Tamara Lantz is responding to a different type of 911 emergency in South King County.
Since she started her part-time position as South King Fire & Rescue’s community care coordinator a little more than a month ago, Lantz has made more progress than she expected she would in so little time.
Lantz, a medical social worker, is taking her knowledge and experience helping people navigate the health care system and applying it to elderly residents who frequently require SKFR service.
Her position, funded by a $71,000 18-month grant from King County EMS, was born out of necessity.
Capt. Jeff Bellinghausen said SKFR has to change the way it does business because the number of 911 calls for service continues to grow every year. In 2016, district first responders answered more than 20,000 911 calls in 2016, which was more than a 10 percent increase from the year before.
Bellinghausen said a number of those calls are referred to as low-acuity, which are considered non-life threatening in nature. He said SKFR is exploring ways to address these calls while still allowing firefighters to prepare for critical emergencies.
That’s where Lantz comes in. Her job is to work with elderly residents who are diagnosed with chronic illnesses, such as diabetes or hypertension, and have called 911 at least five times in a month and visited the emergency room at least once a month for non-life threatening, low-acuity reasons. While SKFR cannot quantify the total number of calls made by that demographic, the program is aimed at determining how to better and more effectively serve those people.
“The root problem we are trying to solve is not a reduction in 911 calls for the fire service, but rather how to bring the proper resources to the patient in the right way in a timely, cost-effective manner,” Bellinghausen said in an email.
By meeting with the clients, Lantz identifies the reasons they are calling 911 or visiting the hospital so much. She can help determine their health care needs and remove any barriers so they can better manage their chronic illness.
“A big part of the success of this program is really supporting people and helping them understand their disease process,” Lantz said.
Since Feb. 1, Lantz has kept busy and is working with about 30 people at any given time, moving people down or off the list when they stabilize or show improvement. The goal is to reduce the number of calls to 911 or trips to the hospital.
One particular client, Lantz said, went to the emergency room 18 times last year for migraines. It turns out, the client is a refugee who speaks limited English and was encountering a language barrier. Upon realizing this, Lantz set her up with a nurse who spoke her language and arranged an appointment with a neurologist, who prescribed medication to treat the migraines.
Since Lantz’s intervention and advocacy, the patient has not called 911 or gone to the hospital.
“I’m not saying we’re out of the woods, but that’s a huge improvement for her,” Lantz said.
Lantz said another part of her job is advocacy. She said she worked with a couple where the man made 26 trips to seven different hospitals in seven months. After talking with the man’s spouse, Lantz said the woman admitted she was unable to care for her husband and herself any longer.
“Really, it was just giving her the permission to say that, to feel that, to verbalize that,” she said.
Now the man is in a higher-care facility, and his wife has a caregiver, Lantz said.
“Obviously, when you’re working with folks who have chronic disease, it’s a very complicated process, with a lots of things going on,” she said. “Lots of times, the conversations are about changing lifestyle habits or moving into higher care facilities or having conversations people don’t want to have.”
Lantz said another patient admitted she had chronic problems and doesn’t always need to go to the emergency room, but she lacks transportation to get to an urgent care clinic. Lantz arranged for the woman to receive taxi vouchers so that now, when the she encounters health problems, she still calls 911, but instead of having firefighters respond, the dispatcher arranges for a taxi to take the patient to urgent care.
A big problem among patients is lack of awareness and communication, Lantz said.
“The trends that I’ve found definitely is communication with their doctor and realizing that if you’re going to have a flare up with your symptoms, you don’t have to wait for it to get so bad that you have to call 911 and go to the emergency room,” she said. “People don’t understand they can call a doctor’s office, and the doctor can diagnose you over the phone and prescribe a medication to you at the first sign of a flare up. Most of these folks don’t even know that that was an option.”
Others are old enough that they aren’t familiar with urgent care clinics, Lantz said.
“The services are there, but oftentimes the people just aren’t aware of it,” she said.
Lantz said, so far, she has not encountered one person who hasn’t been happy to work with her.
“I haven’t yet met a patient who wasn’t thrilled to avoid a trip to the ER, and the ER is thrilled they can focus more on the people the emergencies,” she said. “So everybody’s happy.”
The goal for Lantz’s position is for her to set up a management program for clients and wean them from calling 911 or making trips to the emergency room. To determine whether she is making progress, Lantz will track the number of calls and trips 12 months prior and determine if any progress has been made after six months and again after 12 months.
She does hope the program will be continued after the initial grant money expires, and she is encouraged by what she’s seen thus far.
“I would love to work myself out of a job, but, unfortunately, no, I don’t think that’s going to happen,” Lantz said.