Fire department pilot program with nurse practitioner

The initial dispatch message was somewhat unclear: a 20-year-old woman was feeling unwell and required assistance. Responding to the call, Anaheim firefighters arrived alongside an ambulance driven by Victoria Morrison, a nurse practitioner. She evaluated the patient's vitals and conducted an interview to decide whether the situation warranted a trip to the emergency room or if the issue could be managed comfortably at home.

"Many people dial 911 out of fear," Morrison remarked as she returned to the ambulance. "Sometimes, all they need is a medical professional to handle minor issues. In other cases, they genuinely require emergency care." As the sole nurse practitioner in Anaheim Fire & Rescue’s Community Care Response Unit, Morrison has been handling these types of low-level medical calls since the unit launched on May 31. Nurse practitioners can also prescribe medications when necessary.

This one-year pilot program seeks to reduce healthcare expenses, prevent unnecessary and costly hospital visits, and allow firefighters to focus on more severe emergencies in Orange County's largest city. "We excel at addressing major incidents like car accidents, shootings, and heart attacks due to established protocols," explained Capt. Dave Barry, the department's EMS manager and Morrison’s partner during her shifts. "However, it's challenging to manage lower-acuity situations where no immediate transport is required. Victoria has been exceptional at providing the right kind of care and keeping patients out of hospitals."

Since its inception, Morrison has treated 230 patients, with 46% either receiving on-the-spot care or being advised to consult their primary care physician for follow-up. The program's annual cost totals approximately $500,000, covering Morrison’s 40-hour weekly salary, medication, equipment, and insurance. Funded through a public-private partnership, Kaiser Permanente contributed a $210,000 grant, while Care Ambulance Service supplied a modified ambulance.

Anaheim Fire Chief Randy Bruegman intends to seek city council approval to extend the program into the following year. "Residents appreciate this innovative approach because it ensures quality care, reduces costs, and allows treatment in the comfort of their homes," Bruegman stated.

As the first city in California to adopt this model, Anaheim drew inspiration from a similar initiative launched by Dr. Gary Smith in Mesa, Arizona, back in 2008. Initially funded minimally, the Arizona program ran for three months before resuming operations in 2011 with support from the city and a local hospital. It currently operates around the clock. Five cities nationwide have replicated Smith's concept, including Los Angeles.

"We aim to stay ahead by delivering medical services directly to patients' homes, and the outcomes have been remarkable," Smith commented.

In Anaheim, patients opting for Morrison's care still incur the standard $350 paramedic response fee but avoid the expense of an ambulance ride or emergency room visit, which can easily reach thousands of dollars. Most importantly, they receive prompt attention from a healthcare professional instead of waiting hours to see the next available ER physician.

"Some believe they'll be seen quicker in the ER if they arrive via ambulance, but that's not always true," Morrison added. "My role is to reassure them that they'll receive the same quality care faster with me."

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