Replacing An Ambulance With A Station Wagon : Shots - Health News There's nothing like an ambulance when you really need one, but they're expensive, and a lot of people who call an ambulance would actually be better served with a different, cheaper kind of care.
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Replacing An Ambulance With A Station Wagon

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Replacing An Ambulance With A Station Wagon

Replacing An Ambulance With A Station Wagon

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The South Metro Fire Department - that's near Denver, takes about 7,000 patients to hospitals every year. Ambulances can certainly be essential in an emergency but they're expensive and a lot of people could be helped with simpler care. So, South Metro is trying an alternative. Eric Whitney reports.

ERIC WHITNEY, BYLINE: Rick Lewis, chief of emergency medical services at South Metro Fire in the Denver suburbs, says the crews that respond to 911 calls are ready for anything.

RICK LEWIS: They have a big sense of pride in being able to do whatever. Skunk in a window well or an atomic weapon.

WHITNEY: So, when they get a call for medical help, most fire departments scramble both an ambulance and a fully staffed fire truck, but Lewis says that's way more than many people really need.

LEWIS: It's not the prairie in the old West anymore where you have to be missing a limb to go to the hospital. Now it's a sore throat or colder or flu sometimes and that can be frustrating.

WHITNEY: It's frustrating for both ambulance crews and patients. Somebody who's been running a fever for a couple of days needs help but not necessarily an ambulance ride to the ER. But Lewis says crews fear lawsuits if they were to leave and a patient gets worse. Also ambulance companies typically don't get paid unless they take somebody to the hospital. So, Lewis teamed up with Mark Prather, an emergency room doctor, to try and come up with a better way.

MARK PRATHER: We've created a mobile care unit that can go to a given patient, if we think they're safe, to treat on scene and provide definitive on scene treatment.

WHITNEY: The mobile care unit is basically a station wagon. While it's parked at South Metro headquarters, advance practice paramedic Eric Bleeker shows off some of the gear it carries.

ERIC BLEEKER: This one is a suture set. So, it has everything for wound closure.

WHITNEY: Ambulances don't have that, so even someone with a small cut that just needs a couple of quick stitches - they get a ride to the ER. Bleeker's mobile unit also carries a miniature medical lab.

BLEEKER: We can run full blood chemistry, we can do complete blood counts, we can check for strep throat or influenza.

WHITNEY: Several pilot programs across the country are using paramedics as physician extenders. Sending ambulance crews to do routine things like hospital follow-up visits in places where basic healthcare is hard to get. But South Metro's model focuses on responding to calls. The team always includes at least one nurse practitioner. So, they can carry and prescribe basic medicines.

BLEEKER: A lot of what we do is sort of that mid-level between the acute care you receive in an emergency department and what the paramedics can currently do.

WHITNEY: So, that person running a fever could end up being diagnosed and treated in their living room for about $500. Instead of spending six or seven times that for the exact same care at an emergency room. South Metro Fire relies on Colorado's new electronic medical records network. They can call up patient records on scene to provide care that's more like an office visit and dispatchers can check recent medical histories to make sure people who might really need an ambulance get one. Mark Prather, the ER doc who helped come up with this new treatment model says so far insurance companies don't pay for it.

PRATHER: And that's maybe why nobody has done it yet.

WHITNEY: For the last nine months South Metro's been running its mid-level service basically for free to prove that it works. But Prather thinks that's going to change because of Obamacare. The law aims to get insurance companies and government programs like Medicare to stop paying for medical overreaction. It has penalties designed to discourage overuse of emergency rooms.

PRATHER: It allowed us to think about payment differently and basically switch from a volume situation to a equality situation.

WHITNEY: Prather is now in talks with several big healthcare payers and hopes to be making money soon. For NPR News, I'm Eric Whitney in Denver.

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