NFPA Journal - January/February 2020 - 62

EMS
Revolution

C O M M U N I T Y PA R A M E D I C I N E

THE

With health care costs spiraling ever higher and EMS systems
nationwide on the brink of collapse, a new model of home-based
care promises to help fix a broken system-and keep people
with chronic ailments out of the emergency room
by Jesse Roman

ELLY ABBOTT SPENDS MOST DAYS in a car,
crisscrossing San Antonio's 465 square miles to visit
the homes of some of the sickest and most desperate
people in the city. Some are mentally ill, like the guy who compulsively swallows metal objects; others are addicted to drugs;
most face a long list of challenging maladies. All of them, for
one reason or another, seem to find themselves in the back of
an ambulance a lot-in some cases, dozens of times a year.
As one of 10 medics on the San Antonio Fire Department's
Mobile Integrated Health Care unit (MIH), Abbott's mission
is to try and help these patients break their dependence on
911 by better managing their health-for their sake and for
the sake of SAFD's overworked EMS units.
On an overcast afternoon last March, Abbott took me on a
ride to show me how he does it. We made our way through
a particularly downtrodden San Antonio neighborhood,
passing rows of small weathered houses with cluttered yards.
As we approached our destination, a small blue house with
peeling white trim and a rusting tin roof, Abbott told me
about the patient we were visiting, a 40-year-old woman I'll
call Tammy.
"She was a train wreck when I met her," said Abbott, a gregarious man in his mid 40s. Most of Tammy's many ailments

62 | NFPA JOURNAL * J A N U A R Y / F E B R U A R Y 2 0 2 0

stemmed from complications related to diabetes, including
kidney failure, infections, amputations, and congestive heart
failure. Her latest stint in the hospital, however, had been
with a bout of pneumonia-at least the 20th time she'd been
hospitalized with the respiratory infection.
Despite the setback, Abbott was hopeful-Tammy, the
mother a young child, was actually doing a lot better than
when he first knocked on her door several months earlier.
Thanks to his help, she was seeing a doctor regularly, was
taking a new and more effective insulin, and had managed to
keep her conditions relatively under control for the first time
in years. She had required far fewer ambulance trips with
San Antonio Fire EMS.
SAFD set up the MIH program in 2016 specifically to
address patients like Tammy. Functioning as a mix of mobile
hospital, social work organization, and detective agency, the
goal of San Antonio's MIH is to find the root cause of why
the city's "high-utilizers" call 911 so often, and to work with
them, their doctors, and community aid organizations to
help them become healthier and less dependent on emergency transport. In just under four years, the program has
already saved the department thousands of would-be ambulance transports, and millions of dollars. u

NFPA Journal - January/February 2020

Table of Contents for the Digital Edition of NFPA Journal - January/February 2020