A new pilot program by the Las Vegas Fire and Rescue Department aims to reduce the number of ambulance trips for nonemergency 911 calls.
As one part of providing the right care in the right setting, the city’s 911 operators are being trained to identify health-related complaints that might not require a full-blown emergency response. Those calls are transferred to a nurse who, with the help of computer protocol software, guides the caller to the right kind of care.
An operator may still rush an ambulance to a 911 caller or reassure the caller that this health issue can be dealt with by seeing a primary care doctor through a normal appointment process.
Or the operator may offer to send the patient to an emergency department or urgent care facility in an unexpected way: the ride-hailing service Lyft.
The Emergency Communication Nurse System and the nonprofit Southern Nevada Community Health Improvement Program have teamed up to fund a ride-hailing option via Lyft for callers who are using 911 because they simply have no other way to get to a hospital, urgent care center or doctor.
“EMS is probably one of the most reliable, time-sensitive services anyone can access,” says Las Vegas Assistant Fire Chief Sarah McCrea. “This program looks at people’s normal navigation through the system and then redirects it” when a call to 911 isn’t really an emergency. It is one component of dealing with access to nonemergency primary care, McCrea says.
The chief medical officer of one of the Las Vegas Valley metro area's busiest emergency departments agrees that access to primary care is lacking.
“Many of the 170,000 ED visits we see annually are due to a lack of access to primary care physicians in our community. So, clearly a great many of these visits are a result of few alternatives, which also extends to the scarcity of urgent care facilities in our immediate service area,” says Jeff Murawsky, CMO of Sunrise Hospital and Medical Center.
The pilot program employs experienced nurses who have worked in high-acuity settings for at least three years, McCrea says. Before the nurses use the structured computer protocol on a phone call, they say, “Tell me exactly what is happening,” she says.
“The nurse is free to do what they do best — ask probing questions to get the best idea possible, especially because they cannot see the patient,” McCrea says. “The software has a couple [of] hundred protocols to choose from, so we need to ask a lot of questions outside of the protocol first.”
The program went live July 17, with Melissa Giammarino, R.N., on the phones for the first shift. Giammarino, who is also a surgical recovery nurse at University Medical Center in Las Vegas, believes the program will free up emergency personnel and equipment for more urgent cases and lead to improvements in the hospital ED.
From an ED nurse’s perspective, eliminating unnecessary ambulance calls helps providers focus on real emergencies, she says.
“I was a charge nurse in an emergency room who had to triage every single ambulance lining up at the door,” Giammarino says. “Each ambulance carrying someone who didn’t truly need emergency care took me away from other emergencies, from helping other nurses and from dealing with other problems in the [ED].”
As with any emergency services, certain safeguards are in place, McCrea says. First, 911 operators take the initial call, only sending certain calls to the emergency communications nurse. Second, nurses may only downgrade the computer-generated course of action to a less urgent response by one level, but may upgrade it as much as necessary. The nurse may always choose to immediately dispatch an ambulance. Third, ride-hailing is only used if the patient agrees to it. And fourth, there is follow-up. If an ambulance is not sent for a call, the nurse on duty the next day will call the patient to check on his or her welfare.
Although 911 callers may have believed an ambulance ride was their only choice, “when they find out there are other options than an ambulance ride to the [ED], they’re excited and glad to use ride sharing or go to urgent care or whatever makes the most sense,” Giammarino says.
Because the pilot program has only been active for just over two months, the department is not yet looking at hard data, but if it proves successful in safely eliminating some unnecessary ambulance trips McCrea hopes it will be expanded from its current 9 a.m. to 6 p.m. availability and cover a larger geographic area.
“The partnership that exists between Las Vegas Fire, as well as all EMS providers and Sunrise Hospital, is an extremely important component of our community service,” Murawsky says. “We will work with our first responders to share feedback or recommendations as the pilot moves ahead.”