Dallas Fire-Rescue to buy new dispatch system, expand community paramedicine

The software will give dispatchers scripted questions to figure out what ails callers and decide which tier of response to provide

By Tristan Hallman
The Dallas Morning News

DALLAS — Dallas Fire-Rescue officials are sick of ever-increasing ambulance runs.

But they say they have two remedies coming: a new dispatch system and an expansion of a program in which the department's paramedics make house calls.

Fire officials told members of the City Council's Public Safety Committee on Monday that they are nearly ready to buy new dispatch software that will help separate true emergencies such as heart attacks from routine medical issues such as stubbed toes.

Currently, Dallas Fire-Rescue responds to both types of calls by rushing an ambulance to the scene. That puts a strain on its Emergency Medical Services, whose call load increased more than 11 percent from fiscal 2012 to 2015.

City Council member Jennifer Staubach Gates, a registered nurse, called that jump "pretty significant." And Dallas Fire-Rescue Chief David Coatney said it's based on "a conservative analysis."

Earlier this year, Dallas Fire-Rescue had to call in private ambulances to help tend to the high number of people calling 911.

"There were a few days where we were really taxed on dispatch," Assistant Chief Daniel Salazar said.

Ideally, the new system will be operating next summer. The cost to the city will be no more than $258,906.

The software will give dispatchers scripted questions to figure out what ails callers and decide which tier of response to provide. All callers who need medical attention will still get help, but paramedics might take more time to get to less urgent cases. And they could show up in a fire engine or an SUV rather than a decked-out ambulance.

A Sept. 28 council vote will end the lengthy process to obtain the software from Priority Dispatch of Salt Lake City. Dallas Fire-Rescue first began looking into buying the system more than two years ago, and the consulting firm Fitch & Associates was hired to help figure out which software to buy.

Plano and other cities have been using similar software for years. Although the switch seems like common sense, the complex system's life-or-death implications have made for a painstaking process. Dallas Fire Fighters Association Vice President Scott Clumpner once called the tiered-dispatch system "a unicorn."

The next challenge will be informing Dallas residents about the new dispatch system. Salazar said City Hall will use social media and other means to tell people that their stubbed toes will soon be less urgent to Dallas Fire-Rescue.

The software also could help collect data on which types of calls are increasing.

Currently, "we don't have a very good ability to look at that data," Coatney said.

Frequent fliers
But the department knows some of the problems are caused by so-called EMS frequent fliers, who use ambulances as their primary medical care.

Dallas Fire-Rescue's Mobile Community Healthcare Program assigns paramedics as caseworkers to the most frequent 911 callers. They make in-house visits to check on the people and teach them how to take care of themselves. The hope is that they will become healthier and stop calling 911 for ambulance responses to every ache and pain.

The Affordable Care Act penalizes hospitals whose heart patients are readmitted within 30 days, so UT Southwestern Medical Center and Children's Medical Center Dallas pay the city to make the house calls.

But the program, which has seven paramedics on staff, hasn't met expectations. It's still not a moneymaker for the city or even self-sufficient. And deals with other hospitals have been slow to develop.

"It's been a very interesting journey, both with the hospital side and us trying to figure out how to make this work," Assistant Chief Norman Seals said.

But he said Monday that he has reached new agreements with MedStar and Texas Health Presbyterian. The deal with MedStar is to serve their hospice patients.

Seals also said the agreement with Children's Medical Center has been expanded.

"Adding these will allow us to get closer to cost-neutral," he said.

But Dallas Fire-Rescue Medical Director Marshal Isaacs told council members that losses on the balance sheet can still be a win.

"While the chiefs and I are certainly cognizant of the needs to be fiscally responsible and good stewards of the city's money, I wish we had more time to communicate to you the tremendous impact this is having on citizens of Dallas' lives, their health and the overall health of the community," he said.

Copyright 2016 The Dallas Morning News

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