1 MEMORANDUM
DATE: May 16, 2023
TO: Justin Hess, City Manager
FROM: Eric Garcia, Fire Chief
BY: Sana Arakelian, Fire Administrator
SUBJECT: Budget Discussion Paper: Introducing a Mobile Integrated Health Model into the Burbank Fire Department
BACKGROUND
At the City Council Meeting on May 9, 2023, Council Member Takahashi requested a discussion paper regarding introducing Mobile Integrated Health (MIH) into the Burbank Fire Department’s (BFD) Emergency Medical Services (EMS) program.
DISCUSSION
MIH is a patient-centered, delivery model that offers a broader scope of practice centered on non-emergent field treatments, chronic care and preventive services, delivered in the patient's home or mobile environment. MIH resources can include a combination of an emergency medical technician or paramedic, and a nurse practitioner or physician’s assistant. The approach aims to deliver high level and more cost-effective medical care by coordinating a combination of these human resources to help patients get the most appropriate care, and social service program referrals that can assist with services to enhance in-home self-care.
In recent decades, fire service delivery has changed where the majority of 911 calls are no longer fire and rescue- related, but instead EMS related calls for service. In Burbank 911 calls for EMS have steadily increased, 84% of calls for service are for EMS and of those about 60% are low acuity or non- emergent calls. The increase in calls can predominantly be attributed to the aging population, the implementation of the Affordable Health Care Act, a growing homeless population, and the plain fact that the use of 911 is the main entry point into the health care system for many individuals.
This increasing volume in low-acuity calls has led fire agencies like BFD to explore MIH models to provide a more comprehensive pre- hospital, medical service by utilizing the appropriate response level. A MIH program in Burbank would likely consist of a unit that
FIRE DEPARTMENT
2 would respond to low level, non- emergent medical requests and be staffed with a nurse practitioner and a Burbank firefighter/paramedic. This would be in place of a standard paramedic rescue ambulance and engine company that equates to a response totaling 5-6 fire personnel.
A MIH unit would respond to non-urgent, low acuity medical calls; acuity is defined as the level of severity of illness. Examples of low acuity medical problems include minor abdominal pain, chronic back pain, lacerations, falls, or possible upper respiratory infections. These are all common medical issues currently called into the 911 system.
When arriving on scene, the firefighter/paramedic, nurse practitioner team would respectively confirm there is not an a dvanced life support treatment need and evaluate the patient to determine whether the patient can be better treated at home or referred to their primary care physician or specialist.
This type of MIH program reduces total costs to the patient and the health care system by delivering appropriate healthcare services on scene, providing positive patient experience, preventing unnecessary transports to the hospital/urgent care whereby relieving the impact on these facilities. Additionally, this would enable BFD to keep rescue ambulances available for emergent medical or fire-related incidents, increasing response effectiveness and resource efficiency.
FISCAL IMPACT
The fiscal impact to the General Fund for introducing a MIH program into BFD will first require an operational proposal and implementation plan to be in place in order to calculate the budgetary needs accurately. BFD staff anticipates the cost of adding a MIH program to range roughly between $450,000 to $850,000 per year.
CONCLUSION
MIH is part of BFD’s EMS vision and overall improvement plan. BFD prides itself on the ability to adapt and evolve with the ever -changing needs of our community. BFD will continue to work with EMS industry partners at the Local EMS Authority, fire communications center, hospital and urgent care teams, and social program resources to pave a path forward for BFD MIH integration. Given the current budget presentation/adoption timeframe, BFD recommends City Council allow staff to develop a MIH integration plan and return with more information and budget proposal for consideration at a later date.