Up to four times each day, fire crews went to a man’s south Tulsa home to help lift him because he couldn’t get up on his own.
The man lived alone, struggled with substance abuse and couldn’t rise on his own because of physical ailments. Firefighters later learned he was facing eviction.
Another woman called 911 services eight times in one day for assistance lifting herself out of a chair. She couldn’t stand up by herself and her husband was unable to help her.
One man called for emergency aid 135 times in one year.
The Tulsa residents are considered “super users” — a relatively small group of people who account for a disproportionate amount of calls made to the city’s 911 system — sometimes more than 100 times per year — for nonemergency situations.
“Out of all these people that were calling, they had a couple of things in common,” said Michael Baker, chief of EMS for the Tulsa Fire Department.
“We found a lot of folks are either living in a home without support, alone, or they have home help up until 5 in the evening and then don’t have anyone. Almost all have services, just not the right kind. The Tulsa Fire Department became the filler of the gap.”
So in 2013, Baker began working on a program that sought to identify the fire department’s super users, figure out why they were calling so much and then connect them with the needed social and medical services. It evolved into the Community Assistant Referral and Educations Services program, or CARES.
As a result, in the first three months of 2017, the fire department saw a 70 percent reduction in return visits for its top 10 utilizers, Baker said.
Baker said although the agency is happy to help people, fire crews aren’t the best resource for some of their needs. And at the same time, the frequent calls take resources away from emergencies and can be a burden on taxpayers.
So how does this program work?
It’s a collaborative effort that expands across the community, and it’s still in the early stages. The department is part of a four-member team aiming to reduce the number of calls made by “super users,” who make 15 or more calls in one year.
A large part of the program involves connecting callers to health services — up to 75 percent of all calls fire crews respond to are EMT-related, Baker said.
The agency partners with St. John Medical Center and joined up with Mental Health Association Oklahoma in late 2015. This January they embedded University of Oklahoma-Tulsa social work masters students into the program through an academic partnership.
Mike Brose, Mental Health Association Oklahoma CEO, said the model focuses on finding long-term solutions to the needs of people who frequently call emergency services. Most of these high utilizers aren’t homeless but have housing problems, severe physical or mental health needs or all of the above, he said.
“Sometimes a firefighter who’s been to the house before will go out and meet them, talk to them, do an assessment and find out what these people need,” Brose said. “They’re often finding people are currently or historically connected to services, and then it’s about helping them get reconnected to that.”
The fire department is in a unique situation because its stations are implanted into neighborhoods across the city, which allows firefighters to forms relationships with callers, Baker said. The frequent utilizers aren’t exclusive to any gender, age or area of the city.
“It affects everybody, this super-utilization of services,” Baker said.
The most frequent nonemergency request the department sees is for lift assists, people who need help getting up or caregivers who need aid lifting a relative, Baker said. Tulsa firefighters respond to up to 2,000 of these each year.
“We don’t mind helping folks,” Baker said. “Who else is an 80-year-old woman going to call who’s trying to manage her 280-pound husband?
“But it injures our firefighters when they go to repetitive lifts. Something that’s like, ‘Wait a minute, why are we here every morning to get you out of bed?’ becomes an issue. Some called every day.”
Kellie Wilson, a volunteer social worker for CARES with Mental Health Association Oklahoma, said the firefighters are able to recognize problems and then contact social workers to come in to help make arrangements for the caller.
“These are folks social services agencies haven’t had access to in the past,” she said. “They’re actually going into people’s homes and finding issues that are actually kind of surprising that they exist.”
In one case, a mother and a daughter were living in a home that was filled with clutter and large amounts of garbage, Wilson said. Both had mental and physical health needs.
“It got to the point where no one can live in that situation where it can be healthy or safe,” Wilson said.
The two were set up in a rehabilitation center to help with immediate health needs, as well as mental health care, Wilson said. They stayed there for three months while the CARES team partnered with volunteers to clean their home.
“Now, they can move back home, and they can move back home with the right services wrapped around them,” she said. “So we’ll continue to monitor that situation and will continue to monitor how many emergency calls are being made out there, making sure they have what they need.
“If it all comes together the right way, then everything should work. They’ll be healthy.”
One of the goals is to keep the program simple and focused on the big issues, such as ensuring people have housing, meals and their proper medication, Baker said.
The initiative is based on the Colorado Springs Fire Department’s CARES program, which integrated a similar approach through a collaborative care model. Partners from Tulsa’s program took trips to observe the program before implementation.
Lt. Juliet Stone, with the Colorado Springs Fire Department Community and Public Health Division, said for at least half of CARES patients, the agency has seen a 40 percent decrease in calls.
The department is in the process of evaluating the program more thoroughly, but Stone said she believes the final report will show similar numbers.
Similar to Tulsa’s program, the goal is to connect callers with primary care. Most high utilizers of the emergency system need help, but not from paramedics or firefighters, Stone said. CARES aims to fill the gaps in care rather than send expensive resources to a call fire crews aren’t trained to do, and at the same time they could be missing fire or cardiac arrest calls, she said.
“Chief Baker really gets it,” Stone said. “It’s around community partnership. It’s around community planning, and for the patient’s best interest is really to have a continuum of care.
“Your fire department might be seeing a patient all the time, but their primary doctor has no clue because the system is closed. So what Chief Baker is really trying to do is connect all the dots.”
The CARE program is apart of an emerging movement within Tulsa to free up law enforcement and emergency services and utilize them efficiently.
In January 2016, the fire department assessed its needs and identified the increasing demands on personnel to provide a network to Tulsans lacking assistance in managing their health and social support challenges.
Another collaborative initiative, the Community Response Team, is a mobile mental health co-responder unit that responds to individuals who have emergent mental health needs.
The pilot program, which started in January, takes place once a week. The team includes a Tulsa Police Department officer, a TFD paramedic and a mental health professional from Family and Children’s Services.
The specialized team aims to free up law enforcement officers who would normally have to respond to these individuals, Baker said.
The team also is designed to divert people from jail, hospital emergency rooms and inpatient behavioral hospital stays.
The CRT program, also in the early stages, is running off volunteered time and personnel from partnerships. It’s seeking long-term funding.
The CARE program is also looking to get funding, Baker said. Right now, it’s spearheaded by himself and students through the academic partnership with OU, who don’t cost the department any money.
“Right now, we’re on a flat budget,” Baker said.
Baker said he would like to see the program get further established with a larger workforce. Program partners are working on figuring out how much expanding the program would cost.
The agency is also working with the city of Tulsa to further analyze success rates and identify how frequent callers affect overall department operations.
“One episode or two, that’s not a problem,” Baker said of the super users. “If we had a building that was always on fire, we would ask, ‘Why is this building always on fire?’
“But this is an individual. It’s an unmet need.”