Exactly why a person frequently calls 911 is the variable.
It could be someone who has repeated falls, an individual with diabetes having difficulties managing their blood sugar, or someone dealing with challenges of a chronic disease. It could be someone not taking their daily medication, or someone living in a house that isn’t suitable for their condition. It could be dementia, mental health issues, alcoholism, or aging in general.
Of the hundreds and hundreds of dispatch codes used in the emergency response system, 74 — including those involving the aforesaid scenarios — are handled with CARES.
CARES (Community Assistance, Referrals and Education Services) is a joint partnership between South King Fire and Rescue and Valley Regional Fire Authority to serve the most vulnerable populations in South King County, program directors say.
Four years ago, the two fire authorities became the pilot project departments for a program serving low-acuity, high-frequency callers, said Capt. Jeff Bellinghausen, the former CARES team leader. After Bellinghausen’s retirement last month, SKFR Capt. Roy Smith is the new leader of the CARES team.
It started off with two firefighters and no social workers in February 2016.
The team has since expanded to five: SKFR’s Smith, VRFA firefighter Johan Friis, social worker Tamara Liebich-Lantz, social worker Carrie Talamaivao, and the most recent addition of a third social worker Brittany Padjen, who joined CARES this month.
Since its fruition, the program has responded to just over 3,000 calls, averaging 500 calls annually.
Last year, 71 times when the CARES team attended a call, a true life-threatening emergency call also came in during that same time, freeing up the fire department rigs for fires, advanced life support emergencies and other incidents needing immediate assistance.
The original partnerships, now expanding to include Mountainview Fire and Enumclaw Fire, allow departments to pool resources and develop county-wide solutions.
Along with working toward regionalization, the CARES collaboration brings departments closer and reaches more patients throughout the district.
“It only makes sense to work across those lines to serve the citizen better and CARES is just another way we’ve done that,” Bellinghausen said.
The fees generated by the partnerships further reduce the cost of the program to local citizens, so King County provides a majority of the funding for the CARES unit, he shared.
King County Basic Life Support provides South King Fire with $361,768 and Valley Regional Fire with $203,667, which the two departments pool together for a total of $565,435 that covers about 70% of the CARES program costs, according to Bellinghausen.
“The thing that we’ve learned through this several-year process of building this team is if someone calls us with a low-acuity reason, there’s almost always an underlying social service reason,” Bellinghausen said.
Originally CARES only responded to incidents with firefighters, but soon realized first responders couldn’t solve the complete emergency, and those individuals in crisis would end up calling 911 again — sometimes the very next day.
Typically, CARES responds to calls in a unit vehicle stocked with medical equipment between 7 a.m. and 5 p.m. Monday through Friday with at least one firefighter and one social worker.
The team has the opportunity to respond within 20-25 minutes, a vast difference from engine response times of three-to-five minutes. Once with the patient, the team may spend one to two hours with them.
On the way to the incident, CARES staffers will connect with the person who called 911 to gather more information to get a broader picture of the scenario and update them on when the unit is expected to arrive. This connection serves as a double interrogation to ensure it is something that can wait the longer response time, or if other emergency responses should be sent immediately.
“That combination of firefighters and social workers going into somebody’s home when they call 911, being there at the time of crisis and also being there afterward is really the key, the consistency of solving their problems,” Bellinghausen said.
Outside of the CARES “business hours,” if firefighters who respond to an emergency in the middle of the night or on a weekend may find the individual to be a fit for CARES, they will send their information to the team to follow-up.
The key of CARES is to spend time with the individual and discover the root of the problem, then connect them with resources to help, but it all comes down to the individual’s willingness to engage, said social worker Talamaivao.
Recognizing the emergency and preventing things from spiraling out of control is another key, she added.
“Working for emergency services, you get to see the problem beginning and then [we] impact them in a proactive, positive way, which impacts their life and their family,” she said.
CARES defines 911 frequent utilizers as any individual who calls typically three times in 30 days. Some individuals call as often as 78 times in a year or even 10 times in one day.
While some challenges may not be immediately life-threatening, timely intervention is the link to survival and a better quality of life for the patient, the team agreed.
Some problems are easily solved. For example, if you fell in the bathroom, you may need a grab-bar installed for stability so you won’t fall again. The CARES unit would help connect you with local resources to have the grab-bar installed.
“There’s any number of reasons someone becomes a high utilizer,” Talamaivao said.
While the problems range, so does required means of assistance.
“The way to solve social service needs are with professional social workers,” Bellinghausen said.
While firefighters are equipped to handle the medical emergency side of calls, there was a need for someone to help with the emotional, mental or systemic side of the emergency.
“Over the years I can think of countless instances where we knew there was a patient that we needed to do something more for and just didn’t know what,” Capt. Smith said of his time as a firefighter before joining CARES.
“Now, I’m that resource for both the firefighters on the street and the people that we serve … It makes it very satisfying personally.”
But CARES doesn’t stop there.
Social workers help assist with setting up and getting to doctor’s appointments, provide guidance to navigate the healthcare system, working through housing or transportation issues and much more.
“It’s so wonderful working for the fire department in that they encourage us to look at the whole patient and all areas of their life — what do they need to become more medically stable, more medically successful? What do they need to get to the right resources to help improve their health outcomes?” said social worker Tamara Liebich-Lantz.
“If there’s a need, we’re encouraged to address it.”