Introduction: For years, rising EMS call volumes have taxed resources in EMS jurisdictions. A significant problem of utilization by frequent 911 callers has contributed to transports and ED utilization, some of which may be unnecessary. Solutions to this have been limited for field providers. Purpose: We wished to both pilot a new EMS partnership with our county's Health and Human Services Agency (HHS) that could intervene with services for these "super-users," and study the scope of the problem, with the goal being appropriate alternate dispositions besides EMS activation.
Hypothesis: Intervention through referrals from multiple sources to a new EMS-HHS partnership will have an impact on EMS utilization by super-users.
Methods: We identified the most frequent 911 users by medical and dispatch records and referred them for intervention by our partnership with HHS. We retrospectively reviewed the call volumes before and after HHS intervention. We then used a new electronic patient care record (ePCR) system to conduct a retrospective 14-month study of the scope of the problem that may be impacted by ongoing partnership.
Results: The highest users (N=14), who generated 128 total calls in the quarter ending in March 2015, were referred to HHS, which enhanced the services available to them. They were primarily vulnerable adults. In the quarter after intervention, their call volume decreased to 47 (64%). In a second phase, we developed field referral and ePCR search programs to identify super-users over a 14-month period from April 2015 to July 2016. There were 265 patients, accounting for 4,393 e-PCRs. Of those, the top super-users (N=20) accounted for 797 responses.
Conclusions: We showed that super-users in our large system are often vulnerable adults. A partnership with HHS had preliminary impacts on call volumes generated by the highest users, and a second phase identified the magnitude of the EMS patient population this partnership might reach. This partnership and the prospective interventions it brings show potential to stem growing EMS over-utilization. Moreover, it might have significant applications for interfacing with responding units at the dispatch and pre-arrival phases. More studies are needed to prospectively prove value and best practice of these programs.