Community Health EMS: Cutting Costs at the County Jail

[Guest post by Travis Spencer: Travis is a Paramedic/Community Paramedic with Payette County Paramedics in Payette, Idaho.]  

Three o’clock Saturday morning. Alarms suddenly blare through the station. The dispatcher orders Medic 20 and Fire Rescue to respond to a medical call at the county jail. First responders rush out the door and into the ambulance, responding with lights and sirens screaming. They arrive on scene to find a male subject sitting in the holding cell, alert and oriented, no obvious life threats noted. They obtain a history, and the patient explains that he’s had tooth pain for three days. Tonight, he feels he needs an ambulance to take him to the emergency room for immediate care. EMS secures the patient to the gurney, handcuffs him to the gurney, and loads him into the ambulance. He’s accompanied by a jailer and taken to the local ER for evaluation.

All over the county (and in counties like it all over the state), EMS agencies experience similar incidents.

Current legislation dealing with EMS mandates that all patients get transported to an emergency room when it’s requested. Many times, patients do not require the medical attention of an emergency department and could be better handled in an urgent care or primary care clinic. So why are EMS’s required to use one of the most expensive patient transport vehicles and the most expensive treatment centers to treat minor illnesses or injuries?

When doing a needs assessment within Payette County, we identified that the county jail is one of the highest utilizers of EMS responses. Many of the prisoner requests involve non-life-threatening emergencies that could be handled differently than the prisoner going to the emergency room. The average cost of medical treatment for the local jail in Payette County is around $250,000 a year. This doesn’t include the cost of ambulance personnel, fire personnel, and the additional jailer required to transport the patient.

Payette County Paramedics have been proactively developing a community health EMS system that would address this problem. The program is based on the idea of the Triple Aim: to reduce healthcare costs, provide a good patient experience, and improve population health. We identified the jail as a huge area for improvement and have placed the problem within our five-year plan for the community health EMS program.

The plan involves obtaining funding for a community EMS provider to be available daily; changing the response plan to just one responder for non-emergency illnesses/injuries; and being able to direct patients to other treatment centers by either utilizing telehealth medicine with a physician or changing protocols and increasing training of community EMS providers to be allowed to treat and release.

Community health EMS can be an essential program to counties all over the state to help reduce overall healthcare spending. Rural areas can benefit greatly from the programs and can focus on similar issues such as the jail as an example of a cost-saving measure. Payette County hopes to be able to implement such a program to keep unnecessary utilization of the emergency room down and eliminate costs of ambulance and fire personnel. And it will keep patrons of the jail, in the jail, where they can serve their time.

To read more articles about virtual PCMH click here.