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911 calls from chronically ill drop after Milwaukee community initiative (jsonline.com)
107 points by SQL2219 on Apr 15, 2018 | hide | past | web | favorite | 69 comments

It is more honest to keep the comparison either between absolute numbers or percentages:

7% of emergency calls made by 0.16% of people

4,288 of 62,763 emergency calls made by 100 people

Does it include things like head of a shopping mall calling for emergencies with customers?

I think you might have a decimal off. 100/62763 = .0016 = 0.16%

You're correct, of course. Updated and fixed.

To further illustrate: On average that's about 44 calls per person, or a 911 call made by one of those 100 people every week or sometimes two, given that these numbers were over the course of a year.

I have a friend dying of congestive heart failure. He'll be dead within a year. But in the meantime, he calls 911 a lot. Not sure what the solution is supposed to be here. A lot of these calls are perfectly legitimate and not the result of anyone "abusing" the system. Some people have more medical problems than others.

Perhaps there needs to be a different solution for these kinds of people. There's probably a way of addressing your friend's needs more effectively and also not taking up dispatcher time.

Years ago, I remember seeing infomercials for a neck worn alert button that folks could use in an emergency (for instance, a fall) that would bring assistance. This seems like a natural solution for someone with chronic health issues that regularly requires emergency services (though not so frequently that they need in-patient care).

Ideally, emergency responders would be linked to the patient's healthy data so the verbal exchange via 911 is less necessary.

Yes, 911 should be for emergencies i.e. unexpected, unplanned critical events. Somebody with a chronic condition should have either regular home visits or be in a care facility.

It's still unplanned, since you don't know when it's going to happen; a home visit might leave 10 minutes before you need help.

As for care facilities, if the need isn't that common (e.g. once a week), is that really more effective than an occasional ambulance trip? Plus the patient might very well prefer to spend his last year as close to his family as possible.

I think the cost could well be close. Here, if you call 911 for a medical emergency you will get a police patrol car, an ambulance, and a fire truck dispatched in most cases. That's at least three vehicles and at least half a dozen people.

If this is happening once a week then it really seems there ought to be a better way to handle it.

Edit: if you also assume that an ambulance dispatch is usually followed by an ER trip, the cost balloons even more. Seems really hard to think that a 911 dispatch followed by an ER trip once a week is the best way to handle a chronically ill person at home.

I don't know the exact rules but in the UK, when calling 999 you're asked which service you require. Fire service will only get police involved when they need it or automatically when more than 2 Fire Engines are dispatched. Ambulance calls can result in an Ambulance with a crew of 2 or a single paramedic in a sensible estate car (station wagon) with a big engine, they'll call the Air Ambulance if they need one and it's free. Dispatchers will send who they think you need as they see fit. That includes Lifeboat Service or Mountain Rescue. Or Police, of course. Each service will obviously ask for backup as required.

The BIG difference with what you've described though is the layout of the UK is much denser than USA. The resources available and the nature and frequency of call outs will obviously be quite different.

How much would they save if they bought the fire department a Prius for responding to medical calls?

Chronic conditions can flare up unexpectedly. Just so you know.

Care facilities are warehouses for the old and ill. There is no care there — they just call 911.

Home visits are great for physical therapy or protocol based care. But again, they call 911 when anything significant happens.

Each individual event is unplanned and urgent (life-threatening). But he has a lot of events. He spends a few days in intensive care, gets stabilized, gets sent home, and then is fine for a while... until something happens. There are lots of people in similar situations, i.e. a person with life-threatening allergies, compromised immune systems, etc. Modern medical care means that there are more people skating closer to the edge of death than there once were.

I live next to an elderly acute care facility. There's an ambulance outside every day when I drive or ride my bike past.

Since the population of Milwaukee is around 600k, that should be 0.016% of people.

Or you should say something like 'of people who made emergency calls'

edit: that second one is still problematic since we only a couple data points on the distribution of calls per capita.

How did you get 1.6%?

its not more or less dishonest, they are the exact same numbers

The original title does not give information on the total number of people, only the 100.

the number of people are irrelevant, 100 people making 4000+ calls to emergency services is outstanding regardless of the size of the population or the time period.

That's 40 calls a year about once a week. If those are homes with many seniors that might not be too shocking. Big malls might have a call a week or concert arenas.

"[In 2015,] 7% of the 62,763 emergency calls [in Milwaukee] came from the same 100 people"

Thank you for this. The title oversells its scope/importance by a fair margin. I hope it is unintentional and not a purposeful tactic...

A coworker was volunteering with the local rescue squad. They knew the frequent callers personally. One was a particularly sad story of lonely old woman who would call because she just wanted a ride to the hospital and it seemed to be her only source of human interaction. They could never say "we are not coming, it's so and so" because well that one time she could have really needed help. Some insurance companies have incentives against this by charging a steep price for the ambulance ride and only waving if person is admitted. But at a deeper level this is a failure of social services and increased isolation and loneliness experienced by the elderly. We usually hear about how it happens in Japan, but it's happening here in US as well.

Their success metric may just be reversion to the mean; since they started by selecting the people who had made the most calls, you would expect the number of calls to come from those specific people to fall in the coming years. Since there was also likely some underlying health condition, you would expect the between-year variance to be large. It might well be that their program has no effect whatsoever.

If no other group is calling at a similar level, then it's not reversion to the mean. The mean has actually been shifted downwards.

> Since there was also likely some underlying health condition, you would expect the between-year variance to be large. It might well be that their program has no effect whatsoever.

The rate dropped significantly each year from 2015 through 2017 -- 3 years in row. It's possible this is pure chance, but it seems rather unlikely.

If they're really tracking the same 100 identified people, with no replacement, then you'd expect the same result even without regression to the mean, simply because very sick people tend to die, and dead people tend not to call 911.

One would hope that they're not doing that, and it's just that the article is imperfectly worded.

The system by which people have to spend 8 years in school to become doctors and the limited amount of spots in medical schools is one of the main impediments to lower health care costs since doctor salaries are astronomical compared to other countries. This program is a good first step for making health care more affordable in that it is empowering paramedics.

A friend of mine, who's a former EMT, once told me: "When you're an EMT, you get to know all of the diabetics in your area."

It's almost like having people be responsible for their own healthcare doesn't actually work in the real world.

Well, it's having people with infinite access to shared, finite resources.

I worked as an EMT and would regularly get bizarre calls from people abusing the system to take their kid to the hospital because he hurt his arm, the parents following in tow by car. Or a domestic dispute where they think it's reasonable to call an ambulance like it's a less-serious police dispatch to handle more minor issues. Or really just a free taxi service in general. -- You don't have to pay if you just walk out of the hospital or ignore the collections. If you don't have insurance, it's pretty much the only option.

I'm not sure if there are any alternative medical models that solve the nature of some people to abuse shared resources.

I don't know which country you live in but I've talked to paramedics about this issue, and it's extremely rare (at least in my country). Once in a blue moon, an old woman living in isolation in a village or something will call an ambulance just to get in town. In that case, she could only do this once because the issue got talked about.

Nobody has infinite access because the access is limited by human intervention. It's limited based on need, not available cash.

How is that relevant?

Why is the fire department launching paramedic initiatives?

If you want a reasonable response time from the fire department, then you end up with way more firefighters on duty at any given time than there are fires to respond to.

Instead of paying them to twiddle their thumbs, most communities train them as paramedics and either have the fire department run an ambulance service or just use them as first responders who can get to a medical scene before an ambulance can.

Additionally, it seems that many rural communities have volunteer fire departments that will respond to local events (fire or medical) much more quickly than the more highly trained/equipped regional departments. Trained as EMTs, they provide immediate care until they can hand off to the full timers.

Most communities? The only place I've heard of it is the US.

Its common in the US for basic life support to be delivered by private or hospital ambulances, or municipal EMS services by cheap EMTs. Sometimes they are just drivers. Usually advanced life support is done by paramedics or others who work for municipal EMS or fire departments.

Bigger paid departments have a split between engine companies and rescue companies. Rescue companies have fancy tools for all sorts of situations and usually have more trained medical capability. That’s why you’ll see ladder trucks dispatched to medical emergencies in the US.

All right then, “most communities in the US.” I’ll admit I don’t really have any idea how it works anywhere else.

However, I can only imagine that all developed countries have the “problem“ that modern building codes reduce the rate of fires such that they are faced with the choice between (1) reducing density of firefighters and therefore increasing their average response time (2) paying them to sit around and do nothing, or (3) giving them something else to do when there isn’t a fire.

Aside from the other answers; because "being on-call 24/7 and having the ability to safely drive through town at high speed" is a capability just as important as paramedical training, for that role, and who else has it?

Most paramedics are branches off of the local fire department.

In my locale, all of the firefighters are also trained as paramedics at some level. When I had my "old geezer chest pain" moment, the ambulance was on another call, so the fire truck showed up first. They had the full kit, including portable EKG, and started working on me right away.

The entire system is based on counting the minutes from 911 call to treatment in the hospital, and treating it as a process to be optimized.

I think statistically, you need more medics than firemen, so it may make sense to think of the fire station as a paramedic station that's also equipped to fight fires.

My friend, the former EMT, told me that they like to have a crew of 4, for any call. The reason is that a large number of patients are obese, and it might take 4 crew to get someone out of their house. He said: "That's why you always see a fire truck following the ambulance."

That seems like an odd delegation of responsibilities

In the US it is more likely that there is a fire department close to any particular residence (in fact they are usually spaced out to minimize response time over the entire area) while ambulances tend to be dispatched from hospitals or ambulance services and so their response time is more varied. Fire department paramedics and ambulances may both be dispatched for emergencies, but ambulances also cover things like non-emergency patient transfers and other medical transport scenarios. It is often the case that the role of the FD paramedic is to be first on scene and try to stabilize the patient if possible so that once the ambulance arrives they can scoop and go if needed.

It's that, be run by the police, or be a completely separate institution. Private healthcare makes hospitals in control a bad idea.

Fireman are for protecting life, police for protecting law.

I'd say the fire service is more the protection of property, which overlaps into protecting life in some cases.

It's odd to me to think of the fire service giving first response medical care, outside of perhaps smoke inhalation and burns.

In the US, fire departments have far fewer fires to respond to, and many more medical calls, varying with the local situation - dual or single response by FD and EMS, transport by EMS xor FD, FD has paramedics (many hundreds of hours of training) or only EMTs (about 100 hours) or variations in between (varies by state).


Yeah, no. Countries with universal healthcare do this too (and why wouldn't they?)

Can you name some countries that do this?

In France firefighters are also paramedics. They provide ambulance services and are usually first responders for any medical emergency.

Thank you!

Germany, at least in some places.


Brazil seems to offer the SAMU ambulance service nationwide.

I would understand a developing country combining responsibilities like this, as they might not have the resources or captial available to the richest nation on earth.

What downsides do you see from this combination?


Aside from Canada, which some commenters here say don't do this any more in some provinces, are there any others?

Genuinely curious. Its a hard thing to Google for.

Its very common in Portugal, particularly outside the largest cities.

Works the same here in Canada. Or did until a couple years ago anyways - people in my town still have the bumper stickers on their cars protesting the switch away from running the ambulance service out of the fire department.

This sort of distribution plays out everywhere. The rich. Three point shooting. Now, 911 calls.

What shall we call it?

Colloquially known as the 80/20 rule, although those percentages aren't fixed, but it's the same idea.

It’s a power law distribution.

That 911 calls aren't actually evenly distributed throughout the population, but instead tend to come from people with bad health and lack of access to health care? I'd call it obvious.

I don't know how the distribution resembles wealth distribution; wealth distribution follows a power rule, because wealth is reflexive i.e. the more wealth, the faster the rate of wealth accumulation.

Normal distribution

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