MCP in the News: San Bernardino County to Roll Out Emergency Communication Nurse System

This article originally appeared on the San Bernandino County's Transportation Authority, which can be found here.

911 service throughout San Bernardino County is getting a major enhancement with a new, more efficient process for handling incoming calls to determine the appropriate level of service. The San Bernardino County Council of Governments (SBCOG) has approved a contract with Mission Critical Partners to implement an Emergency Communication Nurse System™(ECNS) Plan within the existing 911 network throughout the county.

ECNS has evolved through an Ad Hoc Committee which includes stakeholders representing all levels of the emergency response system, from the initial 911 call to the Emergency Room. The Ad Hoc Committee includes:

• CONFIRE Regional Emergency Communications
• San Bernardino County Fire Department
• Inland Counties Emergency Medical Agency (ICEMA)
• California Department of Forestry and Fire Protection (CAL Fire)
• Rancho Cucamonga Fire Department
• San Manuel Fire Department
• Rialto Fire Department
• Chino Valley Fire Department
• Loma Linda University Medical Center
• Desert Ambulance Service
• San Antonio Regional Hospital
• American Medical Response (AMR)
• Inland Empire Health Plan (IEHP)
• Kaiser Permanente
• Priority Dispatch Incorporated
• San Bernardino Council of Governments (SBCOG)

The goal of this Ad Hoc Committee is to address Emergency Room overcrowding and the “domino effect” of having ambulances waiting to transfer patient care to Emergency Room staff, otherwise known as ‘offloading’. Offloading can take several hours depending on how congested the Emergency Room might be on any given day, which prevents 911 ambulances from being available for the next emergency calls. This service will initially be provided to those who call for an ambulance, within the CONFIRE service area. Data provided by CONFIRE (Emergency Communications Center) for calendar year 2019, identifies approximately 155,211 medical calls processed in San Bernardino County, 125,500 or 81% of those medical calls were processed by CONFIRE, which use the Emergency Medical Dispatch (EMD) system to distinguish severity of patient illness or injury. 911 calls deemed non-emergency and that may benefit from ECNS is projected to be approximately 12% of the calls processed by EMD. Current 911 response includes an ambulance and a fire department sent to every call. In an effort to maximize available resources and minimize emergency responses to calls that don’t warrant an “emergency” level of response, the Ad Hoc identified the ECNS as a solution that can be applied to through the dispatch phase of the 911 system, while positively impacting the rest of the first response system.

ECNS will facilitate county residents in receiving the right care at the right time in the right place, while freeing up ambulances and fire crews for situations that require their urgent attention. The process includes:

• Once the 911 call comes in to dispatch center, and it is given a code.
• Any call requiring or demanding an emergency response will be processed as such
• Non-Emergency calls routed to the ECN will go through a series of questions, including:
  • Recheck of Airway, Breathing, and Circulation status and other patient assessment applications
  • The ECN will designate a recommended level of care for non-emergency calls
  • Community resources would be made available if needed for non-emergency calls
  • Transportation modes, other than a 911 ambulance is then determined, if transportation is necessary

Thanks to the Federal CARES Act funding received by the County, the CONFIRE Emergency Communications Center governing board has approved the initial implementation of the ECNS program, which includes services to the residents of Colton, Loma Linda, Apple Valley, Rancho Cucamonga, Redlands, Chino Valley, Rialto, San Bernardino County, Big Bear, Montclair, San Manuel, Running Springs, and Victorville. The program began on Friday November 27, 2020.

The ECNS to be implemented in San Bernardino County through CONFIRE is modeled after the Regional Emergency Medical Services Authority’s (REMSA) ECNS system. REMSA serves the Reno, NV area. From January 2013 – June 2016, the data shows that the Reno ECNS:

• Averaged 2,000 calls a month, 150 of which were non-emergency calls (>60,000 calls)
• Safely reduced costs while still providing appropriate care
• Only 1.5% of callers required referral to the 911 for emergency ambulance dispatch
• 635 ambulance transports avoided
• 4,414 emergency department visits were avoided
• Based on average payments for ED visits and EMS transports, the Nurse Health Line saved more than $5.75 million from October 2013 until June 2016 Implementation of the ECNS by January 1 will be the initial step, and CONFIRE along with the Ad Hoc Steering Committee is working on a business plan to find steady funds to run the ECNS following the use of the allocated CARES Act Funds, including seeking private funds through health care providers.

For more information, visit goSBCTA.com/sbcog.