Easing the Healthcare Load by Helping Frequent Fliers at Home

“Frequent fliers” are a constant challenge for EMS agencies. These are people with chronic healthcare problems who call 9-1-1 for help on a regular basis.

In a bid to better serve this community while reducing their use of EMS resources, Wauconda Fire Protection District (WFPD) of Lake County, Illinois, has implemented a Mobile Integrated Healthcare–Community Paramedicine (MIH-CP) program. It provides free nonemergency preventive home-based treatment to these patients. In doing so, WFPD and its MIH-CP partner agencies—the Greater Round Lake Fire Protection District, Libertyville Fire Department, Countryside Fire Protection District, and the First Fire Protection District of Antioch—are easing the load on their EMS staff, ambulances, and local hospitals, while providing better health care and improving patient outcomes in their jurisdictions.

“We started looking at implementing an MIH-CP program back in 2017 when I became a medical officer, to better serve the rural parts of our jurisdiction,” said Lt. Erik Christensen, WFPD medical officer and MIH-CP coordinator. “Our analysis of call volumes showed that a lot of our callers were elderly people suffering from chronic health conditions. We reasoned that if we provided them with proactive care and education within their homes, it would reduce their reliance on EMS assistance when problems occurred.”

The people the MIH-CP program is designed to support are defined as being “high utilizers” of the EMS system. “These are patients who end up calling 9-1-1 ten times or more a month,” Christensen said.

The program itself is not original to WFPD. “We learned about it after doing a Google search,” he said. Initial funding to launch the WFPD’s MIH-CP program came from the Healthcare Foundation of Northern Lake County.

In the early days of this MIH-CP program (2018–2020), its focus was on rural residents who would have to travel 2–4 hours by road to get to a hospital. After COVID eased, the WFPD and its partner agencies expanded the MIH-CP program’s reach to include more suburban areas within their jurisdictions.

“MIH-CP programs were initially oriented in the rural setting just after the passage of the Affordable Care Act (ACA),” Christensen said. “We used this approach and tailored it to the suburban setting to better meet our needs.”

According to the Northwest Community/Northern Lake County (NWC/NLC) Mobile Integrated Healthcare—Community Paramedic Program brochure, the services that the WFPD and its partner agencies provide to prospective home users include:

• Physical examinations to determine the person’s current state and progress in meeting health targets.
• Ensuring the availability and proper use of medications, medical supplies, and equipment by the person in their home, along with adherence to care guidelines.
• Assessing the person’s ability to perform activities of daily living and their fall risks.
• Assessing the person’s understanding and compliance with making healthy choices.

“The person will be supported in achieving their best possible state of wellness through health coaching and connection to community resources and social services information,” noted the MIH-CP brochure. “A home safety check is completed if authorized. MIH-CPs will offer installation of smoke detectors if needed.”

Based on the shared experience of the agencies belonging to the WFPD’s MIH-CP program, treating frequent fliers proactively is the right way to reduce demand on local EMS while improving the health of high utilizers.

“In the WFPD alone, about 50% or so of our patient population is above the age of 60,” Christensen said. “As a result, the No. 1 reason for an ambulance dispatch over the last eight years has been for patients who have fallen. When our crews arrive, they often see that reasons for these falls were completely preventable—rugs that were bunched up, or showers and bathtubs without grab bars. When you address these risk factors before something happens through proactive visits, you reduce the number of subsequent incidents and thus the number of calls to 9-1-1 for help.”