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N.C. county launches EMT-basic program to cut costs

These Guilford County providers respond to lower-acuity calls, and fire departments are handling minor calls without ambulances


Photo/Guilford County EMS

By Kenwyn Caranna
News & Record

GREENSBORO, N.C. — Guilford County is launching a unique program aimed at reducing the cost of responding to 911 calls.

Dubbed the Interagency Medical Provider Assessment and Care Team — also known as IMPACT — it uses “EMT-basic” providers to respond to calls requiring less intensive care. This would include falls where the person isn’t injured but can’t get back up on their own, or minor injuries that typically don’t require a trip to the emergency room.

The program is the first of its kind in North Carolina and is getting attention from EMS systems nationwide, said Scott Muthersbaugh, a spokesman for Guilford County Emergency Services.

“I haven’t heard of any other program nationwide that’s tried this yet, so that’s pretty exciting to see that taking off from here,” he said.

Because “EMT basics” — as they are called — are not as highly trained as EMT advanced providers or paramedics, they are paid up to $15,000 less annually, Muthersbaugh said. But he added that EMT basics can easily respond to minor emergencies, where little advanced equipment or procedures are needed. And the vehicles they use — such as pickups or SUVs — consume less gas.

Traditional ambulances are usually staffed by an EMT (basic or advanced) and a paramedic as well as carry lots of equipment.

“Everything we have on the big yellow and white ambulances that you see are incredibly important, but they’re also a huge engine and a big rectangle driving down the road,” Muthersbaugh said. “So having the miles and the fuel savings of a smaller vehicle helps to ... save those costs.”

Buying and stocking an IMPACT vehicle also costs 25% less than an ambulance, he said.

Two teams comprised of two basic EMTs will be deployed for around-the-clock coverage once permanent vehicles for the teams are secured, Muthersbaugh said. Because the non-emergency calls generally require less time, the teams will run between 30% and 50% more calls than ambulance crews — constantly moving from one call to the next, he said.

“And we can see those patients more quickly because if we were triaging them normally, they would kind of be a little further towards the back of the line,” Muthersbaugh explained.

Patients will be billed the same as an ambulance response, he said, but these costs will vary according to the treatment required, the patient’s insurance and if transportation to a hospital is needed.

Emergency Services Manager Justin Hargett and Assistant Medical Director Hannah Muthersbaugh ( Scott Muthersbaugh’s wife) spearheaded the project. They looked at almost 300,000 calls, analyzing them for safety ramifications, interventions performed and the outcome — such as transportation to a hospital. Based on this evaluation, they identified a subset of 39 dispatch codes that likely could be handled by basic EMTs.

The county conducted a pilot program from Sept. 10 through December last year where 911 dispatchers sent the IMPACT crew to respond to those lower-level emergency codes.

In 92% of the cases, the patient did not require transportation to a hospital.

“We would absolutely still send an ambulance under normal circumstances, but then that’s tying up a pretty high-level resource that is finite and we are trying to save for large-scale calls — cardiac arrest, strokes, something like that,” Muthersbaugh said.

Area fire departments also are participating in the program by handling minor calls without the aid of an ambulance.

“They’re now pulling more than 100 calls out of the system a week that they are responding to themselves,” Muthersbaugh said.

Collectively, the fire departments and Guilford EMS units have run more than 1,000 IMPACT calls to date.

Fire departments and IMPACT crews can always call for an ambulance if they determine a higher level of care or transportation to a hospital is needed.


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