Neighborhood Fire Stations Expand Public Health Services

State: TX Type: Model Practice Year: 2019

The City of El Paso Department of Public Health (CEPDPH) serves the West Texas counties of El Paso and Hudspeth. El Paso is located in the Southwest Region of the country and in the Far West corner of Texas abutting the US/Mexico border. Total population for the service region is approximately 820,000. Twenty-five percent of the population is below the federal poverty level and 33% are uninsured. Ethnically, Hispanics represent 82% of the origin distribution. Due to a primary care physician shortage, exacerbated by high Medicaid coverage (23% of population) and even higher rate of uninsured (33% of population), low income residents have difficulty obtaining regular sick care and preventive health services through traditional venues, e.g., private physician offices. With limited access, low income residents seek care only in the event of an acute condition or protracted, unmanageable illness. And, often, that care is obtained through the emergency department at the nearest hospital. Making an appointment with a physician for routine preventive health services is rarely an option. An estimated 41% of the El Paso population does not have a primary care medical home (v. 19% nationally). However, many of these unassigned residents do obtain some level of sick care through alternate portals, e.g., hospital emergency departments, urgent care centers, EMS ambulance runs. Resulting in costly billing claims or uncompensated care. The City of El Paso Department of Public Health through the El Paso Fire Department aim to improve Medicaid and uninsured access to health education, health promotion, and disease prevention services by using Emergency Medical Services (EMS) personnel as providers of screening/vaccination services by retrofitting neighborhood fire stations as service venues. Main objective is to serve 1,000 participants annually by providing one or more select health screenings including blood pressure check, glucose testing, pneumonia and/or flu vaccine and fecal occult blood test. Other objective includes retrofitting fire stations, as needed, to accommodate onsite provision of vaccinations and health screenings. Lastly, to develop and test standardized health messages to promote participation of target population. (Small media pieces, brochures, flyers, etc.) Implementation activities include: Supplemented existing EMS and health department staff with program manager and field coordinator(s) staff. Evaluated paramedic staff for knowledge and skill in tailored health messaging and administering vaccines/select health screenings. Prepared protocols/standing orders for vaccine administration/health screening. Obtain authorization of medical directors of the respective departments. Identified and addressed HIPAA-related issues relative to health department/fire department mutual access to immunization/health screening data. Expand electronic health information (data systems) for EMS and the health department bridge for capturing select health information, e.g., immunization registry, from the respective databases. Specified and purchased transport unit and fire station equipment and supplies for the program. Coordinated staff according to scheduled health screening event and fire station. Results have exceeded expectations by serving more than 1,000 participants per year who received select health screenings. A total of 4,661 participants have been served during 125 scheduled events at fire stations conducted by EMS personnel. About 3,000 participants were immunized against influenza and 500 with pneumonia vaccine. The overall goal and objectives were met resulting in unprecedented success of expanding access to preventive health screenings due to the organization and collaboration of the fire and health departments. In addition to the collaborative, the presence of EMS personnel resonated among participants as community leaders and thus a trusting relation to accessing services which also led to the success of this practice. For more information please visit the website at
The Emergency Medical Services Division of the City of El Paso Fire Department responds to over 48,000 calls per year. Fifty-five percent (26,000) of the ambulance runs are for Medicaid and uninsured. Many of these low-income residents have limited, if any, access to private medical care for treatment of illnesses and routine preventive health services. EMS is in a unique position to identify thousands of unassigned, low-income residents in need of critical vaccinations and health screenings. Further, with proper training, EMS paramedics can provide vaccines/health screenings during scheduled health clinics at the 35 neighborhood fire stations. Health department and EMS staff employ combination evidence-based practices for immunization services. These practices have proven efficacious in raising immunization compliance rates and recommended by the Task Force on Community Preventive Services. For example, combination interventions have proven to be effective in vaccination campaigns. These vaccine interventions include expanded access through alternate sites, reducing out-of-pocket expenses, and use of standing orders. This collaboration model and expansion of service venue is an innovative practice in the field of public health. Only two to three successful projects have been documented nationwide, this initiative being the only one in Texas fully running in fire stations. The Neighborhood Fire Station project capitalizes on the availability of fire department/EMS as a neighborhood resource to promote community health through trusted, uniformed representatives of the healthcare system, i.e., paramedics. Further, with the significant volume of transport contacts (26,000 runs per year for Medicaid and uninsured), there is the opportunity to positively effect change in the vulnerable population at a meaningful scale.
The City of El Paso Department of Public Health built a partnership with the Fire Department and provided guidance throughout the planning, implementation and evaluation phases. With the vast experience in immunization services, the health department was instrumental in guiding development of standing orders for vaccine administration and protocols for health screenings with authorization of medical directors of the respective departments. Through a collaborative effort of both departments, EMS personnel were then trained to provide vaccines/screenings accordingly. Another objective for the health department is to provide the full continuum of healthcare services after the EMS initial services, from wellness to preventative care to disease management. In the event that participants' glucose level or blood pressure check is abnormal, the health department is available to connect through referral to the medical home of record with appropriate follow up. If client is unassigned, participant in informed on community healthcare resources or a safety net provider for further health assessment and disease management services. The health department's role is also to provide health education with appropriate/tested health messages about importance of vaccines/screenings. In addition to the interdepartmental collaborative, the Health and Human Services Commission (HHSC) served as stakeholder for this practice as part of the 1115 Healthcare Transformation Waiver. Technical assistance to formulate outcome measures was provided and resulted in approval of funding pool for this practice. In 2014, start up funding of about $100,000 was awarded by the HHSC to cover initial costs for medical supplies and equipment as well as promotional material. Since then the HHSC has reviewed impact of practice through semi-annual reporting and quantifiable service outcomes. The preventive health services offered through the "Neighborhood Fire Station Clinic" have been deemed satisfactory by HHSC after a mid-point assessment and approved for continuation the past four years.
The evaluation of the "Neighborhood Fire Station Clinic" was part of the activities implemented to expand electronic health information. This activity consisted of establishing a shared database between departments to access real-time information on participant demographics, services rendered and health history. With this database monthly reports and assessment was conducted by a patient care technician at the health department and a database administrator with the fire department. A program manager then reviewed reporting documentation to evaluate the progress of objectives to serve 1,000 participants per year and amount of scheduled clinic events conducted in retrofitted fire stations. During the participants visit at fire station clinics, a registry form was completed to collect demographic information (insurance and income status, age, gender, language) as well as health history (illness, medications, immunizations). This information was then transcribed into an electronic database, however, this was improved by transitioning to all electronic data collection using tablets at point of registry by EMS personnel after the first year of implementation due to the high volume of participants and to reduce waiting times. Initially, about 10-20 participants received preventive health screenings during the four hour scheduled fire station clinics which currently serves about 50-100 participants per event. The cross-sectional data analyses using the data collected from participants at point of registry demonstrated that 1,200 participants are served annually of which 4,661 are unduplicated (139 participants returned for additional services in other years). Sixty-four percent of the participants reported to be uninsured and of low-income status, who would otherwise have limited access to crucial health screenings and vaccinations. Most participants are females (63%) and between the ages of 50 to 69 (58%). Participants, predominantly reported being of Hispanic descent (93%).
The impact of the "Neighborhood Fire Station Clinic" merits the existing sustainble system supported by collaboration, community, and stakeholders. An ongoing pursue for sustainability approaches include developing payment methodologies in collaboration with managed care organizations, uncompensated care pool, and grants. To date, the main source of funding from HHSC has enabled continuity of operations with a total of $3M earned with matched funds. El Paso City Council and administration has also been very supportive of this service to the community by allowing use of fire stations as venues, promoting and showcasing services. Lessons learned in relation to partner collaboration is appreciation of added services to EMS personnel, established rapport and frequent communication via meetings, calls and site visits. This partnership environment facilitates efforts and opens a window of opportunity for other joint initiatives to improve community health for those who need it the most. Specifically, for this insight, an older fire station that was closed was remodeled as a community health center to offer other services such as training for EMS personnel, fire safety classes and other illness/injury prevention education. Overall, the collective efforts and systems change approach from fire departments providing emergency services to preventive health screenings has been a model to other regional partners including New Mexico State University who is developing a partnership with the local fire department to implement a similar initiative. This unique model may also be replicated and sustained in other parts of the country to address the physician shortage and prevent costly hospitilizations.
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