EMS in the Era of Healthcare Reform - Social Work Prevails
by Carrie Talamaivao, MSW
In 1968, the United States established a universal emergency telephone number that could be remembered easily and dialed quickly. Fast forward 50 years, and you’ll be hard pressed to find anyone who doesn’t know about the emergency 9-1-1 system. But 9-1-1 calls today are more complex than they were 50 years ago. Often, the 9-1-1 calls received are a patient’s perceived emergency, or one that has been building over time that emergency medicine is not likely to fix. We have moved beyond simple calls for house fires, to cries for help.
Across the nation, fire agencies are struggling to find ways to meet the needs of their most vulnerable population. An effort of the Affordable Care Act, Mobile Integrated Healthcare-Community Paramedicine (MIH-CP) seeks to provide patient-centered healthcare using mobile resources outside of the normal healthcare environment. Although models vary, this emerging approach to coordinating care aims at improving quality of life by connecting people to adequate medical and mental health care services - reducing non-emergent 9-1-1 calls, medical spending, emergency room visits, and ultimately achieving better health outcomes for patients.
I am a social worker within a fire department who co-responds to 9-1-1 calls alongside Fire Fighter/EMTs. We also receive internal referrals from our Fire Fighters/EMTs on the street who have encountered someone in need and referred to our program. Our Mobile Integrated Healthcare program (South King C.A.R.E.S) integrates different providers, both clinical and non-clinical, in meeting the holistic needs of the patients who are enrolled in the MIH program. Our Fire Fighter/EMTs are highly skilled, highly trained, and provide a great service in ensuring medical stability during a crisis. They are trained to respond quickly, assess quickly, and get the patient to help as if their life depends on it - because sometimes it does.
But what about when it doesn’t? A whopping 85% of the cases our Mobile Integrated Healthcare team sees have a behavioral health component. Social workers in fire service have a unique opportunity to provide assistance to patients in real time, a service unlike any other I’ve experienced. We partner with local community entities, such as hospitals, community mental health clinics, substance treatment centers, food banks, senior centers, and more to ensure wrap-around care for these vulnerable people. With the access that EMS provides, and the clinical skills of a social worker, our team is uniquely positioned to address the medical and psychosocial needs of the patient in real time.
As a social worker in my fifteenth year of service, I have had the privilege of serving children; families; people with disabilities; seniors; people with mental health needs; those struggling with addiction, housing, and food insecurity; and those with chronic medical conditions. But nowhere have I served all of those patient populations at once, except in fire service. And never have I truly had the opportunity to “meet the client where they are” than here. What an extraordinary opportunity for social workers!
Carrie Talamaivao, MSW, received her BSW from Western Michigan University and MSW from Florida State University. For 15 years, she has worked with a variety of populations, including: people with developmental disabilities, foster care, mental health, and aging. Carrie thinks people have more strength than they give themselves credit for and, given the right amount of support and encouragement, people are eager for change.