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Chronic 911 callers to get aid from 'community paramedics'

By Susan Essoyan

LAST UPDATED: 04:14 a.m. HST, Oct 28, 2012

Dennis oda / doda@staradvertiser.comThe Honolulu Emergency Services Department's new community paramedics program was created to stem 911 calls by the system's top 50 chronic users, whose ambulance calls, when hospitalization is factored in, could cost as much as $7 million this year.  Chris Luan, a paramedic and dispatcher who already is on a first-name basis with the system's most frequent users, said she is excited about the program. "This way we will be able to spend more time with the patients. That's what I like about it."

In hopes of giving better care and saving money, the Honolulu Emergency Services Department will begin deploying "community paramedics" to help people who call 911 so often that they are on a first-name basis with the dispatchers.

"The top 50 callers to 911 are on track to make 1,600 calls this year," said Dr. James Ireland, director of emergency services. "If you're calling 911 and going to the emergency room every couple of days, obviously something's wrong."

More than 70 percent of the top 50 callers have chronic medical issues, which if left untended can lead to emergencies. About a third are homeless. A third have mental illness.

"Some call because they can't breathe, but they can't breathe because they don't have their medicine," Ireland said. "The problem is if you don't have a doctor, you don't have access to medicine. If you have an untreated mental illness, the cycle of calling 911 and going to the ER is not going to fix that."

Rather than reacting to 911 calls, the community paramedics will take the initiative, reaching out to these frequent callers in person in hopes of uncovering the source of their problems. The plan for the pilot program is to visit the top 50 callers once a week, whether they are at home, at a shelter or in a park, and guide them to the social and medical support they need.

"What we want to do is have a system for these vulnerable patients so that we can find out what is the reason they keep calling 911," he said. "Is it access to medicine? Is it access to shelter? We're going to connect folks to various resources in the community. We're going to short-circuit this cycle of using Emergency Medical Services and the ER."

The pilot, announced Saturday and slated to begin by the end of the year, aims to cut the number of 911 calls by the top 50 clients in half. The cost savings could be dramatic.

Each ambulance ride costs about $800 and each emergency room visit runs about $800, according to the Emergency Services Department. That puts the direct cost for the top 50 at $2.6 million this year.

When the projected cost of hospitalization for those who are admitted is factored in, the tab for the top 50 callers could run as high as $7 million this year, or roughly $140,000 per patient, Ireland said.

"Unlike the 911 ambulance, our goal is not to take them to the hospital," Ireland said. "The goal with this system is to keep them out of the hospital, out of the ER. We feel people will get better overall care, which is our primary goal, but it will also ease the financial burden on the system."

Patients will be given a hotline number to reach the community paramedic, rather than automatically relying on 911, although everyone should call 911 in true emergencies.

The Emergency Services Department has been meeting with community partners to develop the program, including the Queen's Medical Center, the University of Hawaii Medical School, social service and homeless shelter providers.

"We think as a team, that's the solution," Ireland said. "Because alone we're not going to fix anything. We feel very strongly that we have to work with the homeless shelters, we have to work with the psychiatrists, we have to work with the community health centers because they're the key to addressing the root causes."

As people on the top 50 list "graduate" from the program, visits can be dialed back, and new people with acute needs can be helped through the system.

Costs of the pilot project are minimal, pegged at $150,000. To start with, two community paramedics will work Monday through Friday, aiming to visit each of the top 50 callers once a week, if the patients are willing to cooperate.

They will use a retired ambulance that was buffed up and repainted with a gold stripe rather than the typical ambulance orange and the words "Community Paramedic Unit" on its side. The community paramedics will wear less formal uniforms: a black polo shirt and khaki pants.

Chris Luan, a paramedic and dispatcher, came to Ala Moana Beach Park Saturday to introduce the program, and said she is eager to try out the job of community paramedic.

"I love being able to help people, not just the emergency part of it but the compassionate part," Luan said. "This way we will be able to spend more time with the patients. That's what I like about it."

"As a dispatcher and as road personnel, you know their voice, you know their address, you know them by first name."

For those who volunteer to try it, being a community paramedic might provide a welcome change of pace from the hectic, adrenaline-fueled pace of ambulance life, with its high stress, lights and sirens.

"Being a paramedic on the road is very challenging and very draining," Luan said. "The attrition rate is very high. This could give our paramedics a break from that, to be able to slow down and be more compassionate and spend time with these people."

Some rural communities on the mainland have been trying the community paramedic system, which originated in Canada. In Hon­­o­lulu, the program will focus on the socioeconomically isolated, Ireland said. Along with giving personalized care and saving money, the program should help ease emergency room overcrowding.

"We're not going to force this on anybody," Ireland said. "But we feel that if they are calling 911, they are reaching out for help, so we feel they will be receptive."

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Bdpapa wrote:
Hopefuly, this pro active approach will work. This may help the homeles, mentally ill, druggies and alchololics get the help they need.
on October 28,2012 | 04:21AM
soundofreason wrote:
""As a dispatcher and as road personnel, you know their voice, you know their address, you know them by first name.">>> Just don't know what method of payment their going to offer. Or NOT offer as the case may be.
on October 28,2012 | 08:16AM
sumotoby wrote:
$140,000 per person per year? It would be cheaper to put them up in a hotel with a full-time nurse per 5 - 10 persons!
on October 28,2012 | 09:34AM
livinginhawaii wrote:
Too bad they can't weed out the drug and alchohol abusers and simply flat out refuse these services to them.
on October 28,2012 | 09:39AM
mulford07 wrote:
This sounds like a much more economical way of dealing with the Chronic 911 callers. So many of them do not have any support system - family, medical, etc.
on October 28,2012 | 09:41AM
nitpikker wrote:
this kind of problem is ALL due to the ACLU!! previously our chronically infirm and mentally disabled people were kept in institutions where they could receive needed treatment. now they're on their own and of course they don't pay any attetion to their health because THEY have to foot the bill.
on October 28,2012 | 12:02PM
nitpikker wrote:
Dr. ireland's comment is ridiculous!! they call 911 because its FREE!!!
on October 28,2012 | 12:25PM
soshaljustic wrote:
I would like an additional breakdown on the "homeless." Are they street "homeless" or those in group and care home "homeless" therefore identifying those falling through which cracks in social services and those that are getting additional attention from others nearby for emergent conditions yet unable to assist in meaningful ways? This would be important in that if the "technically homeless" person in a group home is getting more emergent 911 service because of living in a supportive environment-then the environment may be able to be better trained to deal with the emergent needs to reduce the chronicity issues rather than let them continually evolve to emergent calls? It would seem proper social resource work surrounding the group home environments might be better coordinated, if this were the case, to avoid the more ill group think and group illness situations wherein the group becomes too comfortable with each other. Support of one another is important. Support of one another to enable in illness is defeating the purpose of the group home environment.
on October 28,2012 | 04:22PM
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