Jon Cohn | Guest columnist
Fire Chief Greenfield Fire-Rescue, Greenfield, Wis.

Chief Jon Cohn of Greenfield Fire-Rescue, center, stands with the department’s first four community paramedics at their graduation at the University of Wisconsin-Milwaukee. (Photo provided)

As the United States continues to age combined with a health care system that is difficult to navigate and reliant on emergency rooms as primary care providers, agencies that deliver medical services continue to see a steady rise in calls for service and transports to hospitals. Fire/EMS departments in many communities are responsible for operating ambulances, and the challenges are mounting.

Fire agencies that provide medical services are predominantly just that, medical providers. Medical calls account for more than 75 percent of the call activity in most communities. Fires have been reduced with decades of emphasis on fire prevention, education and outreach. Agencies must use similar prevention/intervention tactics to address the growing need for medical services and ambulance transports. Programs centered around community paramedics, community EMT’s or cumulatively Community Emergency Medical Services — or CEMS — are attempting to do just that.

Traditionally, ambulances would respond to medical calls and be faced with two options: treat and transport to an emergency room or evaluate, treat, have the patient sign a release and stay home. CEMS is opening other lanes of options for medical responders. One such program is collaborating with hospice agencies. Located in Wisconsin, Greenfield Fire-Rescue saw hospice as an opportunity within CEMS.

Hospice programs and their services are relatively unknown unless someone has had a personal family experience. Under the direction of Greenfield’s medical directors and the hospice medical director, several opportunities to enhance understanding have occurred.

• First, all members have been trained in a “Hospice 101” course. Greenfield paramedics and EMTs learned about hospice, the dynamics of caregiving and patient/family decisions.
• Second, patients within Greenfield’s service area have been noted in our dispatch system so medical responders have access to initial contact information for hospice staff and family. This not only makes responders more situationally aware of the patient’s hospice status, but gives responders information to connect to hospice staff quickly and directly.

In an environment where medical responders are usually rushing to get patients to the hospital, the understanding of hospice has increased medical responders’ awareness to slow down and contact hospice staff to confer on next steps instead of whisking hospice patients to the emergency room. Greenfield has seen several actual instances where our members have slowed down, contact with hospice was made and a hospice representative responded. Whereas, we typically would have transported despite the hospice plan of the patient and family.

The last program is an agreement between hospice and our city. If the hospice evaluates one of their patients and they are coded as high potential to revoking hospice, we will dispatch one of our five trained community paramedics to the home. Other programs have shown that these introductory visits and knowing that the hospice and local medical responders are working together lowers hospice revocation. In return, the city receives a capitated payment per month per patient for these services.

While there are many unknowns surrounding community EMS programs, providers must address the growing demands on medical services and ambulances. Simple programs can make a difference, even in patient and family satisfaction. Hospice programs are just one example. Providers could consider a fall prevention program, home assessments for falls, home safety checks and collaborating with other agencies to direct patients to more appropriate care providers and services than an emergency room.

The current system is unsustainable for medical providers and the medical system, so we must attempt new initiatives to alleviate the strain and even improve satisfaction for all. We need to stop being reactive and responding and move to a model of medical prevention.

Jon Cohn currently serves as the chief of Greenfield Fire-Rescue in Milwaukee County, Wis., and emergency management director for Greenfield. Cohn will also become president of the Wisconsin Fire Chiefs’ Association in June 2017.

He has worked in a couple of fire departments throughout his career, including as a charter member of a consolidated department. Cohn continues to hold a paramedic license, although not a regular practitioner.

He believes the challenges facing public sector services are immense but also exciting and an opportunity to change, reinvent and modernize these systems. Despite the focus on fire suppression and emergency handing, the primary mission remains prevention; however, we must broaden our focus and prepare our organizations for a more holistic approach: Community Risk Reduction.