Identifying Additional Focus Areas for Las Cruces Fire Department's Mobile … · 2019. 5. 6. · The Las Cruces Fire Department (LCFD) implemented a Mobile Integrated Health Program

Running Head: Mobile Integrated Health 1

Identifying Additional Focus Areas for Las Cruces Fire Department’s Mobile Integrated Health

Program

Michael N. Daniels

Las Cruces Fire Department, Las Cruces, New Mexico

MOBILE INTEGRATED HEALTH 2

Certification Statement

I hereby certify that this paper constitutes my own product, that where the language of others is

set forth, quotation marks so indicate, and that appropriate credit is given where I have used

language, ideas, expressions, or writings of another.

Signed: _______________________________________

Michael N. Daniels


Abstract

The Las Cruces Fire Department (LCFD) implemented a Mobile Integrated Health Program

(MIH) in 2015 to reduce repeat 911 calls. The problem was LCFD had not formally identified

additional focus areas for the expansion of the MIH program. The purpose of this research was to

identify MIH focus areas relevant to LCFD and the City of Las Cruces and identify the

characteristics of successful MIH programs. Descriptive research methodologies were utilized to

complete this research. The research conducted as part of this applied research project (ARP)

sought to answer the following question: a) What are the characteristics of a successful Mobile

Integrated Health program? b) What focus areas are other Mobile Integrated Health programs

addressing in their communities? c) Which identified incident types or focus areas are risks for

the Las Cruces community that can be addressed by the Mobile Integrated Health program? The

literature review sought to identify the characteristics of successful MIH programs and current

focus areas outside of Las Cruces. The procedures used as for this research included two surveys

and a review of incident data for the City of Las Cruces. The surveys targeted outside

organizations and local providers to identify additional MIH focus areas and the perceived

effectiveness of those focus areas in Las Cruces. The research identified current MIH focus areas

and the key characteristics and recommendations for MIH program development. The

recommendations made were to conduct a review of the costs of current services to identify the

costs and benefits of expanding focus areas. The second recommendation was to identify clear

program objectives for the focus areas as identified in the successful characteristics of MIH

programs. Lastly, it was recommended that the focus areas be identified at a community level

and not just programs that are for the benefit of LCFD.


Table of Contents

Certification Statement……………………………………………….…………………………...2

Abstract……………………………………………………………………………………………3

Table of Contents………………………………………………………………………………….4

Introduction…………………………………………………………………………………….….6

Background and Significance…………………………………………….………………...……...7

Literature Review…………………………………………….………………………………..…13

Procedures………………………………………………………………………………………..26

Results...………………………………………………………………………………………….31

Discussion………………………………………………………………………………………..45

Recommendations………………………………………………………………………………..51

References………………………………………………………………………………………..54

Table of Figures

Figure 1: ………………………………….…………………….………………………………..34

Figure 2: …………………………………………...…………………………………………….35

Figure 3: ………………….…………………………………….………………………………..36

Figure 4: …………………………….………………...…………………………………………38


Table of Tables

Table 1: ………………………………………………………………………………………….37

Table 2: ……………………………...…………….…………………………………………….39

Table 3: ………………………………...………..………………………………………….…...40

Table 4: …………………………..……………….. ……………………………………………41

Table 5: …………………………...……………………………………………………………..42

Table 6: ………………………………………………………………………………………….43

Table 7: ………………………………………………………………………………………….44

Appendices

Appendix A: MIH/CP Survey………………….………….…………………………………….61

Appendix B: Queued Incident Types by Year…………………………………………………..64

Appendix C: Queued Condition Codes by Year……………………….………………………..65

Appendix D: Las Cruces Overdose and Psychiatric Incidents.…………………………….……67

Appendix E: Las Cruces Falls and Lift Assists…………………………………………….……68

Appendix F: Preventable/Unnecessary Emergency Room Visits………………………….……69


Improving Quality of Life for the Citizens of Las Cruces: Evaluating the Effectiveness of the Las

Cruces Fire Department’s Mobile Integrated Health Program

Introduction

In recent years, mobile integrated health (MIH) or community paramedicine has been a

favored subject in the fire service. The thought of community risk reduction from a broader

community perspective outside of preventing fire alone has helped contribute to this, along with

the financial benefits of hedging call volume growth for repeat 911 use and the potential for

reimbursement under the Patient Portability and Health Care Act of 2010 for preventing

unnecessary readmissions (Brown, 2015).

In 2015, the Las Cruces Fire Department began researching the feasibility of

implementing a mobile integrated health (MIH) program. Following the feasibility study and

implementation review, the MIH program was implemented in September 2016. The focus of the

program was to reduce the impact of those who repeatedly use the 911 system for primary care

issues that can be managed more appropriately through other means. Since the program’s

implementation, there has been a discussion on expanding the role of MIH beyond repeat 911

use. The problem is that the MIH program has not evaluated other focus areas for expansions

compared to the specific needs of the citizens of Las Cruces. The purpose of this research is to

identify other areas of focus that are reflective of the community’s needs.

Descriptive research methodologies will be used to identify focus areas that other

MIH/CP programs are using, comparing them to the call types and identified needs within the

City of Las Cruces, and evaluating the costs and benefits of each focus area by answering the

following research questions:


a. What are the characteristics of a successful Mobile Integrated Health program?

b. What focus areas are other Mobile Integrated Health programs addressing in their

communities?

c. Which identified incident types or focus areas are risks for the Las Cruces community

that can be addressed by the Mobile Integrated Health program?

Background and Significance

The City of Las Cruces covers over 76 square miles in South Central New Mexico and

according to the United States Census Bureau (2017), as of July 2017, Las Cruces, NM had an

estimated population of 101,712, an increase from 97,618 in 2010. The LCFD responded to

approximately 17,000 calls for service from July 1, 2015 through June 30, 2016 (City of Las

Cruces, 2016). It is the second largest city in the state of New Mexico and surrounded by several

volunteer and combination departments. The closest career municipal department is the El Paso

Fire Department over 40 miles from Las Cruces. There are an estimated 60,605 citizens over 25,

and nearly 35 percent of them have no college with 14.56 percent not graduating high school and

the other 19.46 percent having only a high school diploma/equivalent (USA.com, 2014).

Additionally, according to USA.com (2014), approximately 23.88 percent of Las Cruces’

population lives in poverty, compared to 20.88 percent and 15.59 percent across New Mexico

and the United States, respectively.

The LCFD is an Insurance Service Organization (ISO) Class 1, all-hazards organization,

serving the City of Las Cruces by providing primary fire response, fire prevention, emergency

medical services, hazardous materials response, technical rescue, airport rescue and firefighting,

and a Mobile Integrated Health (MIH) program. The organization is operated through two


divisions, Operations and Administration. Each division is managed by a deputy chief assigned

directly under the fire chief. The Operations Division consists of response personnel operating on

three shifts working a 24-hour on and 48-hour off schedule. There are eight stations with two

battalion chiefs and ten lieutenants per shift. The lieutenants manage crews consisting of three to

four personnel per unit. There are eight engine companies, two truck companies and two

transport capable squads in operations. The Administrative Division consists of operational

support, training, prevention, and emergency medical services. The Emergency Medical Services

Division is managed by a battalion chief who is the direct supervisor of the Mobile Integrated

Health program. The LCFD has strived to improve response models and service delivery as an

organization continually. The effort is exemplified by the addition of two-person squads that are

transport-capable and serve a dual purpose of transporting in case the private ambulance system

is unavailable in the Las Cruces city limits and alleviating four-person companies in responding

to an incident where only two people are needed. Also, the LCFD has implemented alternate

response vehicles (ARV’s), that are staffed by Truck Company crews to respond to calls where

the aerial apparatus is not needed, decreasing wear and tear on the unit. The result of each of

these has shown benefits with reduced response times and wear and tear on the apparatus where

squads and ARV’s are located.

In 2016, the LCFD implemented the MIH program with the primary goal reducing repeat

unnecessary 911 calls by evaluating the candidate’s needs and helping them access the

healthcare system or social programs in a manner that meets their specific requirements. The

MIH coordinator helps with access to primary care, referrals, and has even helped obtain access

ramps for wheelchair-bound citizens with the overarching goal of improving quality of life for

those in need and reducing the need for 911 response in preventable situations. The MIH office


is operated Monday through Friday by a single firefighter temporarily assigned to the program

based on his interest in the subject area. The MIH program candidates are identified by

operations crews who notice increased 911 usage for situations that appear to be poor healthcare

system access or other social conditions. While writing the report after the incident, the report

writer can select whether the individual is a candidate for the MIH program. The MIH

coordinator evaluates all candidates that are identified by operations personnel and placed on a

candidate list for follow up.

Regular audits of responses are performed based on incident address and person involved

as a means of proactively identifying repeat 911 users that may not have been identified by

operations personnel. As openings in the MIH program become available, the identified

individuals are screened to see if they need services that can be provided more effectively than

the emergency response system. There are also referrals from outside agencies to the program

where community partners identify citizens who may benefit from the resources available

through the MIH program. Such references often come from Adult Protective Services or home

health agencies that identify a client with social needs they cannot provide. In these cases,

LCFD’s MIH coordinator will seek solutions the MIH client’s problem such as building a wheel

chair ramp with union personnel. The original template has morphed to include referrals who

have never accessed the 911 system, yet still have needs that are not being met, leading to a

significant amount of scope creep from the original intent. LCFD’s MIH program to date

receives nearly 90 percent of its referrals outside of excessive 911 calls (P. Ford, personal

communication, December 10, 2018).

In August 2018, the MIH program received $50,000 from a local insurance carrier as part

of a cooperative pilot program to follow up with patients and see if they had any healthcare


needs that were not being met. The overall purpose is to help them navigate the healthcare

system and available services as a means of decreasing unnecessary emergency room visits. Of

the $50,000 allotment, $10,000 was for the purchase of the software needed by the program to

accurately track the program candidates and the remaining $40,000 to cover the associated cost

of bringing operations personnel in on overtime to help with patient follow-up. This agreement is

a one-time agreement that the LCFD hopes will trigger additional interest from other insurance

companies seeking to reduce unnecessary 911 access and improvement in the quality of care. In

late 2018, the initial success of the program was once again exemplified as a local health care

provider approached the organization on the willingness of LCFD to begin a post-discharge

follow-up for congestive heart failure (CHF) pilot program that would help fund the efforts of

the LCFD in maintaining the MIH program. Details of the pilot program were not released as of

the writing of this research but highlight the significance of LCFD needing to evaluate what

additional focus areas would be best suited for LCFD to consider adopting.

In discussion with Firefighter Paul Ford, the LCFD’s MIH Coordinator, there have been

77 people admitted to the LCFD’s MIH Program in addition to countless referrals without

admission since the program’s implementation in 2016. Additionally, of the 77 people admitted

to the program, not all of them have been high utilizers as many have been citizens with unmet

social needs or living in unsafe conditions. This has led to a significant increase in workload

without measurable benchmarks as the ancillary services provided to the end-user were not part

of the original program design but have been accepted by the organization. The acceptance of

such services, despite the lack of measurement tools or benchmarks, has been promoted as a

means of reducing community risk and increasing overall health as issues are identified, thus

preventing the potential for subsequent 911 use should the individual’s health deteriorate with


the social gaps present. Of the high utilizers of 911 enrolled in the MIH Program, there has been

a decrease of 74.8 percent in calls from six months before admission as compared to 6 months

after entry. Of the calls post admission, one individual who has significant needs has accounted

for nearly 50 percent of them. Most of the individuals enrolled have shown a decrease in overall

call volume to a range closer to 90-100 percent (P. Ford, personal communication, December 10,

2018).

In discussion with LCFD’s Fire Chief Eric Enriquez on November 20, 2018, he

expressed his observations on how the efforts of the MIH program have already begun to show

success in improving the overall quality of life of the citizens of Las Cruces, which is the

program’s primary goal. Increased 911 access was merely the means of identifying who may

need an alternative approach to solving their issues, as the continued use by a group of

individuals can help us point out where our citizens and community’s social system is struggling

to meet their needs. He expressed this is where LCFD fits in as the fire service has access to

those in need either personally or through data gathered by LCFD or other stakeholders willing

to share the information. He also expressed the decreased use of 911 by those who could be

served better through alternate service delivery models has allowed more time for operations

crews to train, making them better prepared to respond to other emergencies, further

exemplifying the benefits of MIH. Additionally, the LCFD has been contacted by private

organizations seeking public-private partnerships that can help improve the overall quality of life

for the citizens, as well as the healthcare system’s funds distributions (E. Enriquez, personal

communication, November 20, 2018).

The United States Fire Administration (USFA) maintains a strategic plan that is focused

on five strategic goals with a mission that reads “We provide national leadership to foster a solid


foundation for our fire and emergency services stakeholders in prevention, preparedness and

response” (USFA, 2014, p.8). MIH programs directly align with the first strategic goal of the

USFA to “Promote response, local planning, and preparedness for all hazards” and the third

strategic goal “Enhance the fire and emergency services’ capability for response to and recovery

from all hazards” (USFA, 2014, p. 9). Understanding community risks and helping the

community’s citizens live healthier lives through supporting integrated health solutions can have

a significant effect on promoting response since units can be more available for critical responses

within their respective districts in the City of Las Cruces. Additionally, money saved in

decreased unnecessary 911 access may help cities and states respond more effectively through

more effective distribution of public health funds.

This research aligns with the Executive Analysis of Community Risk Reduction

(EACRR) course. The goal of EACRR is to improve executive abilities in multi-hazard

community risk reduction, and strategic community risk reduction for both the citizens and

firefighters in the community (National Fire Academy [NFA], 2018). The LCFD’s MIH program

is geared toward identifying at-risk citizens and providing them a service that is geared toward

meeting their specific needs, thus reducing the impact of inefficient systems and increasing the

effective response at emergency incidents through increased availability.

Failing to evaluate the areas where the City of Las Cruces and LCFD can expand their

focus areas in MIH may lead to decreased effectiveness in reducing community risk proactively.

Additionally, failing to evaluate areas of expansion can lead to further additions of services that

are not aligned with the program’s scope or measured for success, decreasing the potential for

support by community stakeholders. Not proactively addressing the needs of the citizens

prevents the LCFD from improving their quality of life by preventing follow-up incidents as well


as the progression to 911 use and decreased overall quality of life. Additionally, the community’s

increased demand of fire department services may begin to outpace the growth and capacity of

the LCFD to effectively respond to community needs, stretching the fire department’s critical

resources because of a dated response model for dealing with non-emergent citizen needs.

Literature Review

A literature review was performed to evaluate current information related to mobile

integrated healthcare, community paramedicine, integrated health strategies. Additionally, the

literature review sought to identify the characteristics of successful MIH programs. Despite the

infancy of mobile integrated health programs and the variability in how or why they are

administered in the United States, there was a significant amount of literature available. The

search keywords used in Google and on the National Fire Academy Learning Resource Center’s

search bar were “community paramedic, community paramedicine, and mobile integrated

health.” The results were then limited to textbooks, journal articles/studies, and Executive Fire

Officer Applied Research Projects. Community specific information in addition to journal

articles, websites and books were reviewed and provided insight into MIH in the City of Las

Cruces. The literature is divided into three sections. The first section is an introduction into MIH

and how it became relevant in the United States. The second section pertains to question A and

the third section to questions B and C of this ARP.

MIH in the United States

The current healthcare system in the United States has continued to struggle from poor

management, which has led to increased fragmentation where providers operate in silos that have

no accountability to others, leading to an environment that is not conducive to improving overall


patient health, but geared toward profitability of the individual provider (Strange, 2009). It has

been a system designed around illnesses and conditions that are treated separately irrespective of

other determinants, failing to recognize the relationship between illnesses such as the impact of

mental health illnesses coupled with other chronic illnesses (Stanhope, Videka, Thorning, &

McKay, 2015). An example portrayed by Druss and Walker (2011) is how 68 percent of those

with mental health illnesses also have medical conditions, and how the treatment of chronic

medical conditions are an average 560 dollars more per visit than those without associated

mental health illnesses. Additionally, access to care has continued to be difficult, affecting the

country’s most vulnerable population, the homebound elderly, where there were approximately

922,000 of them in the United States in 2011 (O’Brian, 2017). Of those, it is estimated that less

than 12 percent of them receive primary health services in the home, leaving the remainder

without the adequate care needed to adequately sustain their health (Ornstein et al., 2015). It was

further evidenced that homebound elderly suffer from as much as two times the chronic medical

conditions and a significantly higher likelihood of being hospitalized due to the lack of regular

care, than those that are not homebound (Ornstein et al., 2015).

Healthcare reform in recent years has been geared toward improving patient experiences,

overall population health, and per capita healthcare costs through integration, also referred to as

triple aim (Stanhope et al., 2015). Integrated healthcare is defined by the Waddington and Egger

(2008) as “the organization and management of health services so that people get the care they

need, when they need it, in ways that are user-friendly, achieve the desired results and provide

value for money” (p. 5). The integrated approach seeks to address healthcare by emphasizing

population-based care and service availability with emphasis on prevention and care

collaboration across providers, reducing the impact of episodic illness-oriented care models


(Stanhope et al., 2015). The foundations of integrated healthcare are not recent, however, the

focus on integration was sparked by its emphasis in the Patient Portability and Accountability

Act of 2010 (PPACA) as well as the recognition of the need to assist patients in navigating the

healthcare system (Stanhope et al. 2015). Morganti, Alpert, Margolis, Wasserman, and

Kellerman (2014), reported that EMS care which resulted in appropriate levels of care in instead

of automatic transport to an emergency room could decrease overall Medicare costs ranging

from $283-$560 million per year.

The fire service has also been plagued with inefficiencies that are the result of operating

in the box of equal resource distribution (Boyd, 2009). The use of equal distribution principles

for all appears to almost always result in decreased efficiency where positive outcomes are

realized for some, but many others are left with poor outcomes (Boyd, 2009). Boyd (2009) states

“To date, fire if any emergency service organizations have explored the factors that drive

demand for those resources to guide locational decisions that might improve service delivery” (p.

1). It begs the question of whether the standard model for fire-based EMS deployment is the best

practice? As of 2015, over 60 percent of the nation’s fire departments provided some form of

EMS (Haynes & Stein, 2017). The current state must be challenged, and fire departments need to

ensure they understand the importance of sending the right number of resources are sent to an

incident rather than continuing to send everyone, all the time (Kostyrka, 2018). Fire service

expenditures have increased 170 percent from 1984 to 2014 after adjusting for inflation in 2015

dollars (Haynes & Stein, 2017). Risk-based approaches to planning that take into account

functionality tend to make the best possible uses if scarce resources (Canton, 2013). “As we

move into the future, more concentration should be placed on patient outcomes, patient

satisfaction, and transporting patients where the need to go for the best care” (Kostyrka, 2018, p.


11). The topic of efficient use of resources leads to discussions on community risk reduction

strategies that can be applied in healthcare and EMS, or MIH. EMS is uniquely positioned to

make significant impacts in ensuring the right care at the right time in the right setting (Zavadsky

& Hooten, 2016).

“Mobile integrated healthcare (MIH) is the provision of healthcare using patient-

centered, mobile resources in the out-of-hospital environment that are integrated with the entire

spectrum of healthcare and social service resources available in the local community” (Zavadsky

& Hooten, 2016, p. 11). The realm of MIH can be broad from a national perspective, but highly

specific to the individual community’s needs under this definition, not only providing but also

assisting in the coordination and management of care. It is a program that consists of a multi-

professional clinical team, creating a needs-matched system that not only results in patient

satisfaction, but also increased efficiency in care, and decreased overall healthcare costs

(Castillo, Myers, Mocko, & Beck, 2016). MIH efforts that are researched and developed to

target community subpopulations with the highest risk as compared to a generalized approach

were shown to yield the greatest overall results (Castillo et al., 2016). This observation is

supported by National Institute for Health Care Management or NIHCM (2012) in the estimation

that five percent of the population accounts for half of the nearly $1.8 trillion spent annually on

healthcare in the United States, reflecting an opportunity in the healthcare community to

capitalize from targeted efforts at reducing unnecessary healthcare expenditures.

Mobile integrated health or community paramedicine programs have been adopted by

prehospital providers to address the continued increase in demand of the 911 system for non-

emergent needs (Stowell, 2016). The increases in prehospital provider demand or 911 access,

according to Stowell (2016), are because those in need are uninsured and the 911 system will


facilitate access to care, or they have insurance but do not know how to access care. In either

situation, whether the patient is knowingly accessing the system inappropriately or not, an

inefficient response is likely to occur if traditional prehospital response models are utilized

(Stowell, 2016). Such responses often yield a trip to the emergency room where the patient is

later released with an order to follow up with their primary care physician or a specialist with

little to no direction on how to coordinate such care. When the patient does not follow up as

ordered, and their condition isn’t improved, another 911 call is likely to occur. The complex

healthcare system is a source of frustration and the ticket to alleviate those frustrations, at least

for the short term, is to call 911 or go to the emergency room for primary care (Zavadsky &

Hooten, 2016).

The number of MIH/CP programs has continued to grow in the United States with more

than 100 MIH/CP programs across the United States known as of 2014, and over 50 percent of

those having started within the previous year, according to a report published by the National

Association of Emergency Medical Technicians (NAEMT) (NAEMT, 2015). In 2017, a second

survey was published by the NAEMT reporting over 200 MIH/CP programs that were operating

across the United States (NAEMT, 2018). Public organizations have become the primary

providers of MIH/CP programs, accounting for over 60 percent of all MIH/CP programs, and

fire-based programs accounting for over 30 percent of all programs (NAEMT, 2018). As the

MIH/CP community continues to grow, it has been met with several challenges. One of the

challenges is resistance from those currently in the emergency medical services (EMS) field as

well as others who may feel the roles of MIH/CP providers are overlapping in areas that are

generally the responsibility of other healthcare personnel such as home health workers

(O’Meara, Ruest, & Martin, 2015). Another challenge that has been difficult to overcome is


funding the start-up and maintenance of the program, with much of the funding having to come

from local operational budgets and limited or no reimbursement opportunities (Pearson, Gale &

Shaler, 2014).

Research Question A

MIH/CP has grown over the last several years to encompass several focus areas that have

been identified where communities can improve the overall health and wellbeing of their citizens

(NAEMT, 2018). Areas of focus based on community needs have expanded far beyond the scope

of LCFD’s MIH program and can provide insight into potential areas of focus where the LCFD

can expand their community services when compared to the identified areas relevant to the City

of Las Cruces. A review of Zavadsky and Hooten’s (2016), Mobile Integrated Healthcare: An

Approach to Implementation, served as a framework for LCFD and other organizations to

continue in their review of potential focus areas. A review of published programs (Zavadsky &

Hooten, 2016) showed most MIH/CP programs at the time centered around reducing

unnecessary emergency room visits and 911 calls through measures such as health hotlines,

alternative transport programs, post-discharge follow-up programs, injury prevention, mental

health intervention, community referral programs, and incident surveillance. Currently, LCFD’s

MIH Program’s, as discussed in the background and significance, focus areas are incident

surveillance for repeat 911 use and community referrals through both community partners and

internal incident responders. Morganti et al. (2014) referred to several steps that innovative EMS

agencies are taking to manage less emergent calls in their agencies. The steps reported by

Morganti et al. (2014) were:

1. Telephone triage of callers with nonemergent problems


2. Proactive management of high-frequency callers to 9-1-1

3. On-site assessment and treatment of selected patients

4. Transport of patients with low-acuity complaints to non-ed settings, such as

community health centers

5. Provision of alternative means of transport, such as a taxi voucher, for patients

who do not require ambulance transport (p. 78)

There have been several areas where EMS programs have implemented programs that

started as small pilot programs within their respective organizations and grew to systemwide

programs (Morganti et al., 2014). Some recommendations from Morganti et al. (2014) for

agencies considering the implementation of a patient-centered EMS program are the

organizations implement strong educational components to minimize the ambiguity of

responders along with strong medical oversight, and a comprehensive quality improvement

program to ensure patients are dispositioned safely and appropriately. Additionally, a community

needs assessment, the consideration of key stakeholders, and an emphasis on the involvement of

a wide array of community health partners were also recommended as keys to successful

program implementation (Morganti et al., 2014).

The Mobile Integrated Healthcare Practice Collaborative (MIHPC) through Medtronic

Philanthropy (2014) included the following characteristics of a comprehensive and accountable

MIH program. The list of characteristics are as follows (MIHCP, 2014):

1. Program and healthcare outcome goals informed by a population health needs

assessment

2. Patient access through a patient-centered mobile infrastructure


3. Delivery of evidence-based interventions using multidisciplinary and

interprofessional teams composed of providers operating at the top of their respective

scopes of practice

4. Improved access to healthcare and health equity through 24-hour availability

5. Patient-centered healthcare navigation and population-specific healthcare services

6. Full utilization of existing infrastructure and resources, including telemedicine

technology

7. Integrated electronic health records and access to health information exchanges

8. Provider education and training based on assessments of program needs and provider

competencies

9. Physician medical oversight in program design, implementation, and evaluation

10. Strategic partnerships engaging a spectrum of healthcare providers and other key

stakeholders

11. Financial sustainability

12. Quality outcomes performance measurement and program evaluation (p. 6)

The International Association of Fire Chiefs (IAFC) has published a guide to MIH titled

Handbook on Mobile Integrated Healthcare (2017). The guide provides a history of MIH in the

fire service, outlines the importance of MIH and recommends 15 steps to implementing an MIH

program. Listed below are the steps recommended by the IAFC for implementing a successful

MIH program (IAFC, 2017):

Step 1- Determine if MIH is right for your department

Step 2- Identify and Analyze your MIH population pools


Step 3- Determine the type of medical personnel needed to staff an MIH unit.

Step 4- Identify those entities that will benefit and those that will be impacted by your

MIH program as well as stakeholders

Step 5- Determine the cost to implement and maintain your MIH program

Step 6- Identify the times and days when your MIH population calls 911

Step 7- Determine a billing rate

Step 8- Target your unit hour utilization rate and MIH patient interventions

Step 9- Implement a patient navigation center

Step 10- Develop agreements with local urgent care facilities to accept, treat, and refer

patients

Step 11- Implement legal authority to bill for MIH services

Step 12- Develop alternate transport methodologies

Step 13- Develop agreements with your local accountable care organizations and health

insurance companies

Step 14- Complete the development of the policies and procedures that will provide

strong medical control and risk avoidance strategies as well as structure and

guidance

Step 15- Develop and implement an effective training program

Zavadsky and Hooten (2016) also highlight several key characteristics of successful

MIH/CP programs that are based on the experience and evaluation of programs that have been


implemented in recent years. They list six principles that are identified as key to a successful

program (Zavadsky & Hooten, 2016):

1. Identify local community healthcare needs.

2. Collaborate with local healthcare system stakeholders in every aspect of the programs

3. Integrate with existing resources, do not seek to replace

4. Involve physician leaders who are committed to the program and patients

5. Start small, test programs

6. Learn and build the program from the mistakes made

Research Questions B and C

Health hotlines are phone lines that connect citizens with a health professional

telephonically and are designed to educate and direct callers to appropriate services regardless of

insurance status (Novant Health, n.d.). Regional Emergency Medical Services Authority

(REMSA) in the Reno, NV area provides this service to all Washoe County residents to ensure

adequate levels of care are provided, and patients are referred to the appropriate facility

(Zavadsky & Hooten, 2016). Novant Health in North Carolina (Novant Health, n.d.) and

Hometown Health (Hometown Health, n.d.) serving Nevada and California residents also

provide such services using registered nurses that are staffed both 24 hours a day during certain

hours.

Alternative transport programs are programs that are aimed toward transporting patients

to the appropriate facility and providing alternative transportation methods to health facilities as

a means of decreasing unnecessary emergency department (ED) visits (Zavadsky & Hooten,

2016). Such programs also seek to triage, treat, and release patients with that do not need an ED


or clinic visit following initial assessment and treatment. REMSA, in addition to their other

programs, has an Ambulance Transport Alternatives Program to provide alternative transport

locations outside of the ED, such as mental health facilities, detoxification facilities for

intoxicated persons, and urgent cares for low-acuity health issues (Zavadsky & Hooten, 2016).

According to Zavadsky and Hooten (2016), Wake County Emergency Medical Services (EMS)

in North Carolina, has a redirect program which offers similar services as REMSA and has

decreased ED visits by over 20 percent, saving an estimated 100 hospitalizations, 2,448 bed-

hours, and reduced overall care costs by $500,000. The savings reported appear to be based

solely on the impact of mental health issues and alternative transport to WakeBrook Behavioral

Health Facility (Zavadsky & Hooten, 2016). Christian Hospital EMS in St. Louis, MO and Eagle

County Paramedics (CO), have programs that use paramedics in the field to diagnose and treat

patients, with the goal of decreasing unnecessary ED visits (Zavadsky & Hooten, 2016). Lastly,

Mesa Fire & Medical Department (AZ) has a program that utilizes community paramedics with

either a nurse practitioner or a behavioral health specialist to decrease unnecessary ED visits and

ensure referral to appropriate care (Zavadsky & Hooten, 2016). This model, however, especially

with the use of only paramedics, has been met with scrutiny as Neeki et al. (2016) reported an

under-triage rate of 19.3% when using paramedics under the standard scope of practice and

training levels. The need for additional training is also supported by the NAEMT (2018) and was

recommended through the review of over 1,500 elderly patients treated by paramedics with

additional training who were able to reduce the need for an ED visit by nearly 25 percent in the

United Kingdom (Mason et al., 2007). Other agencies that utilize programs that route patients to

more appropriate facilities beyond the ED or treat at home services. Seattle and King County

EMS implemented a six-month pilot program where a total of 204 patients met inclusion criteria


where it was determined the program avoided 200 visits to the ED and an estimated cost savings

of $750,000 (Morganti et al., 2014).

Post-discharge follow-up programs have become a mainstay for funding MIH programs

as they are programs that can provide pass-through funding through the savings realized by

hospitals or insurance companies (NAEMT, 2018). Post-discharge follow programs are funded

on a per-patient contact basis, outcome-based payment system, or a shared savings model, which

the latter of the two rewards the success of the program through readmission reductions

(Zavadsky & Hooten, 2016). The Center for Medicare and Medicaid Services (CMS) has the

Hospital Readmissions Reduction Program (HRRP) which was mandated by Section 3025 of the

Affordable Care Act (ACA) and requires payment reductions or penalties for excessive

readmissions (CMS, 2019). According to CMS (2019), the measures HRRP focuses on

readmission reduction for are acute myocardial infarction (AMI), chronic obstructive pulmonary

disorder (COPD), heart failure (HF), pneumonia, coronary artery bypass graft (CABG) surgery,

and elective primary total hip arthroplasty or total knee arthroplasty (THA/TKA). The potential

for organizations to capitalize on helping reduce readmissions has continued to grow with more

and more MIH/CP programs partnering with hospitals and/or insurance companies (NAEMT,

2018). Zavadsky and Hooten (2016), reported seven of the ten highlighted MIH/CP programs in

the United States were reducing hospital readmissions as one of their respective focus areas.

Zavadsky and Hooten (2016) noted the many services that have partnered with local

organizations to receive payments for reducing preventable readmissions.

Fall prevention programs are programs geared toward preventing at-risk populations from

the catastrophic effects of falls. The most at-risk population for falls in adults over the age of 65

as they account for the greatest risk of death or serious injury from the fall (Kopp & Ofstead,


2010). The age group 65 and older has been shown to account for anywhere between 65 and 75

percent of all incident responses to falls (Theut, 2017). It is believed that fall prevention has a

significant education component that starts with adults at all ages as knowledge of the problem

and repercussions of such incidents can trigger changes in people’s attitudes toward falls (Theut,

2017). In 2012, unintentional falls were the third leading cause of unintentional injury for all

ages and the fourth leading of cause injury-related death in New Mexico, according to the New

Mexico Department of Health [NMDOH] (2014). Additionally, New Mexico’s fall-related death

rate of 97.6/100,000 people was 1.8 times higher than the national rate of 53.4/100,000 in 2011

(NMDOH, 2014). From 2010 through 2012, nearly half of the falls where the patient was

hospitalized in New Mexico resulted in either discharge to a skilled nursing facility or required

home health care services (NMDOH, 2014).

In 2015, it was estimated over 43 million people age 18 and older had a mental illness

and 9.8 million having a serious mental illness in the United States (Moss, 2018). Mental health

intervention by EMS resulting in transport to the ED is estimated to account for approximately

2.2 million transports in the United States annually (Trivedi, Glenn, Hern, Schriger & Sporer,

2018). Trivedi et al. (2018) reported “Only 0.3 percent of patients receiving involuntary holds

needed any critical interventions” (p. 50). Their study further showed that when a diversion

program in EMS exists, the paramedics’ expertise has allowed for 41 percent of those who would

receive an involuntary hold to be successfully diverted from an ED to a psychiatric facility based

on established screening protocols (Trivedi et al., 2018). Mental health issues in the United

States are much more than a behavioral health problem as it affects the entire health care system,

compromising the quality of care for all who visit the ER due to overcrowding and psychiatric

boarding (Alakeson, Pande, & Ludwig, 2010). According to Alakeson, Pande, & Ludwig (2010),


“Boarding times in Georgia, for example, average thirty-four hours, and many patients wait

several days for an inpatient bed in of the state’s seven psychiatric hospitals” (p. 1637). During

this time, scarce emergency room resources a being consumed, creating increased wait times for

all seeking emergency care (Alakeson, Pande, & Ludwig, 2010). Overall quality of care often

lacks through the traditional methods of EMS response and transport to the ED, where the care

of the patient is merely transferred from one agency that is ill-prepared to another (Bronsky,

Giordano, & Johnson, 2016). Over six months, with an average of 81 patients seen per month,

the Colorado Springs’ Community Response Team (CRT), was able to decrease ED transports of

their patients by over 85 percent (Bronsky, Giordano, & Johnson, 2016). Such program success

is seen when organizations come together in a coordinated manner to help ensure those with

mental health illnesses are receiving the appropriate care.

In summary, the literature reviewed for this ARP reviewed how MIH/CP programs

became a commonplace for EMS providers and more specifically fire-based EMS providers. The

literature review also sought to identify the common characteristics of successful programs or

recommended characteristics for a successful program. Additionally, a review of current

MIH/CP focus areas was performed, specifically targeting programs that LCFD has minimal data

to support through incident data.

Procedures

The purpose of this research was to identify focus areas beyond LCFD’s MIH program’s

current scope by reviewing the characteristics of successful MIH/CP focus areas, current

MIH/Community Paramedicine focus areas, and comparing and matching the identified focus

areas to the needs of the City of Las Cruces. A descriptive methodology was utilized to guide the


research for this ARP through an extensive literature review, a survey of other organizations, and

lastly a review of Las Cruces incident data for comparison and evaluation.

A survey instrument (See Appendix A) was developed to identify other organizations

who have MIH/CP programs. Additionally, the questions were designed to gather information on

the type and size of the organization, the focus areas of the organizations, the budgets assigned to

the programs, outside funding sources, obstacles, and benefits realized. The survey was a 10-

question survey that was developed using Survey Monkey, an internet-based survey development

software on November 21, 2018, and was open through December 15, 2018. The survey was

anonymous and only allowed for one response per IP address to limit the potential for duplicate

agency responses. It was sent across the fire service through posting on the International

Association of Fire Chiefs (IAFC) Knowledge Net on November 21, 2018. Additionally, the

survey link was sent to the president-elect of the National Association of Emergency Medical

Technicians, to be forwarded on a mailing list of MIH/CP personnel nationwide specifically

seeking to target most organizations with MIH/CP Programs. Following the deadline, there were

21 responses collected, and the data was evaluated and categorized. The survey’s design

provided data for research question B of this ARP in identifying organizations that had MIH/CP

programs, their organizational make-up (career, volunteer, or combination), population served,

respective focus areas, budgets/funding sources, obstacles, and benefits of their program.

Following the identification of other MIH/CP focus areas that are being addressed in

other organizations, a review of call data from Las Cruces Fire Department was performed for

the years of 2014, 2015, 2016 and 2017. The purpose of this was to help answer question B of

this ARP by identifying and aligning incident responses with the identified focus areas. National

Fire Incident Reporting System (NFIRS) codes as described in the 2015 edition of National Fire


Incident Reporting System: Complete Reference Guide (USFA, 2015) were utilized to limit the

call types across the years evaluated consistently. Specifically, the codes that were utilized to

limit calls related to the MIH areas of focus identified were the 300: Rescue and Emergency

Medicals Services Incidents, 500: Service Call, and 600: Good Intent Call series. The data from

the 300 series incidents were limited to 300: Rescue and EMS Incident- Other, 311: Medical

Assist, 320: Emergency Medical Services- Other, 321: EMS Call- Excluding Vehicle Accident.

The 500 series incidents were limited to 510: Person in Distress- Other, 512: Ring or Jewelry

Removal and 554: Assist Invalid. Lastly, the 600 series codes were limited to 600: Good Intent

Call- Other, and 661: EMS Call where Party has Left Scene (See Appendix B).

Incident data related to EMS incidents was also queried and cataloged by the condition

codes that were utilized by LCFD during the reported years for all incidents with patient care

reports attached (See Appendix C). Not known, not reporting, not applicable, and not available

codes utilized by the report writers were combined. These codes represent areas where LCFD

personnel were able to categorize patients that did not fit in to any of the pre-defined condition

codes available. The other codes were also used for incidents where reports were generated on

interactions with individuals not categorized as patients by LCFD. Additionally. All other codes

were combined by like types to condense the data from 74 individual lines to 42 commonly

themed conditions. The data gathered was then reduced to incidents that accounted for one

percent of the patient care reports completed or greater. In addition to the review of LCFD

incident data, an email was sent to the Mesilla Valley Regional Dispatch Authority (MVRDA)

on February 4, 2019 to identify the amount of mental health-related incidents and overdoses any

response unit was sent to in the City of Las Cruces from 2014 through 2017 since LCFD does

not respond to all behavioral calls. Behavioral issues and suicidal ideations incidents are


primarily referred to Las Cruces Police Department (LCPD) and American Medical Response

(AMR), the county’s contracted transport provider. A response was received on February 5,

2019, from Robert Milks, MVRDA’s National Crime Information Center (NCIC) Coordinator

(See Appendix D). An additional email to Robert Milks was sent on February 11, 2019,

requesting the number of times LCFD was dispatched to lift assists and falls from 2014 through

2017 since the data obtained through LCFD’s incident reporting system did not allow the

incidents to be specifically limited by the individual types. A response was received from Robert

Milks on February 13, 2019 (See Appendix E). Fall victims are dispatched when there is

generally an injury associated with the fall, while lift assist are generally dispatched when there

is no reported injury and the subject needs assistance back in bed or to their wheelchair and so

on. The areas where incident data was sparse, literature was reviewed to supplement the

available information.

A second survey was sent out to local providers on February 1, 2019, with a deadline of

February 15, 2019, seeking the input of prehospital paramedics and emergency department staff

from the two local hospitals, Mountain View Regional Medical Center and Memorial Medical

Center (See Appendix F). The survey asked respondents first to identify their role and answer

what percentage of ED visits were preventable/unnecessary as multiple-choice answers for the

first two questions of the survey. Questions three through ten of the survey asked them to rate

their perceived effectiveness of each of the identified focus areas utilizing a single-row Likert

Scale. The numerical score for each response was based on a one to five scale with very unlikely

scoring a one, unlikely scoring a two, neutral scoring a three, likely scoring a four, and very

likely scoring five points. Question 11 of the survey was a free text box seeking to answer what

the respondents perceived to be the condition that contributed to the majority of preventable or


unnecessary ED visits. Lastly, question 12 asked the respondents to rank the identified focus

areas from one through eight, with focus area one being the area with the most perceived

effectiveness and eight being the program with least perceived effectiveness. During the time

allotted, 45 people responded to the survey. The survey was anonymous and only allowed for

one response per IP address to limit the potential for duplicate agency responses. The questions

were tallied based on overall averages as well as by individual provider type to provide insight

into the provider group perspectives. The emergency room technicians yielded only one

response, providing for lack of representation of the impressions of those serving in such roles.

The results from questions three through ten were compared to question 12 to help identify the

focus areas with the highest levels of perceived effectiveness. The areas were then compared to

incident counts for the City of Las Cruces.

While the procedures performed sought to control the limitations of this research, there

were still several present. The first was the lack of response to the survey, potentially limiting the

response pool of focus areas in MIH. The posting locations sought to capitalize on reaching

members of organizations globally, but only yielded twenty-one responses. Additionally, while

the setting limited responses from the same IP address, there is a possibility that the same

organization could be represented since the responses were anonymous and did not identify the

represented organization by name. The survey responses were also likely influenced by those

interested in the subject matter and those who respond to most EFO surveys posted on the IAFC

Knowledge Net. This may correlate to the lack of response as the interest in MIH/CP programs

appears limited across the fire service. The NAEMT (2018) reports over 200 MIH/CP programs

across the United States. The seven respondents with MIH/CP programs are a small sample of

those programs.


Another limitation was found in the collection of the data and the difficulty in identifying

areas of focus. The reporting software utilized by the LCFD before October 2017 did not capture

detailed data points outside of general incident types and condition codes, significantly limiting

the author’s ability to capture information that can be utilized in the evaluation process. The extent

that the reporting software was able to capture incident data was limited to NFIRS call types and

National Emergency Medical Services Information Systems (NEMSIS) condition codes. The lack

of consistent documentation has led to difficulty in analyzing call volume.

Results

The data obtained to answer the three research questions presented in this ARP are

outlined below. The first research question was answered by performing a literature review of

available data regarding the characteristics of successful MIH programs. The second question of

this ARP was answered by performing a literature review of MIH programs and a survey

instrument that looked to identify current MIH programs. The third question was answered

through a review of LCFD incident data and local provider perspectives and then comparing it to

the focus areas identified as part of the second question of this ARP.

Research Question A: What are the characteristics of successful Mobile Integrated Health

programs?

The purpose of this question was to identify the characteristics of successful MIH/CP

programs which will allow LCFD to identify not only the programs that have been successful but

also how to ensure the focus areas that LCFD considers expanding to are built upon a successful

framework. The literature review conducted as part of this ARP identified several common

characteristics that were recommended for a successful MIH program. The characteristics of


successful programs that were identified appear to be universal recommendations across all focus

areas. Below, the characteristics identified in the literature review are highlighted below in no

particular order:

The programs implemented should be based on the results of a community risk

assessment as affirmed by IAFC (2017), MIHCP (2014), Morganti, et al. (2014), and Zavadsky

& Hooten (2016). Community risk assessments provide insight in to the community and its risks

based on health data and community demographics. Understanding the community facilitates

targeted approaches to strategic community risk reduction, where the areas addressed are not

blindly addressed, but supported by community specific data. Castillo et al. (2016) noted, MIH

efforts that are researched and developed to target community subpopulations with the highest

risk as compared to a generalized approach were shown to yield the greatest overall results.

Another characteristic of successful MIH programs is they have high stakeholder

engagement and integration as affirmed by IAFC (2017), Morganti, et al. (2014), MIHCP (2014),

and Zavadsky & Hooten (2016). Engaging stakeholders provides for integration among

community providers, programs, and services that are able to collectively address the problems

of those needing assistance. Stakeholder engagement is supported by O’Meara, Ruest, and

Martin (2015) as the involvement of as many stakeholders can reduce duplication of effort and

prevent feelings of encroachment from other providers in the community.

Program implementation should have a cost-analysis performed as recommended by

IAFC (2017), MIHCP (2014), and Zavadsky & Hooten (2016). Understanding the costs of

implementation when compared to the services currently provided can provide insight in to the

benefits that can be realized through program implementation. Utilizing the costs of services


provided and the services proposed allows for opportunity cost analysis for organizations to

determine the potential impacts of implementation or not.

The problem should also attempt to identify stable funding sources for the program as

suggested by IAFC (2017), MIHCP (2014), and Zavadsky & Hooten (2016)]. Ensuring

sustainability for the program to maintain its efforts is critical to the success of programs. MIH

programs failing to secure stable funding sources risk regression if the program is terminated

despite success due to lack of stable funding sources.

Another important characteristic is the providing of population specific navigation

services [IAFC (2017), Morganti, et al. (2014), MIHCP (2014), and Zavadsky & Hooten (2016)].

Based on the results of the community risk analysis, it is important for organizations with MIH

programs to take action in addressing the areas identified. As discussed, targeted approaches

yield the greatest results (Castillo et al., 2016). Additionally, population specific services can

minimize scope creep, ensuring the program is adhering to serving the populations with the

greatest needs.

Strong policy, protocol, medical direction and quality improvement programs are also

important characteristics of successful MIH programs [IAFC (2017), Morganti, et al. (2014),

MIHCP (2014), and Zavadsky & Hooten (2016)]. Policies, protocols, and medical direction

provide guidance on expectations of the program to ensure ambiguity and risk are minimized.

Quality improvement allows for the retrospective review of the care and services provided to

ensure they meet the guidance set by policy, protocol, and medical direction. Strong quality

improvement also helps identify the gaps in policy, protocol, and medical direction.

The last of the identified characteristics of successful MIH programs is a well-trained

provider team [IAFC (2017), Morganti, et al. (2014), MIHCP (2014), and Zavadsky & Hooten


(2016)]. Adequate training helps reduce risk and ensure high levels of quality care are provided.

The role of an MIH program is often proactive, where traditional EMS is reactive. Providers

should be trained in proactive measures as well as any expanded scope of practice provision that

have been approved. Mason et al. (2007), noted how additional training of paramedics in the

United Kingdom reduced unnecessary emergency room visits of elderly by nearly 25 percent.

Research Question B: What focus areas are other Mobile Integrated Health programs

addressing in their communities?

The survey that was sent out yielded minimal responses with 21 recorded responses

during the time period the survey was opened. Of the 21 responses, only seven of the

organizations had a MIH/CP program (See Figure 1). The literature review performed identified

that as of 2018 there were over 200 MIH/CP programs operating in the United States (NAEMT,

2018). Of the 200 plus programs, the NAEMT (2018) reported that 33 percent of the reporting

MIH/CP programs were public, fire-based systems that have started MIH/CP programs in their

respective communities. The results of the survey provided insight in to other MIH/CP program

focus areas but appeared lacking in response from other fire-based organizations that have

implemented MIH/CP programs in their respective communities.

0

10

20

714

Yes No

Figure 1: Presence of an MIH/CP program


The organizational makeup of the seven respondents that currently have MIH/CP

programs consisted of four all career departments, three combination departments, and zero all

volunteer departments (See Figure 2). The literature review performed did not delineate the

organizational make-up of those with active MIH/CP programs. Of the 14, respondents that did

not currently have a MIH/CP program, 11 were all-career organizations, two combination, and

one all-volunteer organization. A review of the organizations highlighted by Zavadsky and

Hooten (2016), showed that all 10 of the represented organizations were career/combination type

organizations where the MIH/CP personnel assigned were paid.

The population served by the organizations with current MIH/CP programs appeared

evenly distributed across the options provided (See Figure 3). Two of the organizations serve

communities less than 50,000 citizens, two serve between 50,001-150,000, one serves 150,001-

300,000, and two serve populations over 300,000 citizens. Of the organizations that responded to

the survey and do not have a MIH/CP program, there was a noticeable difference in the amount

0

1

2

3

4

Career Combination Volunteer

4

3

0

Figure 2. MIH/CP Program Organizational Make-Up


of organizations who served less than 50,000 citizens as compared to the other three options.

There were seven or 50 percent of the respondents that did not currently have MIH/CP programs.

None of the respondent organizations without an MIH/CP program served populations of less

than 50,000. Two organizations served populations of 50,001-150,000, three served populations

of 150,001-300,000, and two served populations greater than 300,000.

0

1

2

Less than 50,000 50,001-150,000 150,001-300,000 Over 300,000

2 2

1

2

Figure 3. Population Served

As identified in Table 1, the seven organizations that reported having MIH/CP programs

in the survey, reported a variety of focus areas they were concentrating on beyond high 911

utilizers, a focus area already performed by LCFD. Post-Discharge follow-up/Readmission

avoidance and prevention were reported as a focus area for four of the seven organizations that

responded to the survey. Post-Discharge follow-up/Readmission avoidance was also highly

represented as a focus area in the literature review with 70 percent of the highlighted

organizations utilizing it as a focus area for their organization (Zavadsky & Hooten, 2016).

Opioid outreach was represented by three of the seven organizations who responded to the


survey. Mental health response was a focus area represented by two of the organizations. One

organization who responded to the survey focuses solely on fall prevention, with another

organization reporting hospice/palliative care partnerships as one of their many focus areas. A

focus area that was not represented in the survey but was identified in the literature review was

alternative transport programs, which transport patients to urgent cares and/or mental health

hospitals instead of transporting them unnecessarily to an emergency room (Zavadsky & Hooten,

2016). Additionally, such programs often use community partners to facilitate such transports

using vouchers for taxis and bus systems (Morganti et al., 2014). Health hotlines have also been

employed as a service provided to educate citizens and reduce unnecessary 911 visits (Zavadsky

& Hooten, 2016).

Table 1

Identified Focus Areas

Organization Type Population

Served Focus Area(s)

Organization 1 All Career 150,001-300,000 High Utilizers of 911

Organization 2 Combination <50,000 Fall Prevention

Organization 3 Combination 50,001-150,000 Post Discharge Follow-Up

Organization 4 All Career Over 300,000 High Utilizers of 911, Readmission avoidance, Mental Health, Opioids, Chronic

Disease Management

Organization 5 All Career 50,001-150,000 High Utilizers of 911, Opiate Outreach

Organization 6 Combination <50,000 High Utilizers of 911, Social Services, Mental Health Response and Follow-Up,

Post Discharge Follow-Up, Overdose Follow-Up

Organization 7 All Career Over 300,000 High Utilizers of 911, Readmission Prevention, Home Health Partnerships,

Hospice/Palliative Care Partnerships


The following list contains the identified focus areas in the survey as well as the literature

review performed. The focus areas are listed in no particular order:

1. High-Utilizers of 911 (Already a LCFD MIH program focus area)

2. Fall Prevention

3. Alternative Transport

4. Post-Discharge Follow-Up / Readmission Prevention

5. Mental Health Response

6. Opiate / Drug Response and Outreach

7. Social Services / Health System Navigation

8. Hospice/Palliative Care Partnerships

9. Health Hotline Services

Research Question C: Which identified incident types or focus areas are risks for the Las

Cruces community that can be addressed by the Mobile Integrated Health program?

14000 14500 15000 15500 16000 16500 17000 17500 18000

2014

2015

2016

2017

15511

16181

16444

17663

Figure 4. LCFD Total Incident Count

An initial review of call data was gathered utilizing LCFD’s records management

systems for the years of 2014, 2015, 2016 and 2017. During the four-year period the incident


counts were 15,551, 16,181, 16,444 and 17,663 respectively (See Figure 4). The incident counts

over the four years show an annual increase of 2,152 incidents in 2017, as compared to the

number of incidents in 2015. The queued results utilizing the specified NFIRS codes were then

gathered, yielding 10,289, 10,529, 10,522 and 10,482 incidents for the same years (See Table 2).

Despite the overall call increases over the four-year period, the incident counts remained

relatively flat for the queued incidents of this ARP, as evidenced in Table 2. The areas reflecting

a significant increase can be attributed to how incidents were classified, and the changes

implemented in 2015 that limited patient care reports generated when the transport agency was

on scene prior to LCFD and when there were no injuries. Before this, a blank patient care report

with minimal incident information was attached to keep track of non-patient disclosures and the

assistance provided to the private EMS service. If any care is provided beyond assisting in

patient movement, a patient care report must still be completed. The changes sought to eliminate

patient care reports for manpower assists.

Table 2

Queued LCFD NFIRS Codes

Incident Types 2014 2015 2016 2017 300: Rescue and EMS Incident, other 546 427 340 312 311: Medical Assist 1,112 1,351 1,714 2,256 320: Emergency Medical Services, other 725 881 800 707 321: EMS Call, Excluding Vehicle Accident 7,413 7,261 6,970 6,429 510: Person in Distress, other 150 165 208 173 554: Assist Invalid 216 311 366 497 600: Good Intent Call 127 133 124 108 Total Incidents 10,289 10,529 10,522 10,482

Table 3 represents the incident distribution based on the patient care reports completed by

LCFD emergency response personnel from 2014-2017 utilizing the condition codes that

represented one percent or greater of the patient care reports completed. The data presented


showed that over 20 percent of patient care reports did not list one of the condition codes

presented. The reporting software required a choice without the ability for free text, which left

the not known, not reporting, not applicable, and not available condition codes making up a

significant portion of the reported codes. Additionally, non-patients or individuals who were

responded to from a 911 call were required to acknowledge they were not a patient and a report

was completed by response personnel, which could contribute to the higher proportions of

incidents in this category. Lastly, there may not have been a condition code that met the

interpretation of the provider, leading to one of the above four codes utilized. In 2015, there were

changes to the classification as described above, which could explain the significant decrease in

such codes after 2015.

Table 3

Queued LCFD Condition Codes

PCR Call Data 2014 2015 2016 2017 Totals Avg. / Year

Percent of Avg.

Total Patient Reports 9415 8844 8296 7,120 33675 8418.75 N/A

Not Known, Not Reporting, Not Applicable, Not Available 2534 2215 1680 712 7141 1785.25 21.206%

Pain (8030) 879 825 961 1204 3869 967.25 11.489%

Trauma (8043-8050) 910 855 823 635 3223 805.75 9.571%

Difficulty Breathing (8010) 647 586 673 593 2499 624.75 7.421%

Abdominal Pain (8001, 8002) 650 634 538 514 2336 584 6.937%

Cardiac Symptoms (8003, 8012, 8020, 8021, 8061) 628 531 594 547 2300 575 6.830%

Sick Person (8040) 445 447 500 536 1928 482 5.725%

Altered Level Consciousness (8016) 518 505 396 381 1800 450 5.345%

Convulsions/Seizures (8017) 374 378 321 348 1421 355.25 4.220%

Unconscious/Syncope/Dizziness (8042) 318 305 331 336 1290 322.5 3.831%

Alcohol Intoxication or Drug Overdose (8034,8035) 314 326 270 255 1165 291.25 3.460%

Psychiatric (8038, 8039) 202 207 161 130 700 175 2.079%

Blood Glucose (8008) 159 183 153 148 643 160.75 1.909%

Back Pain (8031, 8032) 131 124 133 101 489 122.25 1.452%

Abnormal Skin/Vital Signs (8004/8005) 130 119 141 91 481 120.25 1.428%

Respiratory/Cardiac Arrest (8009,8011) 77 106 97 98 378 94.5 1.122%

Neurologic Distress (8029) 84 80 108 101 373 93.25 1.108%


The data represented above in Table 3 shows nearly 20 percent of all patient care reports

completed utilized condition codes related to pain, excluding chest pain which is captured in the

cardiac symptoms code grouping. Traumatic incidents accounted for the next highest amount of

patient care reports accounting for nearly 10 percent of all completed reports. Following

traumatic incidents, difficulty breathing, cardiac symptoms, sick person, and altered level of

consciousness accounted for 7.42, 6.83, 5.73, and 5.35 percent of all reports, respectively. The

remaining eight condition code groups accounted for approximately 21 percent of the total

PCR’s completed.

The email sent to the area’s regional dispatch authority, MVRDA, seeking the number of

times any units were dispatched to behavioral/suicidal and overdose incidents yielded similar

amounts of overdose incidents, but a significant difference in the number of psychiatric incidents

(See Appendix E). MVRDA reported that during the years of 2014, 2015, 2016, and 2017, units

were dispatched to overdoses in the City of Las Cruces 358, 463, 427, and 415 times,

respectively. As for the number behavioral/suicidal incidents for the years of 2014, 2015, 2016,

2017, there were 1,373, 1,596, 1,579, 1,899 as compared to 202, 207, 161, and 130, respectively

(See Table 4).

Table 4

The second email sent to MVRDA requesting the number of dispatches in the City of Las

Cruces there were for falls and lift assists yielded results that were not available through the

CLC Incident Comparison Call Type 2014 2015 2016 2017

Incident Type LCFD CLC LCFD CLC LCFD CLC LCFD CLC Behavioral/Suicidal 202 1373 207 1596 161 1579 130 1899 Overdose 314 358 326 463 270 427 255 415


initial incident review performed using LCFD’s incident records (See Table 5). For 2014, there

was a combined 1,599 fall and lift assist incidents the LCFD was dispatched to, of 15,506 total

calls. For 2015, there were a combined 1,759 fall and lift assists out of a total 16,148 incidents

LCFD responded to. In 2016, there were a combined 1,874 fall and lift assists out of 16,416

incidents responded to. Lastly, in 2017, there was a combined 1,949 fall and lift assists out of

17,590 total incidents responded to. Each of the years surveyed as part of this ARP, falls and lift

assists accounted for over 10 percent of LCFD’s incidents.

Table 5

LCFD Fall and Lift Assist Incidents Incident Type 2014 2015 2016 2017 Fall Victim 1106 1169 1228 1263 Lift Assist 493 590 646 686

Total LCFD Incidents 15,506 16,148 16,416 17,590 % of total LCFD Incidents 10.31% 10.89% 11.42% 11.08%

The survey (See Appendix F) sent to local providers yielded 45 responses during the

allotted time. Of the 45 responses, there were a varied set of responses based on who the

provider was. There were 15 providers that were physician/nurse practitioners, or 33.33 percent

of the total survey respondents. Registered nurses accounted for 10 of the respondents or 22.22

percent. Prehospital paramedics accounted for 19 responses or 42.22 percent of the survey

respondents. Lastly, a single response or 2.22 percent of total responses were from an emergency

department technician.

When the providers were surveyed on the number of emergency room (ER) visits they

felt were unnecessary (See Appendix F), three providers felt 25 percent or less of the visits were

unnecessary. Of the 45 respondents, 20 providers felt the percentage of emergency room visits

that were unnecessary was between 26-50 percent. An additional 18 respondents felt the percent


of unnecessary visits to the ER was between 51-75 percent. Lastly, four respondents felt 76-100

percent of the visits were unnecessary. The provider response distribution showed most

providers perceived the number of unnecessary visits to be between 26-75 percent, as only one of

each of the providers listed, with exception to emergency room technicians, perceived the

percentage to be either zero-25 percent or 76-100 percent (See Table 6). The responses show a

significant number of what is perceived by first-hand providers to be unnecessary visits to the

ER.

Table 6

Unnecessary ER Visits: Provider Distribution Prehospital Paramedic

% Unnecessary ER Visits 0-25% 26-50% 51-75% 76-100% Respondents 1 8 9 1

Registered Nurse % Unnecessary ER Visits 0-25% 26-50% 51-75% 76-100%

Respondents 1 4 4 1 Physician/Nurse Practitioner

% Unnecessary ER Visits 0-25% 26-50% 51-75% 76-100% Respondents 1 7 6 1

Emergency Room Technician % Unnecessary ER Visits 0-25% 26-50% 51-75% 76-100%

Respondents 0 1 0 0

The identified focus areas were then rated individually and against one another to

evaluate the perceived effectiveness the respondents to the survey felt about the focus areas (See

Table 7). The results of the survey showed that the highest rated perceived effectiveness was

among five of the eight focus areas. The area with the highest weighted average of perceived

effectiveness when rated alone was mental health response and outreach but was third when

ranked against the other focus areas. Post-discharge follow-up/readmission prevention programs

had the second highest weighted average as well as ranked second among all other focus areas. A

Social services/health system navigation program was ranked the highest overall when compared

to the other focus areas and had the third highest weighted average of perceived effectiveness.


Alternative transport and fall prevention ranked fourth and fifth, in both weighted average and

ranked among the others in perceived effectiveness. Health hotline was sixth in weighted average

and ranking among the other focus areas. Hospice/palliative services navigation was seventh in

the weighted average scores and eighth in the overall ranking among the focus areas. Lastly,

opioid response and outreach programs were rated to be the least effective in reducing

unnecessary 911 visits in the weighted average scoring but ranked seventh in perceived

effectiveness when compared to the other identified focus areas.

Table 7

Focus Area Weighted Average vs. Ranking

Focus Area Weighted Average Ranked Scores Incidents

Mental Health Response and Outreach 4.51 5.33 1,612

Post Discharge Follow-Up/Readmission Prevention 4.49 5.70 Unknown

Social Services/Health System Navigation 4.47 5.74 Unknown

Alternative Transport 4.43 5.30 Unknown

Fall Prevention 4.18 4.96 1,795

Health Hotline 4.07 3.11 Unknown

Hospice/Palliative Services Navigation 4.00 2.84 Unknown

Opioid Response and Outreach 3.80 3.05 291

Table 7 also shows the number of incident responses the City of Las Cruces responds to,

based on a four-year average of 911 calls for service and incident reports if available for the

specific focus area. In the City of Las Cruces, there were incident counts that were

representative of three of the eight identified focus areas. Falls in the City of Las Cruces

accounted for a four-year average of approximately 1,795 incidents. Behavioral/mental health

incidents in the City of Las Cruces had a four-year annual average of approximately 1,612

incidents. Lastly, the four-year annual average for opioid overdose incidents is approximately

291 incidents. Each of the incident types with counts also showed an increase in incidents from

2014 to 2018.


Discussion

The results of this ARP show that in many areas LCFD is on the right track as many of

the organizations identified are also addressing repeat 911 use as one of their primary focus areas

as reported by NAEMT (2018) and Zavadsky and Hooten (2016). The focus areas identified and

the incident data support many of the informal discussions that have occurred as well as the

programs expansions already being considered such as CHF readmission reduction. The results

of this research provide a framework for LCFD to expand the focus area discussions with local

stakeholders. The incident and survey data, as well as the information gathered in the literature

review, appears to present opportunities as there are several areas not being proactively

addressed by LCFD. Such results can help the organization move forward in selecting focus

areas. The research did highlight a significant lack of understanding of the workload possibilities

of LCFD’s MIH program.

MIH in the United States became a focus of many fire-based EMS organizations

following the passing of the Patient Portability and Accountability Act of 2010. As of 2017,

there were over 200 MIH programs in the United States, with over 30 percent of them being fire-

based (NAEMT, 2018). Three years prior, in 2014, there were just over 100 known MIH

programs (NAEMT, 2015). The research performed provided insight into the characteristics of

successful programs. There have been many programs that have found success and upon

evaluation seem to share some common characteristics or procedural recommendations. The

PPACA of 2010 focuses very heavily on the importance of integrated care in creating healthier

populations to reduce skyrocketing healthcare costs (Stanhope, 2015). Some of the common

characteristics of or recommendations for a successful MIH program is to integrate with local

providers, maximizing stakeholder engagement and the collective resources of the entire


healthcare system. Such recommendations were presented by Morganti et al. (2014), MIHCP

(2014), IAFC (2017), and Zavadsky and Hooten (2016). Community risk knowledge based on

demographics, incident data for the community, as well as emergency room visit data and

provider perspectives should be gathered as part of an organization’s community health risk

analysis. Morganti et al. (2014), MIHCP (2014), IAFC (2017), and Zavadsky and Hooten (2016)

each documented the importance of community-specific data as a basis for program

identification and implementation. This concept for identification and implementation is further

supported by Castillo et al. (2016) as they highlighted how MIH efforts that are researched and

developed to target community subpopulations with the highest risk as compared to a

generalized approach were shown to yield the greatest overall results.

All programs must consider funding sources in whether the organization will fund the

program, or will they leverage community partnerships and seek reimbursement for service

options (IAFC, 2017). Zavadsky and Hooten (2016) highlighted the difficulties of

reimbursement for MIH programs as many states do not have provisions for such

reimbursements, leaving the primary means of reimbursement being from partnerships.

Additional considerations should be given to the savings realized through the impacts to

emergency services through reductions in call volume, if applicable (Stowell, 2016). It is the

author’s belief that 911 reductions can serve as a hedge against growth, especially in times when

there are significant budgetary constraints serving as the primary bottleneck in effective

emergency response.

In addition to the financial security of the program, there needs to be a significant effort

in developing the program scope and outcome objectives with a comprehensive policy and

protocol implementation with continuous review. As discussed by Morganti et al. (2014),


medical oversight, strong training curriculums, and a comprehensive quality improvement

program are some of the recommended pillars for successful programs. Ensuring such measures

are in place limits the risk of mistakes, improves overall outcomes, and also helps prevent scope

creep.

The review of focus areas yielded common areas that appear to be problems in

communities across the nation. The focus areas identified by Zavadsky and Hooten (2016), as

well as NAEMT (2018), were like those identified in the survey sent to agencies outside LCFD.

The respondents to the survey showed similar demographics to the organizations represented.

The author found that the commonalities listed in the survey and text could have been better

investigated if the surveys were not anonymous. Additionally, follow up with each of the

responding agencies may have yielded additional characteristics of successful programs beyond

those identified in the literature review, or further supported them similar to how the focus areas

identified were supported.

The survey sent to local providers highlights the perceptions that most providers feel the

identified focus areas can be effective in reducing unnecessary emergency room visits. A

reduction in unnecessary emergency room visits using integrated healthcare measures benefits

both the patient and the community. Alakeson, Pande and, Ludwig (2010) noted that emergency

room boarding for unnecessary emergency room visits decreases the quality of care to those

awaiting care for significant emergencies. This may correlate to the enthusiasm displayed in the

perceived effectiveness of several of the programs from physicians/nurse practitioners in the

clinic setting.

The focus areas that were identified by Zavadsky and Hooten (2016) in several of the

programs highlighted, in no particular order, were alternative transport programs, hospital


readmission prevention, social system navigation, and mental health response and fall prevention

programs. Such programs also yielded the highest perceived effectiveness among the local

providers in reducing unnecessary emergency room visits. Morganti et al. (2014) noted that

alternative transport programs are one of the innovative EMS programs being performed. As of

the writing of this section, LCFD received a grant to seek transport vouchers to minimize 911

usage for non-emergency situations. Stowell (2016) noted that a barrier to appropriate care is

often attributed to lack of transportation, making transport to the emergency room via ambulance

a convenient option. Seattle and King County EMS saved an estimated $750,000 to the local

health system using alternative transport programs (Morganti et al., 2014).

A staple for MIH programs has been hospital readmission prevention where the program

aligns with an accountable care organization based on a fee for service schedule since it has

yielded the most consistent funding source for MIH programs across the nation. The Center for

Medicare and Medicaid Services (CMS) has the Hospital Readmissions Reduction Program

(HRRP) which was mandated by Section 3025 of the Affordable Care Act (ACA) and requires

payment reductions or penalties for excessive readmissions (CMS, 2019). Over 75 percent of

MIH/CP programs have hospital readmission reduction programs as a focus area (NAEMT,

2018). There appears to be a significant amount of opportunity in readmission reduction

programs in the United States with nearly 20 percent of all Medicaid fee-for-service patients

being readmitted within 30 days of discharge from the hospital, costing hospitals a significant

amount of money (NAEMT, 2018). Readmission prevention programs had the highest ranked

score when ranked among the other programs and the second highest perceived effectiveness at

reducing unnecessary emergency room visits by local providers. The findings of both surveys

support the literature.


The research performed as part of this ARP showed that social system navigation had

become one of the primary focus areas of LCFD along with repeat 911 use. The author feels this

research displayed evidence that the extent of scope creep has not been realized by LCFD since

the initial intent of the program was to reduce repeat 911 calls yet most of the referrals to

LCFD’s MIH program are not repeat 911 users. Social system navigation is an important

component to reducing repeat 911 use, however. Stowell (2016) noted, that perceived barriers to

care due to lack of knowledge leads to 911 use for non-emergency situations as it is the path of

least resistance for many. Additionally, low income/socioeconomic status is also an indicator of

health system navigation barriers (Stowell, 2016).

Mental health response accounts for a significant number of incidents in the City of Las

Cruces. Despite the lack of incidents LCFD responded to, the City reported nearly 1,900

incidents in 2017 and had a handful of fatal encounters with police in 2018. Locally, mental

health programs are perceived to be able to provide a significant reduction in unnecessary

emergency room visits. Such a program can vary widely in scope based on the needs and

available resources of the community. Research shows that deliberate attempts to reduce

unnecessary visits to the emergency room can be effective, supporting the perceived

effectiveness of a program the local providers felt. The current state in the City of Las Cruces is

representative of the case noted by Bronsky, Giordano, and Johnson (2016), where the care of

the patient is merely transferred from one agency that is ill-prepared to another. The City of

Colorado Springs was able to decrease ED transports of their patients by over 85 percent through

the use of a Community Emergency Response Team (CERT) (Bronsky, Giordano, & Johnson,

2016). Trivedi et al. (2018) noted that when a diversion program exists, EMS agencies have been

shown to successfully diver over 40 percent of mental health encounters, freeing up necessary


beds for emergencies since less than 0.3 percent of mental health patients seen in the emergency

room required any emergency interventions.

While fall prevention programs ranked toward the middle of perceived effectiveness both

individually and when ranked by local providers, they account for over ten percent of LCFD’s

incidents. Additionally, the deaths from falls rate in New Mexico is 1.8 times higher than the

national average at 97.6 people per 100,000 population as compared to 53.4 people per 100,000

population in 2011, respectively (NMDOH, 2014). The author believes proactive programs that

are focused on identifying risks and providing solutions may provide relief in the number of falls

experienced in the City of Las Cruces. Theut (2017) believes that fall prevention has a significant

education component that starts with adults at all ages as knowledge of the problem and

repercussions of such incidents can trigger changes in people’s attitudes toward falls. This

sentiment is shared by the author.

One area that was of surprise to the author was opioid outreach. Not only was the

perceived effect on the lower end based on the responses to the local survey, but the incident data

was also very low. This was an area where the author’s perceptions were not supported by the

provider perceptions or the incident data in the City of Las Cruces. The author fell victim to the

constantly reported “Opioid Epidemic” and made assumptions that Las Cruces, less than 50

miles from the border, was guaranteed to have such problems. While it may be for certain sub-

populations, it does not appear to be a significant problem for the City of Las Cruces based on

incident data and provider perception, or it is grossly underreported in the area.

Overall, LCFD’s MIH program has started on the right track and its successes have

generated community interest in the program. The research performed highlighted the positive

attitude about MIH programs in the City of Las Cruces and is hopefully reflective of a


willingness to continue building community partnerships geared toward improving the quality of

life of its citizens. MIH provides a framework for positive community interactions and greater

patient satisfaction with their healthcare system experience (Zavadsky & Hooten, 2016). The

author believes this research shows a need for expansion and to proactively seek ways of

improving the quality of life for its citizens while creating positive outcomes for all involved.

LCFD incident data points to several areas where targeted efforts may have significant positive

impacts on the community.

Recommendations

The purpose of this applied research project was to identify additional focus areas that

LCFD MIH program may consider expanding their services to, based on a review of the

characteristics of successful MIH/CP focus areas, identification of focus areas addressed by other

departments, and a comparison of the identified focus areas to the incident data and perceived

effectiveness by local providers. The research and review of the literature identified several

common areas that MIH programs have focused that are also relevant to LCFD. Based on the

results of this research, the following are recommended.

The first recommendation is LCFD conduct a comprehensive study on the cost of

services provided to the public based on available budgetary information, incident data, and

operational expenditures. Having a clear understanding of the costs of services provided to the

citizen will also allow for the calculation of the opportunity costs of implementing a program or

expanding MIH focus areas for LCFD. Organizations seeking to expand their services or add

programs will be faced with similar challenges to those presented in this ARP with limited

literature on the cost of response or a framework for the individual organization to quantify the

costs and benefits of their respective programs.


The second recommendation is LCFD establish clear program objectives for MIH with

each focus area clearly defined in its scope and objectives. This research provided insight into

the current state of LCFD’s MIH program concerning scope creep, and the lack of using the

program to reduce unnecessary repeat 911 calls. In the realm of establishing a clear scope and

objectives, this ARP is not de-emphasizing LCFD’s MIH program’s effectiveness at its current

state when looking at the value to the community. It has, however, morphed to more of a social

referral program with many clients having never been identified as a repeat 911 user, requiring

an evaluation and revision of the current program’s scope and objectives. Minimizing creep will

allow resources to be utilized and tracked effectively to ensure adequate unit hour utilization.

The last recommendation is that the focus areas considered be considered at a community

level, irrespective of the obvious financial benefits of LCFD, taking in to account the end-user

benefit. This ARP highlighted how incidents such as psychiatric/behavioral incidents, while they

are a small number of incidents for LCFD, they are a larger issue for the community at large.

Additionally, it is evident through this research how reducing unnecessary ED visits impacts the

entire community with improved access to emergency care and decreased costs of care for those

diverted from an unnecessary ED visit. Ensuring stakeholders at all levels are accounted for will

help LCFD implement programs of social benefit, where hours spent have a direct impact on

quality of life for its citizens in need. Should the recommendations presented be approved and

implemented, a framework for successful focus area expansion should be realized.

The above recommendations seek to ensure the focus areas yield the greatest return on

investment through improving the quality of life of the citizens of Las Cruces. Researchers

seeking to replicate this study should consider the specific need of their respective communities

based on a risk analysis and utilize available literature and external information to supplement


and support the needs of the community. The anonymity of respondents for this research proved

to be unnecessary and limited the content potential for review. Future research should provide

opportunities for follow-up with survey respondents.


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Appendix A

MIH/CP Survey




Appendix B: Queued Incident Types by Year

Incident Types 2014 2015 2016 2017

300: Rescue and EMS Incident, other 546 427 340 312

311: Medical Assist 1112 1351 1714 2256

320: Emergency Medical Services, other 725 881 800 707

321: EMS Call, Excluding Vehicle Accident 7413 7261 6970 6429

322: Motor Vehicle Accident with Injuries 581 539 591 619

323: Motor Vehicle/Pedestrian Accident 59 34 42 32

324: Motor Vehicle Accident No Injuries 194 187 166 157

331: Lock In 6 5 6 8

340: Search for Persons, other 0 0 0 0

341: Search for Persons on Land 2 0 0 0

342: Search for Persons in Water 0 0 0 0

343: Search for Persons Underground 0 0 0 0

350: Extrication, Rescue, other 0 3 1 0

351: Extrication from Building or Structure 1 0 0 0

352: Extrication from Vehicle 3 2 2 2

353: Removal of Victims from Elevator 0 0 8 1

354: Trench Rescue 0 0 0 0

355: Confined Space Rescue 0 0 0 0

356: High Angle Rescue 0 0 0 1

357: Extrication of Victims from Machinery 0 0 0 1

360: Water and Ice Rescue, other 0 0 0 0

361: Swimming/Recreational Water Area Rescue 0 0 0 0

362: Ice Rescue 0 0 0 0

363: Swift Water Rescue 0 0 0 1

364: Surf Rescue 0 0 0 0

365: Watercraft Rescue 0 0 0 0

370: Electrical Rescue, other 0 0 0 0

371: Electrocution or Potential Electrocution 0 0 0 0

372: Trapped by Power Lines 0 0 0 0

381: Rescue or EMS Standby for Hazardous Conditions 8 9 8 11

510: Person in Distress, other 150 165 208 173

512: Ring or Jewelry Removal 2 1 3 7

554: Assist Invalid 216 311 366 497

600: Good Intent Call 127 133 124 108

661: EMS Call where Party has Left Scene 9 12 3 7

Total Incidents Queried 11154 11321 11352 11329

Total Incidents for LCFD 15511 16181 16444 17663


Appendix C: Queued Condition Codes by Year

PCR Call Data 2014 2015 2016 2017 Totals Avg. / Year

Percent of Avg.

Total Patient Reports 9415 8844 8296 7,120 33675 8418.75 Not Known, Not Reporting, Not Applicable, Not Available 2534 2215 1680 712 7141 1785.25 21.206%

Pain (8030) 879 825 961 1204 3869 967.25 11.489%

Trauma (8043-8050) 910 855 823 635 3223 805.75 9.571%

Difficulty Breathing (8010) 647 586 673 593 2499 624.75 7.421%

Abdominal Pain (8001, 8002) 650 634 538 514 2336 584 6.937%

Cardiac Symptoms (8003, 8012, 8020, 8021, 8061) 628 531 594 547 2300 575 6.830%

Sick Person (8040) 445 447 500 536 1928 482 5.725%

Altered Level Consciousness (8016) 518 505 396 381 1800 450 5.345%

Convulsions/Seizures (8017) 374 378 321 348 1421 355.25 4.220%

Unconscious/Syncope/Dizziness (8042) 318 305 331 336 1290 322.5 3.831%

Alcohol Intoxication or Drug Overdose (8034,8035) 314 326 270 255 1165 291.25 3.460%

Psychiatric (8038, 8039) 202 207 161 130 700 175 2.079%

Blood Glucose (8008) 159 183 153 148 643 160.75 1.909%

Back Pain (8031, 8032) 131 124 133 101 489 122.25 1.452%

Abnormal Skin/Vital Signs (8004/8005) 130 119 141 91 481 120.25 1.428%

Respiratory/Cardiac Arrest (8009,8011) 77 106 97 98 378 94.5 1.122%

Neurologic Distress (8029) 84 80 108 101 373 93.25 1.108%

Hemorrhage (8024) 70 80 89 70 309 77.25 0.918%

Non-Traumatic Headache (8019) 54 41 50 38 183 45.75 0.543%

Allergic Reaction (8006, 8007) 55 52 41 34 182 45.5 0.540%

Heat Exposure (8022, 8023) 29 29 23 30 111 27.75 0.330%

Pregnancy/OB (8037) 21 33 30 27 111 27.75 0.330%

Patient Safety (8068-8071) 33 26 25 20 104 26 0.309%

Dehydration (8041) 21 25 22 23 91 22.75 0.270%

Choking (8013) 18 21 29 19 87 21.75 0.258%

Poisons (8033) 19 23 24 12 78 19.5 0.232%

Eye Symptoms/Injury (8018, 8058) 17 15 18 27 77 19.25 0.229%

Animal Bites and Stings (8053, 8054) 13 17 16 29 75 18.75 0.223%

Medical Device Failure (8027,8028) 12 6 12 16 46 11.5 0.137%

Post Operative Procedure Complications (8036) 11 12 12 10 45 11.25 0.134%

Burns (8051, 8052) 13 8 6 6 33 8.25 0.098%

IV Meds Required (8063) 4 12 4 3 23 5.75 0.068%

Third Party Assistance Required (8067) 3 4 6 8 21 5.25 0.062%

Special Handling (8072-8074) 7 5 3 6 21 5.25 0.062%

Sexual Assault (8059, 8060) 5 3 2 3 13 3.25 0.039%

Cold Exposure (8014, 8015) 1 1 3 3 8 2 0.024%


Lightning/Electrocution (8055, 8056) 3 0 1 3 7 1.75 0.021%

Airway Management Required (8062, 8065, 8066) 2 4 0 1 7 1.75 0.021%

Hazmat Exposure (8026) 1 1 0 1 3 0.75 0.009%

Infectious Diseases (8025) 2 0 0 0 2 0.5 0.006%

Near Drowning (8057) 1 0 0 1 2 0.5 0.006%

Chemical Restraint (8064) 0 0 0 0 0 0 0.000%


Appendix D: Las Cruces Overdose and Psychiatric Incidents

Michael Daniels From: Robert Milks <[email protected]> Sent: Tuesday, February 5, 2019 1:44 PM To: Michael Daniels Cc: Albert Flores; Nick Jeter Subject: Records Request Good Afternoon, I was forwarded your request for total counts of calls for service for certain type codes within the City of Las Cruces. The total counts I have are as follows: 2014- behavioral/suicidal are 1,373 for OD 358 2015-behavioral/suicidal are 1,596 for OD 463 2016-behavioral/suicidal are 1,579 for OD 427 2017-behavioral/suicidal are 1,899 for OD 415 If you have any questions, please contact me

Robert Milks NCIC Coordinator Mesilla Valley Regional Dispatch Authority 911 Lake Tahoe Ct. Las Cruces, New Mexico 88007 Phone: 575-647-6820 Fax: 575-647-0370 Email: [email protected]


Appendix E: Las Cruces Falls and Lift Assists

From: Robert Milks <[email protected]> Sent: Wednesday, February 13, 2019 2:11 PM To: Michael Daniels <[email protected]> Subject: RE: Records Request

Hello,

The numbers for Fall victims and Lift Assists are:

2014 Falls - 1,106; Lift Assist – 493

2015 Falls – 1,169; Lift Assist – 590



Robert Milks NCIC Coordinator

Mesilla Valley Regional Dispatch Authority

911 Lake Tahoe Ct.

Las Cruces, New Mexico 88007

Phone: 575-647-6820

Fax: 575-647-0370

Email: [email protected]

mailto:[email protected]


Appendix F: Preventable/Unnecessary Emergency Room Visits






Documents

Identifying Additional Focus Areas for Las Cruces Fire Department's Mobile … · 2019. 5. 6. · The Las Cruces Fire Department (LCFD) implemented a Mobile Integrated Health Program