Emergency medical service runs by the Springfield Fire/Rescue Division have increased nearly 40 percent in a decade, something local officials attributed to the economy and the health care industry.
It’s also a trend those same officials say cannot continue.
Springfield Fire Chief Nick Heimlich said that as technology has grown, more people have cell phones, which provides ready access to the system.
“We’ve told the community to call 9-1-1,” said Heimlich. “If you have a problem, you can’t handle, you call 9-1-1 … so they call 9-1-1 and we become the problem solvers.”
The Springfield Fire/Rescue Division performed more than 17,000 total runs last year — a 23-year high for a group that employs 127 firefighters and has an annual budget of about $13 million.
The division’s fire runs have remained steady at about 2,080 annually over the last 10 years, but emergency medical service runs have increased from 10,816 in 2005 to about 15,097 last year.
The division and the Clark County Combined Health District are working together to decrease the number of squad runs, including performing mobile integrated health care and providing dispatchers more flexibility when answering 9-1-1 calls.
The district has focused on reducing the number of squad runs since the last Community Health Improvement Plan was released in 2012. The topic will also be included in the 2016 plan, which will be released Tuesday.
Many Clark County residents are using the emergency room as their sole source of primary care, said Health Commissioner Charles Patterson.
“It’s still happening and it’s something we need to move away from in this community if we’re going to be successful long-term,” Patterson said.
No negative incentive
With so many people uninsured in Clark County – about 14 percent of the population, according to the 2016 County Health Rankings – the only safety net for health care for some residents is the emergency room, said IAFF Local 333 President Andy Rigsbee.
“That’s their, in essence, family doctor,” Rigsbee said. “When we become a part of that primary care for a larger and larger percentage of the population, it drives our run volumes up, it drives the cost of the entire system up.”
There are currently no immediate out-of-pocket expenses for city residents who use the EMS service; however, the city does bill insurance, Heimlich said.
With no negative incentive for accepting the transport, it’s led to more people using the service, said Springfield Assistant Fire Chief Brian Miller.
The two biggest factors contributing to the increase in squad runs are mental health and lack of primary care physicians, Patterson said. While the community keeps adding physicians, the effects of the Affordable Care Act won’t be seen in Springfield and Clark County for a few more years.
“People are waiting to be treated for something, rather than see their primary care physician,” Patterson said.
The number of ambulance calls is increasing across the state, said Solon Fire Chief William Shaw, who serves as the president of the Ohio Fire Chiefs’ Association Board of Directors.
Ohio saw about 1.1 million EMS runs in 2014, up from about 952,000, according to the 2015 EMS Incident Reporting System annual report compiled by the Ohio Emergency Medical Services Office of Research and Analysis.
As the large group of baby boomers continues to age and develop chronic medical issues, so do the number of calls, Shaw said.
Residents without health care using the emergency room as their primary form of care is also statewide trend, Shaw said.
“They don’t go to the doctor on a normal basis, they don’t have preventative health care,” Shaw said. “When they do get sick enough to say ‘Geez, I have to go to the hospital,’ or go see a doctor, they call the ambulance to go see the emergency room doctor.”
The Urbana Fire Division’s EMS runs are up about 32 percent since 1996. The division is averaging between 1,700 and 1,850 over the last five years, according to their 2015 Executive Summary. The division has 23 employees, said Fire Chief Mark Keller.
The increase may be attributed to the aging population in Urbana, Keller said.
“We have our regulars who call quite a bit for similar or slightly different reasons who we transport frequently,” Keller said. “Some of them probably are people who don’t have a ride to the hospital, but I’m not sure that’s really increased either.”
Urbana has performed safety inspections for residents on an as-needed basis for years, Keller said. In the future, they could check-in on patients who have recently left the hospital, he said.
New law means new roles
Historically, fire departments in Ohio have been required by the state legislature not to diagnose patients, but rather assess and transport patients as needed.
As part of the state budget bill passed last year, Ohio EMS crews will now be permitted to perform mobile integrated health care in non-emergency situations. The law will allow paramedics to perform duties inside homes of residents, as long as they fit into their current protocols, Heimlich said. It will also allow paramedics to refer patients to other medical resources.
Springfield is working with its medical director to create operational standards, he said. The changes would allow paramedics to meet with patients in the days following an emergency before they go off path, Heimlich said.
The fire division has other duties outside of fire and EMS runs, Risgbee said, including community education and fire inspections, among others – all of which are public safety functions. However, all of the runs must still be made, he said.
“How do you tell someone: ‘We’re not coming today?’,” Rigsbee said.
As part of its strategic plan, the division restructured earlier this year to create some two-person EMS crews, allowing other personnel to focus on other tasks, such as training or fire prevention.
“The goal is to move away from jacks of all trades, masters of none,” Rigsbee said.
The division is also working on ways to change how it responds to certain calls, allowing for smaller crews to be dispatched to a scene while still meeting the need of the caller, Heimlich said. The goal is to increase the number of options for dispatchers to allow them to triage the problem based on information provided.
The division also wants educate residents about appropriate uses of 9-1-1, Miller said.
More changes are coming to the health care system, Heimlich said. In the next five years, Medicare – the nation’s largest insurer – is likely to require local health care agencies – such as CareSource – to contract with those local agencies who provide EMS services. The change will bring minimum standards for performance and if they’re not met, could lead to some agencies not receiving a contract.
“It’s going to be critical to make sure we’re on pace with the changes to the health care industry to benefit the citizens of Springfield,” Heimlich said.