Walk into a dispatch center and you’ll overhear questions like, “Is your mother breathing?” “What is the color of the smoke that’s showing?” or “What kind of medication did you take?”
Most people dial 911 during the scariest moments of their lives, and on the other end of the line are emergency dispatchers like Gilbert Lopez, with the San Bernardino County Fire Department.
“It can be overwhelming,” Lopez said. “It could be smooth sailing or chaotic from the get-go.”
Until very recently, dispatchers ended most 911 calls by dispatching an ambulance.
“We're all just taught, 'You call, we haul,' ” Lopez said.
It’s an effective protocol when the caller needs an ambulance, but the thing is, a growing number of 911 calls don’t need a paramedic escort to an emergency room. When non-emergency calls come in, they can take a heavy toll on the system. Dispatchers can’t answer other calls that may be more important, ambulances are routed to locations where they aren’t needed, and emergency room nurses and doctors get backlogged by processing patients who don’t really need to be admitted, leaving ambulances tied up at hospital parking lots instead of on the street, ready to respond to a real emergency elsewhere.
Leigh Overton is the EMS supervisor of the San Bernardino County Fire Department. She said roughly 20-30% of all 911 calls are not true emergencies.
“They don't need a response from lights and sirens,” Overton said. "Most people call because they don't know what to do.”
Another effect is felt at hospitals, where emergency rooms fill up with patients who should have sought other options.
“Many people who don't require an ambulance may require to seek care in four hours,” Overton said. “They may require 12 hours and an urgent care or a doctor's office appointment may be incredibly appropriate for them.”
Instead, visiting an ER costs folks thousands of dollars in medical billing that didn’t need to happen.
"An emergency department visit that's unnecessary for an uninsured patient could break them [financially],” Overton said. “It could break anybody.”
NBC 7 Investigates has been looking into problems with the EMS system for months. In June, we revealed how patients are spending hours waiting to get into local hospital emergency rooms, waiting inside the ambulances that brought them there. Again, many of those patients didn’t need that ride, and that prevented ambulance crews from responding to other emergencies until patient transfer-of-care takes place.
For the past three years, dispatchers in San Bernardino County have been trying a better option. They transfer non-emergency callers to a nurse dispatcher. That professional determines what level of care the caller needs. That care could include calling a rideshare service to take them to an urgent care, helping them find a 24-hour pharmacy or connecting them with other medical experts.
“It's our job to help calm the patient and let them know that they're speaking to a professional who's gonna help them get to the level of care that they require,” Overton said.
It’s also possible these calls will still get a dispatched ambulance if the nurse determines it rises to that level or if the patient demands one.
Overton showed NBC 7 Investigates one example of a call where a woman accidentally drank medication that was supposed to be vaporized through an inhaler. The nurse dispatcher connected the caller to a poison control center that determined she wasn’t in immediate danger and made sure she was in contact with her regular doctor.
“In my experience, um, there's a giant sigh of relief,” Overton said. “Those calls typically end very very well with a very satisfied customer.”
The city of El Cajon is embarking on a similar system called the Nurse Navigator program. The $300,000 pilot program is being finalized right now. The city council has a vote scheduled for July 12 to select a contractor, a company called Access2Care. That company falls under the umbrella of Global Medical Response, which operates the ambulance company AMR.
During a council meeting in March, local lawmakers praised the idea.
It’s a win for the patient, Councilmember Steve Goble said.
“It’s a win for the hospital system, and it’s a win for the city,” Goble said.
Deputy Mayor Michelle Metschel agreed, telling the council, “If we combined it with educating the public, I think it's going to be a win-win for everybody.”
Lopez said public awareness is important because callers will often push back when they’re being transferred to a nurse. However, he said, ultimately, callers realize getting connected to care over the phone, instead of a costly trip to the ER, is the better option.
Paying for these programs isn’t so simple, as money can come from local, state or federal funding. Some programs get money from health insurers, which benefit from fewer claims from their customers, but some ambulance companies and hospitals may not be supportive because it can cut into their profits.