Starting in March 2016, the Fire and Emergency Medical Services Department (FEMS) began using American Medical Response (AMR), now renamed Global Medical Response (GMR), to supplement patient transport services. From FY-17 (beginning 10/01/2016) and forward, FEMS expanded AMR-GMR services to enhance healthcare services for District of Columbia residents and reduce less-emergent use of the District’s Emergency Medical Services (EMS) system. AMR-GMR services now include the following:

• Nurse Triage Line (NTL) services – AMR-GMR provides NTL evaluation services for FEMS. When a 9-1-1 call is received by the Office of Unified Communications (OUC), a 9-1-1 call taker assess the nature of each call. If the call is determined to be a non-emergent EMS call meeting certain criteria, the 9-1-1 call taker transfers a caller to NTL services. Additionally, if a non-emergent patient is identified by FEMS first responders during a call (after they arrive at a dispatched incident), such patients may also be referred to NTL services. A nurse speaks with the 9-1-1 caller or patient by phone to assess their condition. This may involve further evaluation of patient condition by FEMS first responders at incident locations. After completing assessment, the nurse determines if a 9-1-1 caller or patient requires EMS transport services or can be referred to Right Care Right Now services.

• Right Care Right Now services – AMR-GMR provides Right Care Right Now services for FEMS. After a 9-1-1 caller or patient evaluated by FEMS first responders is referred to Right Care Right Now services, a nurse may guide the 9-1-1 caller or patient through self-care. This may involve simple first-aid, the use of over-the-counter medication, or other self-care options. Alternatively, a nurse may schedule a clinic or physician office appointment for the 9-1-1 caller or patient using rideshare services (public conveyance) to evaluate and treat non-emergent conditions. Expanded Right Care Right Now services may also include telehealth evaluation and treatment by a physician, in coordination with a nurse, FEMS first responders, and/or AMR-GMR responders. 

• Basic Life Support (BLS) EMS transport services – AMR-GMR provides BLS patient transport services for FEMS. BLS patient transports do not require advanced life support (ALS) monitoring and treatment by a Paramedic and are considered non-life threatening. AMR-GMR provides BLS patient transport services upon request from FEMS first responders or by referral from NTL services.  

FEMS leverages AMR-GMR services to improve the speed and efficacy of patient evaluation and treatment by avoiding long waits in hospital emergency departments and delivering such services in at-home or local neighborhood settings. Such practices encourage healthcare engagement by residents with limited means, improve healthcare outcomes, and reduce community risk. By creating alternatives to traditional hospital-only EMS transport services, reliance on such services is reduced, improving EMS system capacity. 

Legislation authorizing AMR-GMR services was part of the “Fiscal Year 2017 Budget Support Act of 2016,” and the “Emergency Medical Services Transport Contract Authority Amendment Act of 2016.” According to the requirements of the “Emergency Medical Services Contract Authority Temporary Amendment Act of 2015” (D.C. Law 21-55), FEMS must submit reports to the Mayor and Council detailing AMR-GMR activity.