Ohio fire dept. continues to struggle with increasing EMS call volume
“My people are saying they’re exhausted,” Private Koenigseker said. “We are running in just an incredibly high volume of runs"
By Ryan Dunn
TOLEDO, Ohio — The Toledo Fire and Rescue Department last year exceeded 60,000 runs for the first time ever, a steadily growing and stark total reflecting national health-care trends.
Of these 60,662 total runs, 53,904 — 89 percent — were emergency medical service calls. The remaining 6,758 were fire runs.
It all leaves an impact on city firefighters, said Jeff Koenigseker, a private in the department and president of Toledo Firefighters Local 92.
“My people are saying they’re exhausted,” Private Koenigseker said. “We are running in just an incredibly high volume of runs.”
He compared it to 1992, his first year at the department, which tallied about 26,000 runs. Now, when he leaves a 24-hour shift, the private feels so tired that the next day is wasted.
More and more patients are seeking emergency aid from the department. In 2009, the medical run total was 42,639, or about 26 percent less than last year’s total.
“I think many facets of the emergency medical system in this country are stressed, and we’re no different,” fire Chief Luis Santiago said.
The chief named several driving factors in that shift. He cited a lack of health-care coverage for many Americans, and the cost and availability of medication as part of the issue.
Toledo calls range from a sudden medical emergency to patients not following orders with medication, he said.
“We find, many times, that we are responding to incidents where some of us think a viable option is maybe calling the family doctor and going into the doctor’s office,” Chief Santiago said.
There is no doubt the opioid epidemic caused further strain, Chief Santiago said, although the rate of growth appears to predate it.
Chief Santiago described the department as an entry point in the health-care system. He said he’s unsure if the medical calls will ever level off.
In the meantime, department officials are looking to improve that rate. Potential programs include educating frequent users and establishing a community paramedic.
This position would teach patients about medication and resources beyond the hospital. Administrators expect to have more on the paramedicine program as it finalizes in the next few weeks.
It would allow greater focus and resources for handling other calls, Chief Santiago said.
“Our folks, our men and women, have done a great job. They’re true professionals. The level of service that we provide for the tax money that we get, I think the city of Toledo is doing very well,” Chief Santiago said.
The department employs 543 uniformed firefighters, 30 of which are in academy until mid-May. It’s a staffing size that has not fluctuated much since at least 2001.
Private Koenigseker advocated for more Toledo firefighters to help deliver better service for city residents.
A paramedicine program, instead of sending a firetruck of emergency medical technicians, could visit those with chronic problems, Private Koenigseker said.
“If we can take care of that citizen’s needs through community paramedicine or other channels, that does reduce the number of runs we’re going on as a fire department,” he said. “And gives us time to more rapidly respond to more critical incidents, be they life-threatening emergencies, or structure fires, [or] other calamities.”
Many conditions leading to the emergency room will not be fixed there, department spokesman Pvt. Sterling Rahe said. These ailments require primary care and following doctors’ orders, he said.
“It’s not always in the best interest of those patients to go to the ER, especially if they have a cold or bronchitis,” Private Rahe said. “They’re not necessarily going to fix that issue.”
ProMedica offers a range of care services and outreach on common diseases, said Emergency Center Medical Director Dr. Brian Kaminski of ProMedica Toledo Hospital.
The outreach helps residents recognize signs of serious illnesses as well as the degree of urgency, he said.
“As a result, ProMedica has seen a significant increase in the number of urgent care visits over the last year, while EMS transports to ProMedica hospitals have decreased, and emergency department volume has decreased,” he said.
Dr. Mark Cockley, chief medical officer for Mercy Health Physicians, said its data show about 60 to 70 percent of emergency room visits — occurring during primary care physicians' typical business hours — are for not urgent or critical care.
“You don't want to be backed up, and that's key,” he said.
Nationally, emergency room visits have increased from 108 million in 2000 to 130 million in 2013, said Jeremy Lapedis, a project manager at the Center for Healthcare Research and Transformation. The organization is housed at the University of Michigan.
“What a person defines as an emergency for themselves might be different than what a physician or first responder defines as an emergency,” Mr. Lapedis said.
Data show those on Medicaid or lacking health coverage often choose the emergency room, he said.
Patients typically opt for its convenience as well. Physicians provide treatment in one visit at a center open all the time and without required appointments, Mr. Lapedis said.
Primary care work can take scheduling weeks or months in advance, he said.
Overcrowding has led physicians to spend less time with patients and hospitals increasing rates to make up for deficits from the emergency room, Mr. Lapedis said.
Mr. Lapedis said the emergency room provides services for many with social problems. In Michigan, officials are looking toward better communication among groups for health care and community paramedics, he said.
“I think the ER is just this Band-Aid for a lot of society’s ailments. These programs can start to address the problems that ER is being burdened with,” Mr. Lapedis said.
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