Paramedic Raena Glauvitz Taking Blood PressureThe Madison Fire Department (MFD) has been studying the delivery of Emergency Medical Services in our city for a number of years.
A majority of emergency medical calls receive a full system activation which entails sending the closest, most appropriate level of care. In most cases, this means sending a basic life support fire truck (the closest truck) and an advanced-level care paramedic ambulance (not always the closest ambulance).
But we all agree that some calls for service aren’t actual emergencies in a medical sense. We continue to discuss strategies to handle these types of calls without a full system activation. 
We launched a Mobile Integrated Health Program in June 2015 that focuses on three distinct sub-programs focused on improving health outcomes for the communities we serve.
These programs are designed to create networks of social service providers who identify members of the community at greater risk of experiencing health issues and we search for ways to reduce the need for emergency care. 
These programs include but are not limited to:

1. Hot spotting with CARE: The Madison Fire Department developed a community outreach program called CARE: Community Action Resource and Education.
This outreach program incorporates MFD field personnel, the Public Health Department, Primary Care Providers, and other community agencies to target facilities and neighborhoods with high rates of 911 use or locations that could benefit from our focused attention.


2. Focusing On High Service Utilizers such as those with chronic illness, the homeless, and/or individuals with mental or behavioral health issues.
The MFD and UW Hospital are participating a grant funded by the National Institutes of Health (NIH) to support older adults who’ve been discharged from Emergency Departments. The goal of this program is to study and potentially decrease hospital readmission rates. 
The Division Chief of Medical Affairs, EMS staff, and MFD field personnel have also identified individual members of the community who have conditions or needs that often result in a disproportionate number of calls for “emergency” services. We’re working with Dane County Public Health and the Madison Police Department (MPD) to identify ways to address those needs.
Through paramedic case management, we focus on identifying and following up on risk factors, as well as connecting clients to community resources in timely ways. We’re also documenting systemic issues, like barriers to access or care coordination, that amplify the risk of repeated Emergency Department use or re-admissions.
The Meriter Health Foundation and the Madison Fire Department have developed a partnership to identify and support high-risk patients, which will reduce utilization, improve outcomes, and prevent the need for emergency transport and EMS.


3. Community Risk Reduction through county-wide data collection, data analysis by City of Madison and Dane County Public Health, and the development and interpretation of survey instruments to identify at-risk individuals.
We have also teamed up with community health partners to monitor opioid overdoses and try to reduce mortality rates. Part of this effort includes assisting Madison Police with the storage and distribution of naloxone.
We remain vigilent against epidemics and pandemics like Ebola.
Finally, we maintain a special focus on pre-hospital cardiac care by providing CPR/CCR training to all non-commissioned members of the MFD and to all other Madison City agencies. We urge all citizens to be a part of this effort by downloading and activating the PulsePoint app.

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All of these programs are based on outcome data.  The end goal is really to explore different approaches to providing emergency medical services in the most appropriate way. 
There will be much more to come in the future, and yes, when you call 911 in the City of Madison, you will still receive the same high level of service that residents have come to expect.

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