NFPA Journal - January/February 2018 - 44

App or
Ambulance?
situations without having to put more
ambulances on the road. It's a way to
manage the call volume and use of
EMS resources."
Robbins estimates that 15 to 25
percent of patients EMS providers
encounter don't require emergency
medical transport and could in theory
be transported to urgent care using a
ride-sharing service. "It depends on the
region, the market, the EMS system,
but all combined, we could be talking
somewhere between 15 to 25 percent of
patients," he said. For all dispatches, he
guessed the figure to be between 7 and
18 percent.
Statistics show that, in many
instances, trips involving patients
being transported to an emergency
department (ED) by EMS providers
are unnecessary. A 2010 article in the
Journal of Emergency Medical Services
(JEMS) reported that in 2006, just over
24 percent of emergency department
visits were classified as semi-urgent
or non-urgent. According to the JEMS
article, studies have also shown that
10 to 40 percent of EMS transports
are "low-acuity transports" involving
minor ailments like sprained ankles or
people with flu-like symptoms. According to a literature review published
in the journal Prehospital Emergency
Care in 2013, articles from the United
States, Canada, and the United Kingdom show that 30 to 50 percent of
ambulance transports to the ED are
inappropriate or unnecessary, which
could translate to millions of unneeded
rides. In 2009, for example, there
were over 28 million EMS transports
in the U.S., according to data from
the National Highway Traffic Safety
Administration.
Both Uber and Lyft have announced
agreements with EMS companies to
provide rides to patients, but that
doesn't mean the system is widely
used, Robbins cautioned. Even his
company, MONOC, doesn't do it. "In
my market, in New Jersey, I don't think
we're going to see this happen for a
really long time," he said. "The reason
is that in New Jersey, the advanced
life support tier, the paramedic tier,
of EMS is 100 percent fee for service.
It's not subsidized by taxes at any

44 | NFPA JOURNAL * J A N U A R Y / F E B R U A R Y 2 0 1 8

level-not from the town, not from
the county, not from the state. So our
source of revenue is only what we're
able to bill. We also happen to live in a
state where the commercial insurance

"GOT A PREGNANT
LADY WHO WAS
IN LABOR WHO
WANTED TO GO
TO A HOSPITAL
THAT WAS ABOUT
30 MILES AWAY
FROM HER HOUSE
BECAUSE SHE
DIDN'T WANT TO
HAVE HER BABY
AT THE LOCAL
HOSPITAL."
companies are not forward-thinking.
They're very much in lockstep with
Medicare, and Medicare only pays if
you transport ... If I call Uber or Lyft to
take a patient, that's a response I'm not
going to get paid for."
In other areas, including those where
insurance companies are willing to
reimburse EMS providers for calls
that don't involve transport, Robbins
foresees the practice becoming more
common. The key to its success, he
says, is a robust triage process to screen
patients and determine the level of
medical care they need. In Las Vegas,
the city's fire department recently
launched a pilot program that uses a
nurse to conduct those screenings. If
the 911 operator thinks a health-related
complaint might not require emergency medical transport, they transfer
the call to a nurse who, with the help
of computer protocol software, determines what's best for the patient-a
process that can end with ordering a
Lyft to take the patient to an emergency

department or an urgent care facility.
"I was a charge nurse in an emergency room who had to triage every
single ambulance lining up at the
door," Melissa Giammarino, an R.N.
who is part of the new Las Vegas
program, told Hospitals and Health
Networks magazine. "Each ambulance
carrying someone who didn't truly
need emergency care took me away
from other emergencies, from helping
other nurses, and from dealing with
other problems in the emergency
department."
NFPA's codes and standards currently do not address the integration
of ride-sharing services into EMS, but
Montes said it could be incorporated
into NFPA 451, Guide for Community
Health Care Programs. Montes is the
staff liaison for NFPA 451, which is
expected to be open for public input
early this year. NFPA 451 is the result
of a growing push for community
health care that incorporates EMS into
the entire health care system-a practice generally referred to as community
paramedicine-where EMTs and
paramedics are employed to check in
on community members after they've
been discharged from the hospital to
address their medical concerns, take
vital signs, make sure they're taking
their medications, and other tasks that
typically do not require a trip back to
the hospital.
The model is meant to reduce
readmissions to hospitals and missed
appointments, which suck millions of
dollars from the country's health care
system each year. It is also flexible and
can address other public health issues
such as behavioral health services and
chronic substance abuse, depending on
an assessment of the needs of the local
community it serves.
Like Robbins, Montes recognizes
the benefit ride-sharing services could
offer not only to EMS providers but
also the people they serve. "It could
absolutely be a positive thing for EMS
as it integrates itself further into the
community health care system," he
said. "It could be a positive for the
whole community."
ANGELO VERZONI is staff writer for NFPA Journal.



Table of Contents for the Digital Edition of NFPA Journal - January/February 2018

Contents
NFPA Journal - January/February 2018 - Cover1
NFPA Journal - January/February 2018 - Cover2
NFPA Journal - January/February 2018 - 1
NFPA Journal - January/February 2018 - Contents
NFPA Journal - January/February 2018 - 3
NFPA Journal - January/February 2018 - 4
NFPA Journal - January/February 2018 - 5
NFPA Journal - January/February 2018 - 6
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