Health

Pilot program uses paramedics to try to cut ER overcrowding

Emergency medical technician Ivan Ufimtsev of AmeriCare Ambulance brings a patient into UCLA Medical Center and Orthopedic Hospital in Santa Monica.
Emergency medical technician Ivan Ufimtsev of AmeriCare Ambulance brings a patient into UCLA Medical Center and Orthopedic Hospital in Santa Monica.
Maya Sugarman/KPCC
Emergency medical technician Ivan Ufimtsev of AmeriCare Ambulance brings a patient into UCLA Medical Center and Orthopedic Hospital in Santa Monica.
Firefighter paramedic Fred Gonzalez of Los Angeles County Fire restocks medical supplies after dropping off a patient at UCLA Medical Center and Orthopedic Hospital in Santa Monica. The UCLA-run pilot program in Glendale and Santa Monica will aim to reduce overcrowding while also freeing up paramedics who get stuck waiting to pass off ER patients.
Maya Sugarman/KPCC
Emergency medical technician Ivan Ufimtsev of AmeriCare Ambulance brings a patient into UCLA Medical Center and Orthopedic Hospital in Santa Monica.
An AmeriCare ambulance leaves UCLA Medical Center and Orthopedic Hospital in Santa Monica. Under the UCLA-run pilot program, paramedics will determine whether someone they've picked up is a candidate for a UCLA urgent care facility rather than an ER.
Maya Sugarman/KPCC
Emergency medical technician Ivan Ufimtsev of AmeriCare Ambulance brings a patient into UCLA Medical Center and Orthopedic Hospital in Santa Monica.
Emergency medical technician Tyler Gay of American Professional Ambulance cleans an emergency vehicle after delivering a patient at UCLA Medical Center and Orthopedic Hospital in Santa Monica.Under the pilot program, patients will be given the choice of going to urgent care or an emergency room.
Maya Sugarman/KPCC
Emergency medical technician Ivan Ufimtsev of AmeriCare Ambulance brings a patient into UCLA Medical Center and Orthopedic Hospital in Santa Monica.
Firefighter paramedic Scott Rosenfeld restocks medical supplies after dropping off a patient at UCLA Medical Center and Orthopedic Hospital in Santa Monica.The UCLA program is one of 13 pilot paramedic projects around the state looking to improve care and cut costs.
Maya Sugarman/KPCC
Emergency medical technician Ivan Ufimtsev of AmeriCare Ambulance brings a patient into UCLA Medical Center and Orthopedic Hospital in Santa Monica.
Firefighter paramedic Fred Gonzalez of Los Angeles County Fire restocks medical supplies after dropping off a patient at UCLA Medical Center and Orthopedic Hospital in Santa Monica.During "advanced life support" 911 calls, LA County Fire joins contract ambulances as the firetrucks have more equipment.
Maya Sugarman/KPCC


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The call comes in late on a recent afternoon: a 48-year-old woman is complaining of shortness of breath and a pain in her chest. Firefighters and paramedics from Santa Monica Fire Station Number One jump in their rig, navigating the traffic-filled city streets with sirens blaring and horn honking until they reach the women's destination several blocks away. 

It's a fairly routine case; Santa Monica's first responders handle up to 40 medical 911 calls each day, says Captain Matthew Hill, the fire department's head of paramedic training.

 In most instances - this call included - patients require follow up care by emergency room doctors. But for others, it’s not necessary.  And for them, some experts say, transport to an urgent care clinic may provide quicker care and a much smaller bill.

"For minor and non life-threatening types of problems, they really are a good option for the consumer," says Baxter Larmon, a professor of medicine and director of UCLA’s Center for Prehospital Care. 

Larmon will be testing out that theory starting this month in parts of Santa Monica and Glendale. Under the pilot programs he’s heading in those cities  - and in similar pilot projects happening in three others regions of the the state - paramedics will be allowed to offer qualified patients a trip to an urgent care clinic instead of an ER (a state law requiring transport to an ER was waived for the pilot projects).

Less serious emergencies

The pilots are open to adult 911 patients who suffer a less-serious emergency, such as a head injury without a loss of consciousness; a cut with controlled bleeding; or a fall with no chest or abdominal pain. 

Across Los Angeles County, officials estimate about 25,000 to 50,000 911 calls each year might fall into this category.

In the pilot programs, the decision on where to go for care will rest with the patient. And, Larmon predicts, those who choose urgent care will be pleased with the much shorter wait times.

"The average time in an emergency department in California are way beyond acceptable," he says. "In fact, the state of California got an 'F' rating by the American College of Emergency Medicine in 2014."

Statewide,  the average ER wait time is nearly six hours,  says Larmon. And that underscores another goal of the pilots:  “We also think that it will reduce the over-burdening of emergency departments in the county," he says. 

Emergency room backlogs affect not just individual patients, but the entire 911 system. Larmon says that’s because when paramedics take a patient to an ER, state law requires them to wait with that person. 

Trying to cut "wall time"

"We have communities where paramedics are out of service in the emergency department for hours because they cannot unload their patient off their gurney and stick them onto a hospital stretcher," he says. 

Captain Matthew Hill of Santa Monica Fire says that wait period – known as "wall time" in the vernacular of emergency rescue - can trigger a countywide 911 domino effect.

"Once those units get taken out of service, we have to call for help from L.A. City Fire Department, Culver City Fire Department to come and back-fill our stations," he says.  And then when they're feeling the same heat that we are, they’re calling for help as well."

But critics, including  the California Nurses Association  and the California Chapter of the American College of Emergency Physicians, say allowing paramedics to transport patients to urgent care clinics is bad practice. 

"If somebody- once they’re in the urgent care setting - has a major problem and requires emergency transport back [to the ER] then you’re talking about delays," says Vicki Bermudez, a policy consultant for the California Nurses Association.

She’s among those who say paramedics, who must undergo about 1,400 hours in training for their license, are not qualified to provide the medical assessments called for in the pilot programs. Transporting all patients to hospital ER’s she says, is really the only way to ensure patient safety.

"When the patient gets to the emergency room you have a physician, with all of the services that are available, caring for the patient," Bermudez says. 

Those in charge of the pilot programs say they've  responded to some of the concerns by requiring each participating urgent care clinic to have a doctor in house at all times the facility is accepting 911 traffic, and to have a dedicated paramedic telephone line.

"We think we have the bases covered where we can actually show, come the end of the pilot, that this is, in fact, a safe and cost-effective way of providing care," says Lou Meyer, who's overseeing all of the state's paramedic pilot projects for the California Emergency Medical Services Authority. 

Getting buy-in from 911 patients will be key to the pilots' success, Hill says.  

"Hopefully we get some people who are willing to try it out and realize in the long run it’s better for them and their pocketbooks," he says. 

The pilot programs, which are scheduled to run through 2016, are part of a larger experiment statewide that's using paramedics in expanded, non-emergency community health roles. The project also includes programs to cut hospital readmissions among cardiac patients; a program to assist hospice patients and another to aid those with mental health issues.