By Katherine Herrian
North Texas fire/EMS agencies are embracing a new concept, namely social work in the out-of-hospital setting. By incorporating a full-time social worker employed by medical control, 11 Dallas-area fire-based EMS agencies now identify citizens in need of additional support in the community and make referrals directly to a social worker.
Identifying a need: Social work in EMS
Four years ago, fire department leadership for the agencies that make up the University of Texas (UT) Southwestern/Parkland BioTel EMS System heard repeated concerns from their crews about the lack of options for citizens who have no or minor medical issues that do not require EMS transport to a hospital emergency department, but who nevertheless faced issues that paramedics in the field could not appropriately address. Frontline firefighter/paramedics wanted tangible solutions for the citizens they serve but weren’t sure where to start.
Following discussions with BioTel administrative leadership and the medical director, a collaborative effort was initiated to develop an innovative social work program designed to improve the quality life for individuals who frequently call 911 with non-medical needs. The hope was that the plan would have the added benefit of reducing 911 calls to these same patients for low-acuity medical complaints.
Becoming an EMS social worker
In October 2015, I volunteered to serve as the first BioTel social worker. I am a licensed clinical social worker (LCSW) with significant adult and pediatric emergency department experience.
My role was initially developed to be a part-time position, but the demand for social work services by the referring departments grew rapidly, so the position transitioned to full-time. I was excited and nervous to see how the skills I developed working in a hospital ER setting would translate to community assessments. I was hopeful that this proactive approach to patient care would be beneficial to patients, fire departments and community hospitals.
I now provide social work consultation and management for 11 EMS agencies that make up BioTel and encourage each agency to customize their social work program to meet their department’s needs. I believe this is an important aspect of the program. Fire departments know their communities, and it’s crucial to tap into their knowledge to be successful.
How it works: Integrating social work
Although the specific referral protocol and points of contact differ from department to department, the general process is the same: Frontline paramedics or firefighters identify an individual who they believe could benefit from social work evaluation. The referral is then made through their department’s established chain-of-command. The department’s leadership and I then coordinate a home visit.
Home visits are conducted alongside a member of the fire department, which I believe is one reason the program has been so successful. People don’t always get excited about the idea of a social worker showing up at their door, but people love firefighters, so having them with me providing their endorsement is what gets me in the door. People will open their homes and their lives to us in ways they may not if I was completing visits independently. The teamwork aspect of the program is essential because we both provide different, but valuable, skills and insight.
Another benefit from the visit being done along with a uniformed firefighter is the community connection that is fostered between residents and the fire department. A shared goal between myself and EMS leadership is that a social work referral never be viewed as punitive, but instead as a reflection of the city’s commitment to caring for their citizens.
A unique program with layered benefits
Unlike other programs developed to respond to the increasing number of low-acuity 911 calls, the social work program takes referrals directly from fire departments and EMS agencies. I work with an incredible group of paramedics, firefighters and officers who are extremely good at determining which patients could benefit from a social work referral. I depend heavily on their understanding of their communities to help me help patients.
Many patients who call 911 on a regular basis do not always require transport to the hospital. Sometimes they just need assistance getting back into bed and don’t want or require any emergency medical care. Because I work directly with the EMS system, if a fire department’s paramedics believe a patient is a candidate for a social work evaluation, then we schedule one.
The program has also resulted in a decrease in 911 calls by patients enrolled in the social work program. In some cases, 911 use has stopped all together, because the patient has been educated how to navigate the complex healthcare system, has transitioned to an appropriate level of care, or had additional support brought into their home.
The cost to add a social worker to the medical control team was nominal, but the benefits to the patients, the EMS agencies and the communities they serve have been substantial.
What the providers think
Captain Collin Blasingame with the Garland (Texas) Fire Department regularly completes home visits with me. Blasingame’s role as an EMS supervisor makes him the direct contact for Garland Fire Department paramedics who seek to refer patients to the social work program.
When asked about the impact of the program, Blasingame said, “By incorporating the additional aspects of social services to our current EMS program, we are now able to connect with our community on a deeper level and provide longer-term care for their needs than was ever possible before. The incorporation of social services has allowed our department and EMS providers to build long-term relationships with our residents and meet their healthcare needs beyond the initial 911 call.”
When asked why the program works well for the city of DeSoto, Texas, Fire-Rescue EMS Chief Bryan Whitacre says, “It just makes sense.” The city of DeSoto is a southern suburb of Dallas so the addition of a social worker as an avenue to connect individuals to needed services just seemed logical. “We have paramedics, but by adding a social worker to the team, we get a different perspective.”
Whitacre believes the implementation of the social work program has had positive outcomes not only for patients but also by improving the morale of his paramedics. “The crews feel like they have options besides just taking patients to the hospital or leaving them in an environment where they need help,” he said. “They now actually have a real option to offer to someone who is struggling.” Whitacre has created opportunities for firefighter/paramedics on shift to take an active role in the program in an effort to increase program utilization and understanding of social work.
Jacob Barkham, a four-year veteran of DeSoto Fire-Rescue, reflects on how he has seen social work help their residents: “It’s amazing to see a patient wanting to go to rehab, to get physical therapy and occupation therapy to better their quality of life and know one day they will return back to their home and will have a better quality of life.”
Chief Eric Lovett with the Garland Fire Department and Chief Bryan Southard of the DeSoto Fire Department both held EMS leadership positions during the initial implementation of the BioTel Social Work Program. They believe it is one of the best things the BioTel System has done in response to the changing demands of EMS.
Marshal Isaacs, MD, medical director for the BioTel EMS System believes the addition of an experienced EMS-savvy social worker to an EMS system can have tremendous benefits for patients, paramedics, EMS agencies and the communities we serve. “Katie has done an outstanding job working with our firefighter/paramedics and chief officers. She brings a whole new level of service to EMS. We are proud of the work she and our paramedics do each and every day in our communities.”
Reflecting on the program myself, I am grateful at the amount of commitment and trust the fire departments have put in me and my profession. Together we have done amazing things, from building wheelchair ramps, placing patients in more supportive living environments, guiding families through difficult transitions or even more basic things like problem-solving insurance issues or helping fill out complex housing applications. Social work is a marathon, not a sprint. We are looking for long-term changes for these patients. All of the departments I work with are committed to improving the quality of life for their residents. They work hard to protect and serve their communities daily. The addition of social work simply allows them to have a more comprehensive approach to patient care.
EMS: A new home for social work
My greatest hope is that social work finds a new permanent home in EMS. The credit for the program’s success belongs with the forward-thinking EMS agencies that asked for this program and continue to actively invest in it. I feel so lucky that I get to do what I do, and I truly have a passion for it. But more importantly, I am fortunate to be partnered with fire departments who have a strong passion for their communities and that has made all the difference.
About the Author
Katherine Herrian is a licensed clinical social worker (LCSW) in the state of Texas. She holds a bachelor’s degree and a master’s degree in social work. She has extensive experience working with both the adult and pediatric population in the emergency room settings. Herrian is the first BioTel social worker and has been with the program since its formation in 2015.