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HOW TO STOP 9-1-1 ABUSE

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

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HOW TO STOP 9-1-1 ABUSE

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  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

  5. THE VALUE OF NOT KNOWING “Ignorance is Bliss” “What you don’t know won’t hurt you” WRONG!!

  6. DISCOVERING THE PROBLEM • Hearing chatter from the field • Calls from ambulance crews and hospitals • “Two guys using the ambulance” “Lonzel” “Cesar” 2010 – 471 transports 2010 – 329 transports

  7. DISCOVERY • LOOKING AT THE DATA • (aka: UH OH!) “Fresno, we have a problem!” Pre-hospital calls only

  8. 5 STAGES of GRIEF Who do they think they are!?! How can this be happening? There is NoWay 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.

  12. DISCOVERY IHSS 80%

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

  14. Odd Jobs

  15. SOLUTIONS • Create a Multi-Disciplinary Task Force “The Group” • Create Policy for EMS Personnel • At some point, we will have to deny service

  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 • Multi-Disciplinary Task Force • Back on track

  17. The Process Identified Frequent User 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. EMS ABUSE POLICY Identified Frequent User (not in system or refusing services) *Letter – 1st Notice Group Notified 30 days *Letter – 2nd Notice Group Notified 30 days *Letter – 3rd (final) Notice Group Notified 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 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) 600-3387. We are not transporting you to the hospital.” Sit-up/stand/walk = No Transport

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

  22. RESULTS 1991 calls / year Savings: $1,771,990

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

  24. *** WARNING *** WATCH THE BACK DOOR! • 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”

  27. 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:

  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) 600-3387 Email: dlynch@co.fresno.ca.us Abuse Policy: EMS Policy #570 Website: ccemsa.org Email me for samples of notices or suspension orders

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