Texas EMT

Houston OKs nurses helping with 911 calls

2008-06-10T18:51:02-07:00

AROLYN FEIBEL, STAFF
The Houston Chronicle

Should you call an ambulance for a sprained wrist or child's fever? A spider bite?

The medical consensus is no, but every year thousands of people in the Houston area dial 911 for non-emergencies.

Hoping to cut back on the number of ambulances responding to non-emergency calls, the City Council voted Wednesday to hire round-the-clock "tele-nurses" to work with 911 dispatchers.

For callers who do not have a true emergency, a nurse will offer first-aid advice over the phone, or help them find a clinic or doctor.

The Houston Fire Department responds to about 750 emergency medical calls a day.

"In a large percentage of cases, when we get there, the patient didn't even want to go to the hospital," said Dr. David Persse, the city's director of Emergency Medical Services. "Maybe they just wanted some advice, get their blood pressure taken."

Some people call 911 because they have no health insurance or no transportation to the hospital. Others have insurance but do not know how to get after-hours care or cannot judge how serious a problem may be.

Until now, the default solution has been to send an ambulance. That costs taxpayers and also can cost the patient: An ambulance ride to the ER costs $415, plus $7.50 per mile. That's before the hospital bill.

"That's a waste of resources, and it also could endanger somebody who really does need an emergency response," Mayor Bill White said.

The city will spend $6.8 million over five years on a contract with the Harris County Healthcare Alliance. The nonprofit group has subcontracted with San Antonio-based CareNet, which will provide at least two nurses around the clock.

If primary care is needed, the nurses can refer callers to health-access "navigators" at the nonprofit Gateway to Care. The navigators will help 911 callers make an appointment at clinics in Houston and can help arrange transportation.

Treated like a cab ride

Houston is among the first cities to try tele-nurses for 911 calls. Richmond, Va., has a similar program, Persse said.

Capt. Alan Nollkamper, who worked for more than 12 years as a Houston paramedic, said flu season is the worst for unnecessary runs.

"It comes in as a `breathing difficulty' call," Nollkamper said. "We get there and realize the patient has a low-grade fever or congestion. Maybe they need antibiotics, but they don't need our services."

Nollkamper said people call ambulances for minor cuts, sunburns or even because they need prescriptions refilled.

"It's a 911 ambulance, but it's treated like a taxicab," said Sebastian Chavez, a paramedic in the Sunnyside and South Park neighborhoods. "You'll get told many times on the street, `just do your job and take me to the hospital.'

"They're taking away a paramedic unit from somebody who may need a paramedic unit."

City officials did not provide an estimate but said they were certain the program will save money in the long run.

At first, the nurses will handle about 20 calls a day, but that could grow to 75 or 100 calls a day.

More than half of emergency-room visits by Harris County residents in 2006 were for problems that could have been treated in a doctor's office, according to a study by UT's School of Public Health. The estimated cost was $50 million, the study said.

Only 32 percent of those ER visitors had no health insurance. The rest had private or federal coverage but may not have known how to use it efficiently, said Karen Love, executive director of the Harris County Health Care Alliance.

"The whole idea is to educate people, help them get self-care when appropriate," Love said. "It's just about getting these folks to connect to what we call a `medical home,' a regular source of care where someone has your medical records there."

There is little danger that a true emergency will get diverted to a phone nurse, officials said.

"If, at any time during the call, the nurse feels the call has shifted and is of an emergency nature, then the call is immediately directed back to (Houston Emergency Center) and an ambulance is dispatched," said HFD Capt. Karen Dupont.

She added that working with the nurse will be voluntary. If at any time a caller wants an ambulance, it will be dispatched, she said.

Fully insured

The alliance is purchasing additional liability insurance, and CareNet, the company providing the nurses, also carries insurance of $3 million per claim, Love said.

More than 30 percent of Harris County residents are uninsured, compared with 24 percent in Texas and 15 percent nationwide.

The reasons are manifold, Love said. Texas has strict income limits for Medicaid eligibility. A high proportion of Texans work for small businesses, which are less likely to offer insurance. Undocumented residents also contribute to the uninsured rates.

Dead Man's Defective Phone Line Calls 911 in Texas

2008-06-10T18:46:29-07:00

Fred Davis
The Beaumont Enterprise, Texas
--

Jun. 5--Faulty phone lines apparently caused mysterious 911 calls from a dead man's mobile home last Sunday and Monday.

After investigating the calls from James Martin Jr.'s home in the 5600 block of Forest Glade, Detective Jerrod Mireles said officers discovered a phone line that ran from the outside into the house by way of a rickety back door. It inadvertently called 911 when the door pinched the phone line, he said.

Mireles said it is possible someone opened the door Sunday night, saw the dead body and left. The door, which didn't shut completely, could have been left open or the wind could have caused it to swing back and forth, affecting the line.

"They hadn't been tampered with," Mireles said of the two phones in Martin's home. However, both were in poor condition and the one nearest the 66-year-old's body was off the hook, possibly knocked over by Martin in his last moments.

Martin's body was found Sunday night after a 911 hang-up at 10:13 p.m. led police to the house. Martin had been dead several days. A second 911 hang-up occurred Monday about 1 p.m.

Family members told Mireles that Martin always had problems with his phone.

Although the autopsy is not complete, Mireles said the death probably is from natural causes. Family members told police Martin had not been in good health in the last few months, and a neighbor said he wanted to call an ambulance for the man, but he declined.

Emergency Services feel pain at the pump

2008-06-10T18:38:17-07:00

Russell Haythorn, 7NEWS Reporter Story by thed
Story by thedenverchannel.com
ARVADA, Colo. --

Another day, another record high.

As gas prices continue to rise, the national average was up nearly 2 cents overnight, increasing to $4.02 a gallon.

In Colorado, prices are inching closer to $4 with Monday's average at $3.94.

These high prices don't just affect summer vacation plans. Many emergency response companies are struggling to provide necessary services.

Pridemark Paramedic Services was paying $27,000 a month for fuel about one year ago. Today Pridemark is paying close to $45,000 a month -- an increase it has largely had to absorb on its own.

"Obviously we can't not use our ambulances. We have to drive around," said Pridemark CEO and president Mike Donner.

Pridemark's diesel-powered ambulances serve Arvada, Wheat Ridge, Golden and Boulder County.

"So that's even worse because obviously diesel is a lot higher than unleaded gasoline right now," said Donner.

Crews with Pridemark participate in street corner posting, meaning they sit on street corners, engines running, ready to go at a moment's notice.

"In the winter, we have to keep them warm so that a patient doesn't get into the back of a cold ambulance, and also so that our medicines and fluids don't get too cold," Donner said.

In the summer months, it’s the same issue with the heat.

Pridemark’s rates are somewhat regulated, so unlike other businesses, they can't simply pass fuel costs on to patients.

"It hurts. If it gets too much worse, at some point I might have to think about asking for a fuel surcharge at least until the prices come back down," said Donner.

"Obviously this is a real big deal to us. And we're in a low margin industry anyway. We don't have crazy profit numbers, and so this takes a real big bite out of our ability to keep going."

Members of the American Ambulance Association are now lobbying Congress.

They are trying to get a special exemption from federal fuel excise taxes.

Air Ambulance Crashes Trigger FAA's Attention

2008-06-10T18:37:40-07:00

4 fatal accidents in 6 months

Alan Levin
USA TODAY

WASHINGTON -- Federal aviation officials said Monday that they are concerned medical helicopter accidents may again be on the rise now that four fatal crashes have happened in less than six months.

"The recent spate of accidents has the FAA's full attention," said Alison Duquette, spokeswoman for the Federal Aviation Administration.

A helicopter carrying a 58-year-old patient, along with a flight nurse, paramedic and pilot, crashed into a wooded area near Huntsville, Texas, early Sunday, killing all aboard. The helicopter struck trees, spreading debris over 600 feet, according to preliminary data from the National Transportation Safety Board (NTSB).

The accident and three others since Dec. 30 have killed 13 people and are similar to a pattern that prompted the NTSB to conduct a special safety review of the air-ambulance industry in 2006, according to preliminary reports and an industry association.

All four of the recent fatal crashes happened at night and in places where pilots had little or no visual reference on the ground, such as a forest or over water, according to NTSB files.

"We're monitoring all these recent investigations with an eye towards whether they are related to previous recommendations we made," said Jeffrey Guzzetti, deputy director of the NTSB's aviation division.

The NTSB said in 2006 that most crashes were preventable. It issued recommendations for better technology and new rules to force pilots to be more cautious, especially at night and in poor weather.

The FAA, which regulates the air-ambulance industry, has taken numerous steps to improve safety in recent years but has balked at the more stringent suggestions by the safety board.

No accidents are acceptable on the helicopters that increasingly ferry the nation's sickest patients from remote locations to top trauma centers, said Tom Judge, program director for LifeFlight of Maine and a safety adviser to the Association of Air Medical Services.

There is no evidence that the crashes are anything more than an "unfortunate cluster," Judge said. "I think all of us are puzzled and are trying to understand what this is."

"Night continues to be a very big risk area," he said.

After a flurry of attention from crash investigators and regulators, the number of fatal air-ambulance helicopter crashes fell to two in 2006 and two in 2007, according to NTSB data. In 2008, there have been three fatal crashes. Recent crashes include:

*On Dec. 30, in Cherokee, Ala., an air-ambulance helicopter assisting in the search for a missing hunter crashed in a wooded area at night, killing a pilot, paramedic and flight nurse.

*On Feb. 5, a pilot and two medical workers died when a helicopter crashed in a bay near South Padre Island, Texas.

*On May 10, an air-ambulance helicopter crashed into trees near La Crosse, Wis., shortly after dropping off a patient at a hospital. The pilot, a physician and a nurse died.

*An FAA inspector and a pilot suffered serious injuries on May 29 when a helicopter crashed on top of the Spectrum Health Butterworth Hospital in Grand Rapids, Mich.

The pilot was receiving a routine check by the inspector. The crash prompted the evacuation of some hospital patients.

The NTSB recommended that air-ambulance companies adopt new technology to warn pilots when they flew too close to the ground and pay more attention to high-risk factors such as poor weather before departing. The NTSB also voted to encourage the FAA to approve the use of night-vision goggles.

The new technology has proved difficult to put in place, according to FAA documents and Judge.

None of the pilots on the four recent fatal crashes at night was using night-vision goggles, according to Guzzetti.

Boy Dies Of Dry Drowning After Leaving Pool And Walking Home

2008-06-06T05:55:40-07:00

Johnny Jackson, a 10-year-old American boy from South Carolina, died at home on Sunday from "dry drowning" more than an hour after going swimming and walking home with his mother. The sad event highlights a little known danger that parents and child carers should be aware of, that drowning can kill hours after being submersed in water.

PTSD causes FF/Medic to be fired

2008-05-14T16:06:19-07:00

UNIVERSITY PARK ¯ A former firefighter-paramedic is suing University Park, claiming the city fired him because of his disability.

Former medic denies declaring live patient dead

2008-05-01T18:32:36-07:00

City of Lockhart - A paramedic declared a person dead even though the victim was revived a short time later and taken to University Medical Center at Brackenridge, the city's Emergency Medical Services director said Wednesday.

Texas Task Force 1 Stages Quake Disaster

2008-04-01T19:27:08-07:00

Mar. 31--Observers from as far away as California turned out to watch Texas Task Force 1 respond to a mock earthquake at Disaster City over the weekend.

Benefit for Harris County Paramedic

2008-03-15T13:00:00-07:00

HARRIS COUNTY - Sadly, a few days ago Jessica Clark, a Texas Paramedic, very suddenly passed away secondary to complications from septic pneumonia.

Dallas Firefighter dies, after drive-by shooting after Super Bowl

2008-02-07T05:54:17-07:00

Dallas Firefighter dies, after drive-by shooting after Super Bowl.