In the past, first responders had two options when arriving at a 911 call; take the patient(s) to the emergency room or leave them at home.
Renton Regional Fire Authority (RRFA) Battalion Chief Rick Myking said they’ve become good at dealing with those in need of immediate medical assistance. But what they don’t do well is responding to those patients that don’t need the emergency room, the patients that get left at home. A third option wasn’t available — until bringing over a program that started in Kent.
Fire Department Community Assistance, Referral, and Education Services (FDCARES) is a division of Puget Sound Regional Fire Authority created to provide better nonemergency assistance. It helps those who have relied on the 911 system for their primary care by getting to the roots of their needs. Renton joined and in July started deploying FDCARES staff to nonemergency 911 calls.
The program has immediately made a difference in Renton. Myking said firefighters are seeing it and so is the community: RRFA won the “Innovation in Health Care” award at the Renton Ahead of the Care Gala in September for FDCARES.
Myking has represented FDCARES for both RRFA and Puget Sound Fire since Renton joined the program. He originally went to Puget Sound Fire authority to figure out what kind of program Renton could provide for frequent 911 callers, ultimately deciding joining was the best way to do it.
In 2015, FDCARES started responding to these nonemergency calls to provide assistance. A firefighter and nurse go to those calls in a nonemergency vehicle, freeing up response vehicles to other life-threatening calls. FDCARES staff talk to the caller and give an estimated time of arrival, to make sure they’re comfortable with waiting. They respond with no lights or sirens. If the caller doesn’t want to wait, they upgrade the call.
In Renton, FDCARES goes out 12 hours a day, five days a week. The responders to nonemergency calls figure out who the patient is, what is going on with them that results in frequent calls and how to improve their health in the long term. They then figure out what services the individual needs; it could range from getting a new oxygen provider to building a ramp for their wheelchair.
Chamber of Commerce Interim CEO Diane Dobson stated in an email that it’s been rewarding, reassuring and reaffirming to see a program like this in Renton.
“It works to improve the quality of health throughout our community and provides for a longer and healthier independent lifestyle for many of our most vulnerable residents,” Dobson stated.
Many callers FDCARES assist are part of Renton’s most vulnerable populations. For example, a Renton woman used to frequently call 911 — 162 times over two years. An FDCARES nurse responding to one of her calls found she’d been through a detox treatment numerous times. A week later, the nurse talked to the doctors who were caring for her. Instead of releasing her, the FDCARES nurse got the hospital nurses to provide the patient with a designated mental health provider. She was then put into the care of her sister when she was deemed unfit to take care of herself.
She didn’t stay under her guardianship for too long and after several months went back to frequently calling 911. But even now, she calls way less, Myking said.
“That’s a direct relation to this unit being in service and talking with her,” he said.
Renton joining FDCARES is a huge step forward in community’s working together, Puget Sound Fire Lead Nurse Adam Davis said. Fire units often respond to calls across jurisdictions, so this is another way to have regional consistency, expand a positive program and share the costs. Myking said it’s unique having Puget Sound Fire nurses with Renton firefighters leaving the same fire stations.
In the health care system a lot of care is transactional. Folks get services, but not long-term better health. As people call 911 for transportation to emergency facilities, fire departments become a part of this system. This also gives them an advantage in addressing the problem of rushing from patient-to-patient.
Davis said that this made FDCARES a natural fit.
“We’re in the homes of people in need on a daily basis, and we’re in a position to help in ways that health care providers in a hospital or clinic really can’t,” Davis said.
Davis said it began by changing how they keep data— instead of looking at incident type, they go by patient name. This helps them see who are the frequent callers, referred to as “low acuity” callers, nonemergency in nature.
Low acuity callers range from seniors who need assistance to folks struggling with substance abuse or homelessness. Davis compares this to the idea that 5 percent of the population makes up 50 percent of health care costs; the folks who make these calls may be temporary, but the use is intense.
The 911 response system is one of the most expensive models in health care. Myking said FDCARES can help connect patients to places outside of the high-cost emergency room. Despite creating this efficiency, the program doesn’t actually save the RRFA money. Myking said the program’s goal is to provide better care.
Engaging with members of FDCARES makes it clear that they’re involved in the program because they care, Dobson stated. It’s a program that’s quite appropriately named.
Outside of 911 calls and monitoring data, FDCARES also follows up with low acuity callers. Davis said about 80 percent of the time FDCARES staff are responding to low acuity calls, the other 20 percent is doing follow up with patients to help them meet their long-term health needs.
Myking said they have a social worker who also helps do those follow ups as well.
“Individuals are much more responsive to help when they call you,” Davis said. “When they call, there’s a window of opportunity to dive in deeper. They asked for help, can we figure out what’s going on? And it’s not always an easy fix.”
FDCARES is a type of service known as mobile integrated health, part of a movement to coordinate providers at every step of health care system. But what’s been missing from the program is “integrated,” Davis said.
“To fully integrate a service like this in the community, you need a way to organize the care and connect it,” he said. “That has become the driver of developing a neighborhood health system.”
The neighborhood health system is modeled from Ellensburg’s community-owned nonprofit “Kittitas County Health Network” which received a federal planning grant for its development in 2017. It includes fire departments, hospitals, law enforcement, public health and insurance companies. It helps create personalized care service to the region’s most vulnerable population.
But organizing a large rural community that is more familiar is easier than the numerous organizations and networks that make up King County’s health care organizations, with overlapping services and gaps in care coverage areas. Davis said they’ve handled this by starting with a hyper-local approach to the neighborhood health system.
In short term goals, FDCARES is in talks with other fire authorities in King County to expand. Myking said for Renton’s side of the program, the next step is seeing if they can expand response hours from 12 hours a day, to 24.
“They call us first responders for a reason. We want to get out there and address the needs that aren’t being met,” Davis said.