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EMS Task Force Recommendation #5

 

Recommendation 5 - Reduce misuse of EMS and delays in patient transfers.

Title: Recommendation 5a
Action Item:
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.

  • Progress:

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, hoarders, mentally ill, and chronic public inebriates. The Street Calls Program is staffed by FEMS paramedics that reach out to other DC government agencies, Hospitals and Healthcare providers to mitigate repeated use of 911.
In 2018, the Department launched the Right Care, Right Now nurse triage line program, which diverts non-emergency callers to 911 to community clinics for the most appropriate care.  It also provides non-emergency transportation to Medicaid beneficiaries and DC Healthcare Alliance enrollees. Additional information on this program is available here: https://fems.dc.gov/page/frequently-asked-questions-right-care-right-now
Status: Complete

Title: Recommendation 5b
Action Item:
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.

  • Progress:

Since 2008, FEMS has initiated such campaigns in partnership with other agencies, including the Office of Unified Communications.
In 2018, the Department launched the Right Care, Right Now nurse triage line program, which diverts non-emergency callers to 911 to community clinics for the most appropriate care.  It also provides non-emergency transportation to Medicaid beneficiaries and DC Healthcare Alliance enrollees.  Additional information on this program is available here: https://fems.dc.gov/page/frequently-asked-questions-right-care-right-now
Status: Complete

Title: Recommendation 5c
Action Item:
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.

  • Progress:

The Office of Unified Communications (OUC) and the Fire & EMS Department jointly implemented the EMD-Q™ (Emergency Medical Dispatch Quality Assurance) and AQUA™ (Advanced Quality Assurance) for the Medical Priority Dispatch System (MPDS™). 
In 2018, the Department and OUC transitioned to the Criteria Based Dispatch system, in an effort to more accurately match emergency and non-emergency callers with the right resources.  Also in 2018, In 2018, the Department launched the Right Care, Right Now nurse triage line program, which diverts non-emergency callers to 911 to community clinics for the most appropriate care.  It also provides non-emergency transportation to Medicaid beneficiaries and DC Healthcare Alliance enrollees.  Additional information on this program is available here: https://fems.dc.gov/page/frequently-asked-questions-right-care-right-now
Status: Complete

Title: Recommendation 5d
Action Item:
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.

  • Progress:
Both Departments worked on a policy on this issue following the issuance of the recommendation in 2007. There are currently no sobering centers in the District that will accept patients from DCFEMS. All such patients are transported to area hospitals.
Status: Complete

 

Title: Recommendation 5e
Action Item:
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.

  • Progress:
A new Closure/Diversion policy was issued on June 12, 2008. This was developed with the active participation and endorsement of the hospital working group formed under recommendation 5 (f). Collaboration with the ED Leaders Meetings, attempts to mitigate delays in patient transfer. Hospital closure is now a rare occurrence for extreme circumstances only and must be approved by the DC FEMS Medical Director. Numerous initiatives have been implemented since then to decrease the transfer of patient care time. 
Status: Complete

 

Title: Recommendation 5f
Action Item:
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.

  • Progress: 

This recommendation was implemented in 2008. The Department’s Medical Director continues to meet with hospital Emergency Department leaders on a monthly basis.
Status: Complete

Title: Recommendation 5g
Action Item:
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.

  • Progress:

In 2018, the Department launched the Right Care, Right Now nurse triage line program, which diverts non-emergency callers to 911 to community clinics for the most appropriate care.  It also provides non-emergency transportation to Medicaid beneficiaries and DC Healthcare Alliance enrollees. Additional information on this program is available here: https://fems.dc.gov/page/frequently-asked-questions-right-care-right-now
Status: Complete

Title: Recommendation 5h
Action Item:
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.

  • Progress:

In 2018, the Department launched the Right Care, Right Now nurse triage line program, which diverts non-emergency callers to 911 to community clinics for the most appropriate care.  It also provides non-emergency transportation to Medicaid beneficiaries and DC Healthcare Alliance enrollees.  Additional information on this program is available here: https://fems.dc.gov/page/frequently-asked-questions-right-care-right-now
Status: Complete

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