Military veteran Douglas Brain, 66, of Hilo is still wearing plastic hospital bracelets on his wrists — two of them bright orange and the others drab white — when Hawaii Fire Department Medical Specialist Jesse Ebersole and his colleague, Vern Hara, also a medical specialist, announce their arrival at his apartment.
Ebersole tells Brain the new Hawaii Fire Department Community Paramedicine Pilot Program will try to “make your life a little bit easier.”
“Well, that’d be nice,” Brain says.
Brain is among the 200 most-frequent callers to 911 in Hawaii County.
The top caller to 911 dialed dispatchers 82 times in the past 12 months — summoning emergency personnel an average of once every 4 1/2 days.
The estimated cost to respond and transport that single person to the ER was $426,000, including $1,200 per ambulance transport and an average of $4,000 per ER visit.
The Fire Department’s medical personnel are now on a quest to see if they can help frequent ambulance riders stay healthier and decrease their need to call 911. After crises pass, they check on frequent ER users and connect the individuals with services, such as the county Office of Aging.
Ebersole typically works East Hawaii and Hara takes West Hawaii.
They offer their phone numbers and encourage individuals, when uncertain if a 911 call is appropriate, to try nonurgent options, when appropriate.
The two professionals set out with names and potential addresses in mind via referrals they’ve received from Big Island agencies. Hara likes to familiarize himself with case files so he’s better prepared for potential patient needs.
The fire medical specialists check a person’s ability to get to and from the bathroom, consider the risk of falls and look at the individual’s walking stability and obstacles, such as rugs, that might slip.
“Ultimately, we’re just trying to connect them with existing services they might not otherwise have known about,” Ebersole says.
The Office of Aging, for example, connects senior citizens with options for home modifications, housekeeping, transportation and case management.
If warranted, the medical specialists can request a home assessment from Services for Seniors. That can lead to affected individuals getting chore services, housecleaning, a helper for bathing or respite care for an elderly spouse.
Ebersole remembers visiting a frequent 911 caller who sat naked in a room, unable to answer the door or get dressed without help.
The person had been discharged from the hospital, at his own request. It became clear, as Ebersole coached the patient to get dressed, that the person could no longer handle “activities of daily living” without supervision. Help was arranged to get him into a care home.
By mid-July, Ebersole said, the Community Paramedicine Pilot Program had visited 55 of the county’s 247 “high utilizer” medical callers to 911 (those who make six or more calls per year).
Their calls to 911 have decreased by 45 percent since the pilot program began Oct. 3 — a cost savings of $26,460 per month for the health care system, including the county, Hilo Medical Center and emergency responders — fire medical specialists and ambulance crews.
Starting this week, the Fire Department’s Community Paramedicine Pilot Program began a partnership with Hawaii Island Family Medical Center.
Every Tuesday, a nurse practitioner and a physician from the Hawaii Island Family Medicine Residency Program will accompany Ebersole, hoping to make further cost savings, while at the same time relieving patients of the stress of heading to the ER.
The Office of Aging in Hilo is a frequent Fire Department collaborator and referrals are sometimes made to Public Health Nursing, which is part of the state Department of Health.
Fire Department medical specialists base their at-home visits upon the referrals “from agencies who have identified somebody who is at risk,” Ebersole said. “And we’re targeting the ‘vulnerable population’ of people who don’t have a safety net, who have fallen through the cracks, who don’t have anybody to advocate for them.”
Email Jeff Hansel at jhansel@hawaiitribune-herald.com.
