Nurses will handle some 911 calls in El Cajon
EL CAJON, Calif. — Several years ago in the nation’s capital, a few hundred people who dialed 911 were not taken to a hospital.
The next year, nearly 2,900 calls didn’t lead to an emergency room. The year after, it was more than 7,000, according to city data.
Since 2018, more than 16,000 calls that once might have resulted in trips to the hospital were instead transferred to nurses, who could still help people find doctors or schedule rides to urgent cares.
Washington is one of a handful of places nationwide rethinking how to respond to emergency calls, and one city in San Diego County wants to follow suit. The El Cajon City Council voted unanimously last month to set aside hundreds of thousands of dollars for a first-in-the-region pilot program.
“This is the wave of the future,” said Art Andres, who oversees 911 calls in San Bernardino County. Nurses could save everybody money by reducing first responders’ workload and easing hospital wait times while still connecting people to care they need, he said.
Andres also cautioned: “Sometimes, early adopters face challenges.”
In interviews with representatives for 911 call centers, fire departments and emergency medicine organizations around the country, officials flagged a series of questions El Cajon will have to answer, including: Are there nearby clinics that can quickly take new patients? What if a caller doesn’t have a way to get there? If someone demands an ambulance, will the city send one even if the person doesn’t appear to need it?
And who’s going to pay for this?
Richmond, Va., first faced these hurdles nearly two decades ago.
In 2004, the Richmond Ambulance Authority launched what was believed to be the nation’s first program to divert less serious 911 calls to nurses.
It shut down six years later.
“It was ahead of its time,” said Rob Lawrence, who was the ambulance authority’s chief operating officer and is now executive director of the California Ambulance Assn.
The biggest problem was there wasn’t a network of clinics ready to take 911 callers, he said. “A patient needs to go somewhere, and where are the somewheres?”
Having mental and behavioral health clinics that can take walk-ins at all hours is key, he said.
San Bernardino County has not seen a significant drop in ambulance trips since it adopted its program at the end of 2020, according to Andres, director of the CONFIRE emergency communications center.
Although around a fifth of the county’s emergency calls do not appear lifethreatening, it doesn’t yet have taxi vouchers or contracts with companies such as Uber or Lyft to get people rides to other appointments, he said.
He and other officials are looking to Nevada for how to improve.
Washoe County, which includes Reno, uses the Regional Emergency Medical Services Authority. It received a federal Health Care Innovation Award several years back to fund a range of reforms, including directing calls to nurses.
During the first four years, the county avoided more than 1,000 ambulance trips and more than 6,000 emergency room visits, according to a follow-up report . That led to saving more than $9.6 million from 2012 through 2016, the report said.
During a more recent 12month period, from February 2021 through January, about 1.5% of all calls were transferred to nurses, according to spokeswoman Alexia Jobson.
Several thousand additional calls were eligible for transfer, but because the county does not use a separate 24/7 call center, a nurse wasn’t always available, Jobson said.
Furthermore, some people just demanded an ambulance.
Whether nurses can overrule callers will be one of El Cajon’s key decisions.
Officials in several cities said they won’t refuse demands for a hospital, even if the caller does not appear to be in any immediate danger.
Lisa Moreno, a doctor and president of the American Academy of Emergency Medicine, said medical professionals should be allowed to make the final decision.
At the same time, the protocols guiding nurses needed to be written by doctors, she said. “We would want to be sure that the nurses had ... the training to make that kind of assessment, so people don’t fall through the cracks.”
One way to see if nurses are making mistakes would be to track whether people denied an ambulance have to call 911 again for the same problem, she said.
The challenges can appear daunting. Philadelphia discussed, but ultimately decided against hiring nurses, according to a fire department spokeswoman.
Many details about El Cajon’s plan remain in the air.
If the county and city give the green light, Heartland Fire-Rescue Chief Steve Swaney has said they could begin diverting calls as soon as this summer.
El Cajon residents dial 911 about 16,000 times a year, and local officials say a third are not true emergencies.
The City Council set aside $300,000 from its general fund to cover the first several thousand calls, and officials have said they hope Grossmont Healthcare District, which oversees Sharp Grossmont Hospital, and American Medical Response, which provides ambulances, could later help foot the bill.
Nelson writes for the San Diego Union-Tribune.