DC Fire and Emergency Medical Services: EMS Task Force Rec 5 Details

Status		Action Item	Progress
	a	The Chief, in partnership with other District agencies and providers, shall develop and begin to implement, no later than March 31, 2008, an outreach program for patients with chronic needs.	On March 27, 2008, the Fire and Emergency Medical Services Department (FEMS) initiated the “Street Calls” Program, designed to perform mobile outreach and intervention for high-volume individual users of 911 services, including the homeless, mentally ill, and chronic public inebriates. The Street Calls Program is staffed by FEMS paramedics paired with social workers and clinicians from other DC government agencies.
	b	The Chief, in cooperation with other District agencies, shall develop and implement, no later than March 31, 2008, a public education program regarding appropriate use of the 911 system.	FEMS has updated the"Make the Right Call" campaign and is partnering with the Office of Unified Communications to distribute material to all District households on the proper use of 911 and 311.
	c	The Chief and the Director of the Office of Unified Communications shall, no later than December 31, 2008, collaborate to improve the 911/311 dispatch process so that call takers and dispatchers have improved training and enhanced ability to distinguish between emergency and non-emergency medical calls.	The Department’s Clinical Quality Program Manager has completed training in EMD-Q™ (Emergency Medical Dispatch Quality Assurance) in preparation for implementation of AQUA™ (Advanced Quality Assurance) for the Medical Priority Dispatch System (MPDS™). The Department has requested resources to assist the Office of Unified Communications with quality assurance for the call-taking and dispatch process. These resources are included in Mayor Fenty’s Fiscal Year 2008 EMS Enhancement funding proposal, currently pending approval by the Council.
	d	The Medical Director, with the support of the City Administrator shall, no later than November 20, 2007, establish and clarify roles and responsibilities for the Department and the Metropolitan Police Department for treatment of uninjured intoxicated patients and for transport of patients to the District's detoxification facility.	Joint statement/ progress report issued on 11/19/07.*
	e	Effective immediately, the Medical Director should exercise his full authority to order hospital emergency rooms within the District not to close to Department transports, and to require hospitals and medical providers to accept the transfer of care of a patient or patients within a specified period of time.	This was a primary agenda item covered in the meeting with the hospitals on 11/14/07. A follow-up item from the meeting is drafting procedures on emergency room closure and patient drop-off times.
	f	The City Administrator shall, no later than November 20, 2007, convene a working group including hospital CEOs, DOH, and the Medical Director to meet quarterly to address and develop standards for drop times, diversion, and closure, and to improve procedures for tracking patient outcomes. The Medical Director should consider the results and recommendations of this group in exercising his discretion under the previous paragraph.	First meeting took place on November 14, 2007.*
	g	The Medical Director shall, no later than September 30, 2008, develop a procedure to authorize patients to be transported to a pre-approved clinic or other non-emergency medical facility, appropriate to the patient's need.	FEMS is partnering with the Department of Health to identify and approach outpatient primary care medical facilities to serve as delivery points for patients with immediate but non-emergent conditions. The Department of Health is also developing community-based interventions and grants to educate and link residents to existing medical homes to reduce calls to 911 and use of emergency transpiration services for situations that can be handled in a more appropriate setting.
	h	The Medical Director and the Director of the Department of Health shall develop and implement, no later than September 30, 2008, a system of alternative transportation options (such as scheduled van service, taxi vouchers, or MetroAccess vouchers), as well as protocols to refuse transport for non-urgent patients, when appropriate, subject to the authorization of a medical supervisor.	Through the Emergency Care Reform Initiative - a city-wide planning process for reducing avoidable hospitalizations, preventable Emergency Department visits, and unnecessary EMS transports - FEMS and DOH are developing options for non-emergent, urgent transportation for residents seeking non-emergency medical care. This includes looking at existing infrastructure, such as the Medicaid non-emergency transportation program, as well as novel mechanisms and vehicles that can link residents with appropriate, cost-effective transportation to outpatient treatment.