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Anaheim Community Paramedicine Pilot Program Shows Promise

Placing nurse practitioner on community response unit is first in the state

Thu, Jul 16, 2015

COURTNEY PERKES, Orange County Register

Anaheim's fire department has become the first in California to dispatch a nurse practitioner in an ambulance to treat non-urgent medical calls that would otherwise result in a hospital trans-port.

The one-year pilot program, which started May 31 and will cost nearly $500,000, will free up Anaheim Fire & Rescue equipment and personnel for true emergencies while reducing costs to the overall health care system, officials said Tuesday.

Anaheim will formally announce the program today, but the city has provided a snapshot of the early results. Out of 56 non-urgent calls to 911 since the program started , 40 percent did not require a trip to the emergency room because patients were stitched up on the spot, prescribed medication or booked to see a specialist.

"Now we're doing it in their living room," Chief Randy Bruegman said.

The specially equipped ambulance, called the Community Care Response Unit, has all the lifesaving equipment of a regular ambulance, but it's also outfitted with supplies found in an urgent care center - pain medications, wound care equipment and eventually a system for running blood tests. The public-private partnership includes insurer Kaiser Permanente, which donated $210,000, as well as Care Ambulance Service, which provided the additional ambulance.

The program, modeled on one in Mesa, Ariz., can treat conditions including allergic reactions, back pain, diabetes, animal bites and upper respiratory infections.

Dr. Todd Newton, regional chief of emergency medicine for Kaiser Permanente in Southern California, said at least 15 percent of patients who go to the emergency room at Kaiser's Anaheim hospital could be treated elsewhere. Instead, they wait "four or five hours for 10 minutes of treatment."

An ER visit costs about $580 more on average than the same treatment provided in a doctor's office, according to a 2013 study by the Robert Wood Johnson Foundation.

"I think it's exciting," Newton said. "The Affordable Care Act has put the entire country on notice that we have to change the way we do business."

About 85 percent of calls to Anaheim Fire & Rescue are medical, and among those, roughly 15 percent are minor enough that they could be handled by nurse practitioner Victoria Morrison and partner Scott Fox, a captain/paramedic.

They work four 10-hour shifts per week, based out of Station 11 in the densely populated western part of the city where many medical calls come from. So far, many calls have come from seniors who live alone or lack transportation and have fallen or suffered a cut.

In addition to providing treatment, Morrison has worked to find timely outpatient care for patients. In one case, after a woman reported seeing stars while at work, Morrison thought she could have a retinal tear and called to get her an appointment with an ophthalmologist an hour later. In another instance, when an elderly man insisted that he be taken to the hospital for leg pain after heart surgery, Morrison first reached his cardiologist, who instead scheduled him for an appointment the next day.

Fox has adjusted to the change in pace from his previous duties, where his job was to quickly load a patient onto the ambulance and rush to the hospital. Now, calls are longer, about 45 minutes, and he said patients are ecstatic that they don't have to go to the emergency room.

With a ride to the ER avoided, there's no $350 ambulance fee or medical bill for Morrison's treatment.

"We just explain to them that this is a pilot program," Morrison said. "There's not a medical bill. They're absolutely shocked."

714-796-3686 or cperkes@ocregister.com

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