They used to call 911; now they call Ken
An advanced care paramedic is in her living room. There is no emergency. He did not arrive at her home in an ambulance with lights and sirens.
His visit is planned. Indeed, anticipated with a certain fondness and familiarity.
“Freddy, do you know what time it is?” asks the paramedic.
She smiles in expectation of his next line.
He says it every time. And every time it makes her laugh.
Holding a finger clip used to monitor heart rate he offers her this instruction: “OK, Freddy. Time to give me the finger.”
On cue, Freddy Fell, a 68-yearold woman who lives with diabetes bursts into giggles.
Ken Kohut is a community paramedic with Niagara Emergency Medical Services. He’s served the region for some 30 years as an advanced care paramedic, responding to calls for help in an ambulance.
But for the past couple years, he’s been answering a different sort of call. As a community paramedic, he visits people who are frequent 911 callers to find out why they are relying so heavily on an emergency telephone number and hospital ER visit for primary medical help. And then he helps them come up with a better plan to keep them healthy and reduce the burden on EMS and the health-care system.
In one month, Freddy called for an ambulance five times.
She felt dizzy. Her blood sugar was very low. She was dealing with diarrhea. And she was scared. Very scared.
“I just wanted it to stop,” she says. So, husband John called 911. An ambulance came to her apartment in Niagara Falls, paramedics put her on a stretcher and she was taken to hospital.
“That was my way of solving it,” she says.
Indeed, Kohut visits about 70 people across Niagara, some more often than others, depending on their needs. He sees Freddy every two weeks.
She looks forward to his visits. He makes her laugh. And keeps her on track with managing her diabetes.
Freddy came into the program the same way as all the others. Niagara EMS and Niagara Health System compare notes to determine who is using Niagara’s emergency system the most — a minimum of five 911 calls or five emergency department visits in a year will catch their attention.
In 2016, high users of 911 in Niagara made up about 10 per cent of all ambulance calls. To date this year, high users account for just over eight per cent of calls — a sign that the community program is working, says Karen Lutz-Graul, commander of quality assurance and performance standards with Niagara EMS.
The highest user of 911, a person who is now part of the Community Paramedic Program, made 26 emergency 911 calls in a year.
They are typically people with complex medical conditions or people who have one major health problem that dominates their life, says LutzGraul. Think the big three — diabetes, congestive heart failure or chronic obstructive pulmonary disease. Almost all live with anxiety, she says.
“They’re not managing at home well.”
They also don’t advocate very well for themselves and aren’t able to manage their health on their own, says Kohut. They usually have trouble following medical instructions and struggle with being compliant.
“It can be scary to navigate the health care system,” he says. “It takes a lot of work.”
Their family doctor might not be able to see them immediately. They aren’t aware of other alternatives such as walk-in clinics or urgent care centres. And they don’t have outside support. Or transportation to get there.
“It’s an emergency to them because they don’t know what to do,” says Lutz-Graul.
“They lack the confidence to either reach out or they don’t know what to reach out to.”
All they can think to do is call 911. “That’s their fail-safe,” says Kohut.
“The bottom line is the fear of the unknown. Is this serious or not?”
Problem is, calling 911 for nonemergencies, or for issues that are serious but could otherwise have been resolved if they’d been dealt with earlier, is not a good solution.
“It’s a big problem,” says LutzGraul.
In general, studies show that a relatively small number of people use a large amount of health-care resources. This according to the report HighCost Users of Ontario’s Healthcare Services, about 1.5 per cent of Ontario’s population accounts for 61 per cent of hospital and home care costs.
Data collected on just four high-frequency callers in Niagara, who have been a part of the community paramedic program for one year, found they visited the ER 80 per cent fewer times and spent 65 per cent less days admitted to hospital. All that translated to a hospital cost savings of $34,900. And that’s just four people over one year.
It also means that ambulances were more available to respond to true emergency calls.
In fact, in a year, about 320 hours of ambulance availability were reallocated back into the system, because paramedics weren’t delayed off-loading patients at the hospital, says Lutz-Graul.
In an emergency department, people are triaged — the most serious are always seen first, regardless of how they got there. A less-urgent patient arriving by ambulance will wait in a stretcher in the hallway until it’s their turn. Problem is, the paramedic can’t leave — and therefore can’t answer other emergency calls — until the patient is off the stretcher.
“I would sometimes sit in the hallways waiting for hours,” says Kohut.
A similar program operates in Wainfleet. It’s called a Community Response Unit, and differs slightly because the two paramedics — Dan Favero and Dan Beauparlant — also respond to emergency calls as well as doing wellness visits.
The Wainfleet program is funded by Niagara Region. The Niagara program receives provincial dollars through the Local Health Integrated Network. Funding will continue into next year although they’d like to expand the program, says Lutz-Graul.
The real savings, however, is in lives changed.
On this day, Kohut opens up a binder and scans the array of numbers on the top page — blood sugar test results — that Freddy has entered since his last visit. He photographs the pages and will fax them to her doctors.
Before he met Freddy, she had connected with a diabetic clinic but she didn’t follow instructions for a variety of reasons. The result was unmanaged blood sugar levels, poor health and multiple visits to the emergency department.
Kohut keeps her on track. “I’m the squeaky wheel,” he says. “If I’m not here bothering her and telling her to take her sugars, she’ll fall through the cracks.”
He has also partnered with the clinic and her doctors to improve her diet. He also helped to solve the mystery of her diarrhea troubles — it’s a common side-effect to one of her medications.
“We provide support so she stays out of the ER and she stays healthy,” he says.
And then with a wink adds: “We want to get her dancing again.”
John, her husband of 45 years, concurs. “I liked watching her swing her hips,” he says with a smile.
It’s Kohut’s friendly demeanour and quick wit they enjoy, says Freddy.
He’s been known to insert a tympanic thermometer into her ear to check her temperature. “I just want to make sure your brain is working,” he tells Freddy.
If it beeps, her brain is just fine, he assures her. To date, it’s always beeped, Freddy reports with a smile. The joke is never old.
He’s shown her how to use a walker safely to assuage her fear of falls. And he’s helped her access a rehabilitation program to improve knee pain.
Ultimately, the program is about building relationships, confidence and empowering people to manage their own health, says Kohut. He spends at least a half-hour with people.
“You get to meet the person outside of their condition,” he says. “It’s refreshing for me to see their personality.”
The program is voluntary and people can choose not to participate. Yet his uniform — the same as any advanced care paramedic on the road — creates trust. He arrives in an unmarked vehicle for privacy. He listens to people without judgement. And when he’s on the job, he’s available.
Partway through his visit with Freddy, his phone rings. It’s a man concerned about a spike in his blood pressure.
“He got himself all worked up, but he called me instead of 911,” says Kohut.
“He’s alone and he’s frightened.” He assures the man it was just a temporary issue and that all is well.
“You can call me 100 times a day,” he tells the man.
And he means that.
His attention back to Freddy, he pulls out a stethoscope and checks other vital signs. They chit chat for a bit before he packs up. And with a handshake, he’s gone.
Freddy is already looking forward to his next visit.
“I think I’d be lost if he wasn’t here,” she says.
“I look forward to seeing him. “He makes me feel like there’s someone who’s interested in what’s going on in my life.”