this program helped Anaheim get ahead of the call, and personnel measured it to show how.
• 83 percent of all ALS units were released after the CCRU responded.
• ALS units were released in 84.3 percent of all patients.
• 56 percent of patients were NOT transported to the emergency department.
• 51 percent were treat and release, 42 percent were transported basic life support, 2 percent ALS, and 5 percent referred for an appointment.
Anaheim estimates that there were about $280,000 of cost savings for medicare expenses, $580,000 of potential cost savings in provider billing amounts, and 523 potential emergency bed time hours saved—which amounts to a very large savings to the hospital providers.
Anaheim is still working on the program, but I think it’s a wonderful example for us to consider. It certainly dispels the notion that CRR is just another name for prevention, though it does help us to focus on a critical aspect of CRR: focusing on outcomes that improve public safety and reduce risks. I have to credit our friends at Marketing 4 Change for coming up with the phrase “get ahead of the call.” They are the marketing firm in Florida that has done so much to help refine outreach efforts for the Vision 20/20 Project.
I also need to credit my friend Monica Colby of Rapid City, South Dakota, for her help in putting the case study for Anaheim in order. A tip of the hat to Chief Bruegman, a long-time friend, who is helping to pioneer the concepts of CRR in Anaheim.
I know there are a growing number of fire departments across the nation that are beginning to look at this model, and I think it’s a big part of the future for the American fire service. It provides us with the opportunity to integrate ourselves into the broader public health arena, where we are viewed as an integral part of the overall medical system. It helps us to improve our community relations, and it does help us focus on getting ahead of the call volume. Because although fires are going down, overall call volume is going up and will continue to get worse as our population ages.
To learn more about Anaheim’s efforts, contact Captain Dave Barry at Dbarry@anaheim.net.
Jim Crawford, FIFireE, is project manager for Vision 20/20 and a retired fire marshal and deputy chief of the Vancouver (WA) Fire Department. He is a member of the NFPA technical committee on professional qualifications for fire marshals, a former member of the Standards Council for the NFPA, a fellow of the Institution of Fire Engineers, a life member of the IAFC, and past president of the International Fire Marshal’s Association. Crawford is the author of Fire Prevention Organization and Management and is an editorial board member of FireRescue. He has received the R. Wayne Powell Excellence in Fire Prevention Award, the Dr. Anne Phillips award for leadership in fire and life safety education from the Congressional Fire Services Institute and the International Fire Service Training Association, the “Fire Protection Person of the Year” from the Society of Fire Protection Engineers, and the Percy Bugby Award from the International Fire Marshal’s Association.