New Snohomish County approach to emergency response provides 911 callers with better targeted care

Everett Fire Chief Dave DeMarco describes how increasing call volumes are straining current staff and resources.

At a Tuesday morning press event, officials from Snohomish County 911 joined representatives from the County Fire Chiefs Association and County EMS  to announce the launch of a new program aimed at providing 911 callers with individually curated care targeted to their specific needs.

Called Nurse Navigation, the new approach calls for 911 dispatchers to perform a limited first-level triage by asking questions directed to determining the acuteness of the caller’s situation. While it is clear that those in acute distress – heart attack, stroke or trauma, for example – need immediate EMS response, other situations such as a sprained ankle or just not feeling well are best met with a less-intense approach.

Calls coming in to the 911 center are initially triaged by one of the 911 dispatchers, who determines if this is a life-threatening emergency requiring an immediate full response or a less acute need that might be best met with a lower-level response. In that case, the dispatcher turns the call over to a nurse navigator for further triage, who then determines the best response based on the individual situation.

While new to Snohomish County, the nurse navigation system is already operating successfully in Seattle and Vancouver, Washington.

“More than 80% of the calls we respond to are medical, and we typically send a full-response team to all incidents,” said Everett Fire Chief Dave DeMarco. “Traditionally, crews responding to 911 calls had two options — transport the patient to a hospital or let them stay at home. But as the population grows and demand for services expands along with it, it’s clear that sending a full-response team to all incidents is not sustainable. The nurse navigation system gives us a more efficient way to allocate our resources, and is a very positive step toward a sustainable 911 system.”

Snohomish County 911 Center Deputy Director Terry Peterson explains how the nurse navigation system will provide care better targeted to the patient while allowing more efficient use of EMT resources.

“Our EMTs and paramedics respond to thousands of calls and save hundreds of lives each year,” said Terry Peterson, deputy director of Snohomish County 911. “The 911 center is the lifeline for this – but over the past five years call volumes have increased by 23% and are projected to go even higher. This has put a strain on everyone involved, including local hospitals and emergency rooms.

“The nurse navigation system will get lower level calls out of the hospital emergency room system and direct them to more appropriate places,” Peterson continued. “Depending on the specifics of their situation, low-acuity callers can now be transferred to a separate call center staffed by nurse navigators who will ask additional questions to determine the best response for that patient. While this could still mean a trip to the emergency room, it could also be a referral to an urgent care clinic, bringing on a doctor to conduct a telehealth visit, referring to a dentist or another response specifically tailored to match the needs of the caller.”

Dr. Ryan Keay, medical program director for Snohomish County EMS, points out that the new program will help ensure that the right resources are provided to each 911 caller.

According to Dr. Ryan Keay, medical program director for Snohomish County EMS, the whole idea of nurse navigation is getting the right resources to meet the patient’s needs.

“We remain 100% committed to providing immediate emergency care for strokes, heart attacks, trauma and other situations that need acute intervention,” she said. “Calling 911 is the default, and we’ve trained people well to do this. But many callers have lower-level needs like simply not feeling well and not knowing what’s going on. This system provides for patient-centric care, and at the same time helps us to use our EMT resources more efficiently – keeping them available to send where they are really needed.”

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— Story and photos by Larry Vogel


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