When you call 9-1-1, you expect an ambulance to come and quickly. But in Fresno County, health officials say a relatively small number of people had been making that difficult, so-called ambulance "super users." These are people who call for an ambulance ride frequently, sometimes hundreds of times a year, in non-emergency situations. Now five years into a project to reduce the burden of "super users" on the system, the numbers show the effort is working.
When the scanner crackles and a call goes out for an ambulance, the paramedics and EMTs who are headed to the scene are usually given an address. But American Ambulance paramedic Derek Ratzel says some addresses are so familiar to their crews, there is no need for GPS.
“We know those addresses off by heart, most of us do, or the street corner that they happen to be calling from. But we get an address and it’s like ‘yep. Been there before’. Happens all the time,” Ratzel says.
The addresses are so familiar because Ratzel says they're usually the home of a person who calls so often, they have become an ambulance "super user."
When the issue sprang into the media spotlight 2012, the top 50 users of the ambulance service in Fresno County took more than 4,300 trips in a year. It was costing the county millions, because the trips were usually not paid for. That's in addition to slowing response times for other calls and clogging emergency rooms.
Ambulances are required by law to respond to emergency calls. But some people were using the ambulance as a pseudo-taxi service. Other "super users" were too quick to call for what was not a medical emergency. And other times it was a person with a chronic but under-treated condition.
Paramedic Jeff Lloyd says he is proud to respond to all calls but responding to non-emergencies over and over again could mean critical health issues could slip through the cracks.
“But of course, it doesn’t take away the frustration of people with life-threatening injuries or medical issues. That we are being taken out of the system [by] somebody [who] could actually do [it] on their own,” Lloyd says.
So the county decided it had to act to stop the abuse.
Dan Lynch with the Fresno County Department of Public Health says while the one man who took 700 rides in a single year caught the headlines, the issue went further than anyone expected.
“And as we started looking into it further we found that there were many individuals doing that. Maybe not in the hundreds of times but multiple times. And we found that we had a problem with the number of frequent users in the system,” Lynch says.
So they start a program to target the top 50 users each year and figure out, one by one, why they were calling so much.
As a result, last year the top 50 users accounted for just under 1,600 rides. That’s a nearly 178% decline in five years. Most of the current top 50 are not the same people that started on the list. And those on the list today, on average, take far fewer trips a year than the initial 50. Every year has seen a roughly 50% decline in the number of rides super users were taking compared to the previous year.
So how did they achieve this?
Lynch says health officials in the county had three realizations.
First, that the frequent calling was a symptom of the problem, not the problem itself. So Lynch said "let’s fix that." Now paramedics try to find out what the underlying issue is, and move health care services to the person, rather than taking the person to health care.
“We feel like we are helping the system by we are pushing them into getting help and getting programs and getting out of the system that way. Our mantra has been we want to help them out of the system before we have to shut them out of the system,” Lynch says.
This worked for the vast majority of people in the top 50. Very few of the originals are left.
But there is a key part of that sentence you might have missed.
“We want to help them out of the system before we have to shut them out of the system” Lynch says.
That’s right, shut them out. There are handful of people, about 15, who refused to stop calling for an ambulance. They are now on a list that alerts crews when they call. An ambulance will still be sent to them, but it will not take them where they ask to go, unless there is a legitimate medical emergency.
The third realization is that the change had to come from the ambulance service. Hospitals might not realize that a person is a "super user or due to privacy laws not even be allowed to talk to each other. And for the people who used the ambulance as a taxi, many never even went into the ER.
Ken Katz with American Ambulance says if hospitals are the heart of the health care system, the ambulance service is its veins.
“The thing that’s common is the ambulance because we take them to all of them. And when a patient gets in the back of the ambulance they say ‘where do you want to go’ and we take them to the hospital that they want to go to,” Katz says.
Despite the progress, Garth Wade the Emergency Department Director for Community Regional Medical Center says ambulance abuse is still a problem. He says for every person they convince to stop, a new person become a "super user."
The key, Wade says, is getting people who have a medical need, but shouldn’t be calling an ambulance, into a more traditional health care environment, rather than using the ER as their source for primary care.
“We will meet with them as much as we are able to, as much as they allow us to. We try to get them into our clinic system. We try to arrange for them to have a primary care physician. We will help them find a place to live if we possibly can,”
Wade does support the practice of refusing to transport the worst offenders in the city. He is also complimentary of the work the county has done, even though he thinks the abuse remains a serious concern.
The shared concern from all, is that the next time you pull over for the lights and sirens of an ambulance is that they are carrying someone in an actual emergency.