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Monday, December 6, 2021

Nurses ease pressure on San Bernardino County’s 911 system

A woman in Apple Valley called 911 because she ran out of blood pressure medication. A nurse referred him to a nearby medical clinic.

The wife of an 84-year-old man called 911 because she didn’t know if he took insulin. Enduring the couple’s estrangement, a nurse arranged a telehealth visit.

And the mother of a 12-year-old boy who fell asleep on his neck also called 911, a nurse also consulted.

Since last December, San Bernardino County’s emergency communications nurse system has taken the pressure off 911, allowing first responders to help those in more need.

Sarah Morning, a nurse in the San Bernardino County Fire Protection District, works the emergency communications nurse system at the Rialto Confidence Dispatch Center, pictured in the background is Sarah Kestner taking a convoy call. (Courtesy of Art Andres, Director of Confire)
Nurses ease pressure on San Bernardino County's 911 system
Kirsten Mendoza works at Confire’s Rialto Dispatch Center. (Courtesy Art Andres, Director of Confire)

“We’ve done a great job in teaching people to call 911 for emergencies,” said Art Andres, the director of Confire, who oversees the program. “But there is overuse of the 911 system.”

Confire, an acronym for Consolidated Fire Agencies, is an emergency dispatch company that covers approximately 80 percent of San Bernardino County emergency calls. Large cities such as Ontario, Yucaipa and Barstow manage their own emergency dispatches.

The program is the first of its kind in California, Andres said.

Each call is evaluated: an “alpha” is a low-level concern, such as a stubby toe. “Echo” is for bigger problems like a heart attack.

Registered nurses working in the local fire department are transferred to Alpha.

They ask questions and connect the caller with immediate care, their primary healthcare provider, or perhaps even care at home. Or they give advice. About 20 percent of Confire calls are alpha.

Figuring out how to release pressure on the 911 program had been in the works since 2017, said Monique Reza-Arellano, program manager for San Bernardino County’s Council of Government, who helped set up the new system.

“(Andres) contacted my boss, and they wanted help getting the project they were trying to get in front of policymakers,” Reza Arellano said. “We were able to secure a budget and put in place a plan.”

Initially, Confire considered a variety of models across the country, said Leslie Parham, a nurse in the Chino Valley Fire District. The nursing model sparked interest.

“We wanted to provide concierge-level services while trying to get the patient to the right place the first time, rather than having someone go to the emergency department unnecessarily,” Param said.

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Fast forward to 2020 – the COVID-19 pandemic took hold and an increased sense of urgency to implement the system was felt by those involved: city managers, fire department labor groups, public and private Ambulance providers and hospitals.

Confire initially received $600,000 from the CARES Act for part-time staffing with nurses within the San Bernardino County EMS network.

Local nurses work for six hours of their normal workday at the Rialto Center in Confire during peak hours, while handling their daily duties of managing emergency medical services for their respective agencies, Param said.

When local nurses aren’t taking calls, under a contract with Confire, a private nonprofit in Reno, Nevada, provides round-the-clock coverage of the program.

San Bernardino County Fire Department spokesman Eric Sherwin called the new nurse system a “powerful addition” to the county’s emergency medical service’s response system.

Sometimes, a nurse determines that an alpha-level call is actually more serious — perhaps the caller’s condition has worsened, Parham said. Those calls are transferred back to a dispatcher.

Finally, the dispatch center can’t deny requests from emergency services — first responders roll in if someone requests help of any kind, Andres said.

Now, for the nurses program, supporters are trying to secure funding for the future.

“We want to have 24/7 full-time nurses in our own dispatch center, and (we) will need to expand our staff and need money to do so,” Param said.

Andres said the staff nurse program as a whole would cost $2.1 million a year.

Andres said the funds allocated through the CARES Act would expire at the end of December. Andres hopes to obtain funding to expand the program and fully staff it through a US rescue plan, but that remains up in the air, Andres said.

In addition, Reza-Arellano said, the county is “begging” for additional funding and is looking at potential sources either through the county or through health caregivers to reduce costs and use of their ambulances.

“The (program’s) goal was to address overuse of the 911 system, so it’s successful from that point of view,” Reza-Arellano said. “But it’s a part-time program and it could have been more successful if it were a full-time program.”

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