Vancouver-area emergency response system re-examined

EMS district looks at fixes that save money, make the most sense

By Andrea Damewood, Columbian staff writer

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When a stubbed toe brings the same cavalry as a heart attack, it's time to fix the system, emergency officials told the Vancouver City Council on Monday.

Clark County EMS District 2, which encompasses most of the county, is in the midst of a redesign process to find ways to save money while providing emergency response that makes sense for each situation.

"A stubbed toe's no different than a cardiac arrest," said Doug Smith-Lee, EMS Manager for Clark Regional Emergency Services Agency. "We're figuring out how to best manage that."

Leaders told the council that everything is open for re-examination, although they are starting to see some promise in a few areas, including sending low-priority calls to a secondary triage, and investing in preventive care.

At this point, none of the ideas are policy recommendations, which each agency served by the EMS district would have to approve.

Monday's presentation to the city council instead caught the elected policymakers up on the process to date.

Fire Chief Joe Molina said that for the first time, his department is able to look at data showing when, where and what kind of emergency medical situations are likely to happen. Vancouver fire could staff in accordance with the most likely needs the data has found for a specific time, he said.

Another idea involves sending 911 callers who don't need emergency services to a secondary triage nurse, who would then direct them to other providers, such as a primary care physician, mental health care, free clinics and more. Some councilors expressed worries that those steps would mean people were left underdiagnosed.

But Molina said that the department would be very cautious as it made changes. He added that in other places where the triage has been used, very few have fallen through the cracks. Already, Vancouver sends just a private ambulance to its lowest-priority calls.

"We have been risk-averse in our triage," Molina said, adding that the district and city could move to a more "algorithmic model of data-driven decision-making."

Also on the docket is at-risk home care that would help cut down on the use of ambulance systems by "frequent-fliers." Instead, emergency crews in their downtime could work with at-risk patients on assessment and prevention of their condition. Smith-Lee said $1 spent on such care saves $6 down the road, but added the program would have to be paid for by a grant.

Also up for change are what vehicles are sent to medical calls -- Smith-Lee and Molina said in some cases an SUV with one or two paramedics can easily and more cheaply do what an engine does.

Vancouver and EMS District 2 contract with American Medical Response for ambulance transport, although the company has been dissatisfied with the arrangement, saying the response time requirements put in place by the city have cut into its narrow profit margins. Earlier this year, EMS District 2 agreed to give the company two extra minutes to arrive on scene if another emergency responder arrives first.

Molina said that the firefighter's union is keen on switching to a system where city crews also transport patients to local hospitals. That option is being studied, he said, but for now, the plan to keep a private ambulance provider remains intact.

The EMS redesign committee plans to finish its work by the end of the summer and present local governments with its findings in August and September. It hopes to have policy changes in place by the end of the year, in time to begin a request for proposals from ambulance companies.

Andrea Damewood: 360-735-4542; http://www.twitter.com/col_cityhall;andrea.damewood@columbian.com.