PLAN ENVISIONS NURSES FOR SOME 911 CALLS

Level of response is not sustainable, says Heartland chief

Each year, El Cajon residents dial 911 about 16,000 times.

Yet local officials say up to a third of those calls are not true emergencies, and don’t require the ambulances and fire trucks that repeatedly rush out.

“We’ve done the same thing for 40 years: Someone calls 911 and we send everybody,” Steve Swaney, Heartland Fire-rescue chief, said in an interview. “It’s not sustainable.”

In response, El Cajon’s City Council voted unanimously last week to set aside hundreds of thousands of dollars for a first-in-the-region pilot program to divert some 911 calls to nurses, who could still help people needing medical care find rides and schedule appointments.

Many details remain up in the air, and the idea will require additional approval from the city and county.

But as soon as this summer, El Cajon could be one of a handful of places around the country to reimagine how cities respond to emergency calls.

“I’ll make a prediction,” Mayor Bill Wells said during the council meeting. “You’re going to save so much more money than you spend that we’re going to have this forever.”

Currently, if you call 911 in El Cajon you speak with a dispatcher at the local Heartland Communications Facility Authority.

That person asks questions to assign your call a letter grade. Even if the situation is ranked as less serious — say you cut your hand cooking, but there isn’t much blood — the dispatcher doesn’t have the authority to call off the EMTS.

Under the program, the dispatcher could instead send you to a 24/7 call center of “nurse navigators.”

Some people just need help finding a doctor or hailing an Uber, local leaders said, and the program would ideally build relationships with local clinics ready to accept new patients.

San Bernardino County announced a similar overhaul a little more than a year ago, and Reno, Nev., Louisville, Ky., and Washington, D.C., have moved in the same direction.

Diverting calls is not without risk, said Criss Brainard, chief of San Miguel Fire-rescue and a former deputy chief in San Diego.

“We have language barriers, we have emotion, we have all kinds of things that happen on those telephones where we don’t always get the best of information,” Brainard said in an interview.

Every second spent asking questions can delay getting ambulances on the road, he said. “If that person at the end of the conversation turns out to be in shock, or something dramatic happens, there’s liability.”

When an El Cajon council member asked about potential liability, City Manager Graham Mitchell said that remained an open question, but he stressed that nurses would be well-trained to quickly assess threats.

One call center option is the Texas-based company Access2care.

Swaney, the Heartland fire chief spearheading the potential changes, said each call would cost about $51. The city has set aside $300,000 from its reserves, meaning there’s enough money to cover more than 5,000 calls.

Once that limit was hit, more money would be needed.

City leaders said they hoped American Medical Response, who provides local ambulances, and the Grossmont Healthcare District, which oversees Sharp Grossmont Hospital, would eventually chip in if the program saves them money.

A spokesperson for the health care district declined comment while details are still being discussed, and a representative for the ambulance service did not immediately return a request for comment.

It’s unclear what the total savings could be. The city budgets millions of dollars for Heartland, which also serves La Mesa and Lemon Grove, but financial reports do not break down the cost of just 911 calls, much less those later determined to not be serious.

Despite the risks, Brainard, the fire chief in San Miguel, said he still thinks diverting some calls is a good idea.

“We’re wearing out our fire engines, our people are not able to get rest,” he said. “We have to do something, and that’s a very good option for us.”