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Innovating Emergency Medical Response: The View From Reno And Portland


All over the country, government agencies are having to look at ways to do more with less.

Portland Fire Chief Mike Myers has been on the job for about 10 months. He recently told “Think Out Loud” host Dave Miller that the Portland emergency response system is great, but there are inefficiencies.

Mike Myers, Portland Fire Chief

Mike Myers, Portland Fire Chief

Portland Fire & Rescue

“I think what may be news to people is we get about 80,000 calls for service a year, and not all of them are emergencies,” Myers said.

But what to do about those non-emergency calls? You can’t deny help to people when they call 911. Myers said he’d like to find ways to get immediate care to those who really need it, but hold back emergency medical care resources when they’re not actually needed. He says responders in Reno, Nevada, among other cities, have begun to do just that.

We called up Dr. Brad Lee, a physician himself and the director of Reno’s Regional Emergency Medical Services Authority, to find out more about how his department has been handling this issue. Lee said the agency got a $10 million grant about five years ago to implement three different medical response innovations.

Innovation 1

“We had community paramedics who picked up patients after they were discharged from the hospital with certain conditions, and they would go visit them with the intent of them not going back to the hospital within 30 days.”

Innovation 2

“Our ambulance service was allowed to take patients directly to places other than emergency departments — with patient consent — to urgent care, to a detox facility, to a mental health facility.”

Innovation 3

“We were able to create a nurse health line which triages patients to the most appropriate level of care,” Lee said.

Lee said over time people learned a separate 7-digit number and called that directly or they were routed, with their permission, from a 911 call.

He says the department anticipated about 2,400 calls in a year. Instead, he says, they’re getting about 2,000 calls a month.

“We did television commercials, and we did advertising, marketing and that number became much more well-known, and if you googled ‘nurse health line,’ we came up number one. In fact, that particular number was so popular, we were getting calls from out of state. …  It was dismaying when we were getting calls from Hawaii and L.A., and you know, we had to explain to them that we were only allowed to provide the service for our local area.”

Myers said he thinks Portland is ready to make changes so that residents can get the right help for the right problem. Emergency responders are spread too thin, he said.

“People call us sometimes simply because they’ve fallen out of bed. Sometimes they’re lonely; other times they have medical issues that you know, you and I wouldn’t think were an emergency, but they don’t know where else to turn. … It can be anything from ankle sprains, to stomachaches, to their back hurts or whatever. Oftentimes it is loneliness, mental health issues,” Myers said.

But Lee cautions Portland — or any city, for that matter — will find changes won’t necessarily come easily.

“They will run into barriers at all levels. Not only the establishment of the EMS system but the patients as well because a lot of times that we sent an ambulance …  the patient just wanted an ambulance,” Lee said.

Myers said he’s committed to identifying and seeing changes implemented, even if, as he anticipates, the process will take years.

“I think everybody agrees that it’s time. It’s time for a change,” Myers said. “If we don’t do it today, we’ll be having this interview again in five years and discussing why haven’t we changed. … We’ve been putting everybody in one box and giving them one solution. That’s inefficient.”

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