LAS VEGAS — In a session at EMS World Expo, Nicholas Adams, MPA, CEM, EMT-P, EMS division chief, Cobb County Fire & Emergency Services; and Samantha Johnson, JD, MBA, MHA, senior associate general counsel, Grady Health System, addressed the challenges EMS agencies face in responding to high utilizers of the 911 system. In their exceptionally well attended talk, they explored case studies and practical solutions for managing frequent callers, with a particular focus on operational efficiency, patient care and legal considerations.
In the session, in which most attendees reported direct experience and examples of frequent service users, their conversation highlighted the critical issues related to the frequent, often non-emergent use of EMS resources and provided actionable insights on how to better manage these “preferred customers,” who can overwhelm the system.
Memorable quotes
- “Most of the time, those body cams are actually used for internal review and QA purposes rather than public use ... They’re not subject to the same rules and open records act as police body cams.” — Samantha Johnson
- “There’s a very simple definition of medical necessity. My question is, is it ethical to continue responding and providing transport when we know there is no medical necessity?” — Nicholas Adams
- “Our medical director has actually gone and sat down with the medical directors for those [nursing home] facilities and come up with more specific protocols of when it is appropriate to call.” — Samantha Johnson
- “We actually fine our nursing homes and assisted living facilities now for medically unnecessary 911 calls ... but some of them are passing the fines on to patients.” — Nicholas Adams
- “One of the biggest areas of litigation is against nursing homes, and if you can tack on an EMS agency with more insurance and more money, why would you not do that?” — Samantha Johnson
Key takeaways
The session began by outlining the growing problem of frequent 911 system users – often referred to as “high utilizers.” These are individuals who call EMS repeatedly, sometimes for non-emergent issues, creating significant operational and resource challenges for EMS agencies. Adams emphasized that while these individuals need care, the frequency and nature of their calls can strain EMS resources and divert attention from genuine emergencies.
Adams and Johnson offered a mix of strategies for managing high utilizers, focusing on real-world case studies, sharing examples from their own experiences. The discussion centered on ethical approaches to balancing patient care with operational efficiency and legal considerations.
While many in the room, and those who read this article will have direct and recent experience in dealing with this patient cohort, below are the key lessons identified.
1. Identifying and managing high utilizers
One of the central lessons from the session was the importance of developing protocols to identify and manage high utilizers. Whether through targeted outreach, clinical interventions or operational adjustments, EMS agencies must have strategies in place to address the needs of these patients while protecting valuable resources.
2. Collaboration with healthcare partners
Johnson highlighted the need for collaboration between EMS agencies and other healthcare providers, including those in nursing homes and assisted living facilities. By establishing clear communication protocols and working closely with medical directors, EMS can reduce the number of non-emergent 911 calls while ensuring that patients receive appropriate care.
3. Ethical and legal considerations for EMS
Managing high utilizers presents ethical and legal challenges. One significant takeaway from the session was that EMS professionals must balance patient care with the need to maintain operational efficiency. This is particularly important when considering the legal implications of refusing to transport or responding to non-emergent calls. Johnson emphasized the need for EMS agencies to establish clear policies and consult legal counsel to navigate these complex situations.
4. Future use of body cameras
The use of body cameras in EMS is becoming more prevalent, particularly in managing high utilizers. While these cameras are primarily used for internal review, the session underscored the need for EMS agencies to implement clear policies regarding their use, ensuring compliance with HIPAA and other privacy regulations. Body cameras can serve as valuable tools for documenting encounters with frequent callers, especially in cases where legal or operational issues arise.
5. Patient education is critical
Many high utilizers refuse transport because of concerns about costs or a lack of understanding of the importance of medical interventions. EMS agencies should focus on educating frequent callers about when EMS services are necessary and the potential risks of not seeking transport.
6. Advocacy for legislative change
Adams and Johnson emphasized the importance of advocating for legislative reforms that allow EMS to be reimbursed for non-transport services, such as treatment in place. Current reimbursement models that focus only on transport create inefficiencies and can encourage unnecessary transport.
7. Developing targeted intervention programs
EMS agencies can implement specific intervention programs tailored to high utilizers, such as community paramedicine or mobile integrated health programs. These programs can address the root causes of frequent EMS use by providing targeted care and resources outside of the emergency response system.
Ethical decision-making
Adams and Johnson offered valuable insights into the operational, clinical and legal aspects of dealing with frequent 911 callers, emphasizing the importance of collaboration, patient care and ethical decision-making. In an increasingly complex healthcare landscape, EMS agencies must adapt to the rising demands placed on their services by high utilizers. By developing clear protocols, working closely with healthcare partners, and staying attuned to legal and ethical considerations, EMS can better serve both high-utilizer patients and the broader community.
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