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Nurses field 911 calls in Richmond, VA

Alternative care is focus of program; Nurses field 911 calls in effort to curb unnecessary Richmond ambulance runs

Call 911 in Richmond about a toothache, an ear infection or a child's fever, and an emergency-room nurse may offer you medical advice.

The unique staffing addition helps the only program of its kind in the United States provide alternative care to those in need while curbing unnecessary ambulance runs.

By Penelope M. Carrington; Times-Dispatch Staff Writer; Richmond Times Dispatch (Virginia)

June 30, 2008

Call 911 in Richmond about a toothache, an ear infection or a child's fever, and an emergency-room nurse may offer you medical advice.

The unique staffing addition helps the only program of its kind in the United States provide alternative care to those in need while curbing unnecessary ambulance runs.

The Community Health Access Program saves the Richmond Ambulance Authority money and educates callers about local resources they can turn to before dialing 911.

"We wanted to do something to help people because every call to 911 is a cry for help," said Richmond Ambulance Authority Chief Administrative Officer Lee Ann Baker.

According to Baker, Richmond handles more 911 calls per capita than any other U.S. city.

"They don't just call once in a lifetime," she said of many Richmond 911 callers. "They may be the ones without a health-care provider or a usual doctor and that may be all they know... 'When you need help and it's medical, call 911.' "

Modeled after programs in England and Australia, the Richmond version taps into community services including free clinics, urgent-care locations and state-sponsored mobile dental clinics.

"We want to use our resources wisely and we want to save the ambulances for the true emergencies. If they're taken off the streets for a toothache then we may run short," said Baker of the nonprofit organization that receives 25 percent of its funding from the Richmond City Council.

"We're doing a lot of good, not just by diverting calls, but with the follow-ups we're doing... If we can get them channeled into the medical system, then everybody wins," said Juanita Garrett, a physician of 20 years and the program's coordinator.

The Community Health Access Program was launched in 2004 as a two-year pilot program. Since it was fully implemented in 2006, more than 750 people have received more appropriate care instead of going to the emergency room.

At $355 per transport, Baker said, that's a savings of more than $266,250 - enough to pay four part-time nurses' $29-per-hour salaries for more than two years.

The program is one of several that have brought the RAA global recognition and visitors wanting to replicate their efforts.

"It's a secret in the town of Richmond because people don't really realize what we're doing here," Baker said.

A nurse staffs the communication center on Hermitage Road from 7 a.m. to 7 p.m. every day with two weekday and two weekend nurses splitting the shifts. All dispatchers have emergency medical training and a paramedic is on hand at all times. Baker said registered nurses - especially those with ER and critical-care experience - are appropriate for this program because they have a level of medical knowledge that allows them to go beyond the computer-generated set of questions.

All calls fielded by the nurses are first screened by regular 911 operators and determined to be non life-threatening. Typically, a nurse handles half a dozen to a dozen calls during a shift.

If a caller wants an ambulance, one will be dispatched. Baker said it is difficult to make a true diagnosis over the phone and "we want to be very careful." The same $355 transport charge applies, even if the caller speaks to the nurse.

Follow-up calls will be made the next day and will continue if needed, Baker said.

"Most [callers] need an ear and they need somewhere they can go to get consistent care," said Kara Page, a nurse with the program.

"We're helping solve acute medical concerns," Page said, "but we're also empowering people to take it into their own hands to find resources that meet their needs."

* Contact Penelope M. Carrington at (804) 649-6027 or pcarrington @timesdispatch.com.

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