By Alan M. Petrillo

The Mesa (AZ) Fire and Medical Department is having success with an emergency medical services (EMS) program that keeps low-acuity patients out of hospital emergency departments (EDs) and directs them to a more appropriate level of care for their particular situation through its Community Care Concept.

The Program

Tony Lo Giudice, Mesa’s program administrator, says the project is a result of a $12.5 million federal grant from the Centers for Medicare and Medicaid Services to test a model that offers comprehensive delivery systems to address the impact of chronic disease, falls prevention, self-management skills, and medication adherence. “The idea is to reduce high-risk patient returns post-discharge from hospitals and treat and divert low-acuity patients from the use of the 911 systems and the ED,” Lo Giudice says. “We had a perfect storm over a five-year period where overcrowding of the EDs was tying up a lot of our paramedics at the hospitals. Working with our fire department, we came up with the concept of pairing a paramedic with a physician’s assistant (PA) or nurse practitioner (NP) to streamline the process of getting the patient to the hospital.”

When the economy crashed in 2007, Lo Giudice says that Mesa went to a transitional response vehicle (TRV) program that staffed a vehicle with a firefighter paramedic and emergency medical technician (EMT) to handle basic life support medical services calls. “Low-urgency calls were coming into the 911 system-people with colds, the flu, and minor trauma-that we were sending to the hospital, which was an expensive way to treat them by sending a fire truck with four firefighters,” he says. “We wanted to make the system more efficient and improve the service to the patients, which bred the idea of our Community Care Concept.”

The Mesa (AZ) Fire and Medical Department runs five Community Care Unit (CCU) ambulances that are built on Dodge 4500 chassis with Medtech bodies and powered by Cummins 8.3-liter diesel engines. Two of the CCU ambulances are bariatric units. [Photos courtesy of the Mesa (AZ) Fire and Medical Department.]

The program takes a firefighter-paramedic and an NP or PA and puts them on a rig to handle low-acuity medical calls that come into the 911 system, which amounts to about 38 percent of Mesa’s low-acuity runs, Lo Giudice says. “We partnered with Mountain Vista Medical Center to provide the NP or PA to ride the truck.”

The Community Care Unit (CCU) ran on a 40-hour-per-week basis from the end of 2011, but Mesa identified another issue: Behavioral-related calls (suicides and mental health problems) were cropping up that the CCU was not equipped to handle. “We came up with the idea to pair a licensed mental health counselor with a firefighter-paramedic in a separate vehicle, a community care specialist (CCS) unit, to deal with those kinds of calls,” Lo Giudice says. “The patient got a basic medical evaluation by the paramedic and a mental health evaluation from the licensed counselor. Most of the time we were able to bypass the ED and go to a mental health facility or do safety reviews of patients at their homes.”

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