Apr. 22—For years, most of the Santa Fe Fire Department's work has not been fighting fires but delivering emergency medical services. It's finally working on a long-awaited reorganization to better reflect that.
When Fire Chief Paul Babcock took over the department in the fall, he made it a priority to create a new EMS division alongside the operations and support services divisions. He is in budget discussions to fill out staffing to oversee emergency response, training and data management, as well as outreach and diversion services to some of the city's most vulnerable residents.
The division's head, Assistant Chief Greg Cliburn, started with the department as a firefighter/EMT in 1998, and became the medical officer in 2014.
"Our call volume has gone up. The health-care system locally has become richer and more complex," Cliburn said. "I'm excited. I've advocated for this pretty much throughout my time as the medical officer."
Cliburn says the number of calls for service has risen from about 8,000 a year two decades ago to about 16,000 a year now. About three-quarters of those calls are for emergency medical services, including vehicle crashes, falls, heart attacks, behavioral health issues and drug or alcohol overdoses, he said. A much smaller proportion of calls are for structure fires.
The Santa Fe Fire Department has about 160 uniformed firefighters, including command staff, all of whom are required to have some form of EMT certification. Each of the five fire stations throughout the city has one or two ambulances and is staffed by at least one paramedic and one firefighter/EMT at all times.
When Cliburn began at the department, there were four fire stations and four ambulances total.
The department's Mobile Integrated Health Office (MIHO) also falls under the EMS division, and the importance of its work also contributed to the reorganization, Cliburn said. Staffed by a battalion chief, paramedics, an EMT and a contract social worker, the office provides case management for frequent 911 users to connect them with behavioral health services or shelters, and tasks as varied as help getting prescriptions filled, signing up for Medicaid, or getting veterans benefits.
"All sorts of things that can help address their real needs in a more direct way, rather than having them go through a cycle of calling 911, getting out an ambulance, generating an ambulance bill, going to the ER, generating an ER bill, [or] maybe because they were intoxicated, wind up going to jail, spend time in jail, then get turfed back out to the street where they call 911 again," Cliburn said. "And it's this cycle that they're sort of stuck in and don't really have a good way out."
MIHO also does followups with opiate overdose survivors to offer harm reduction training, distribute anti-overdose medication and connect them with treatment services. And it has recently taken over the city's Law Enforcement Assisted Diversion (LEAD) program, which aims to stem the cycle of arrest and incarceration by referring low-level offenders who are receptive to receiving addiction, mental health or homelessness services in lieu of jail.
"It's doing good work," Cliburn said of MIHO.
The evolution of Santa Fe's health care system—which has grown from one hospital and one emergency room to two hospitals and three emergency rooms as of last year—is another factor calling for a separate EMS division within the department, Cliburn said.
The proposed EMS division would have the assistant chief overseeing a medical officer and two EMS captains, the MIHO unit and two LEAD staff, and administrative staff.
Babcock told the city's Public Safety Committee on Tuesday that the reorganization would work with existing positions and not result in an increase in its budget. Budget proposals are expected to be finalized in late May.
The department is also looking to join a federal Medicaid program to secure money to help reimburse the fire department for unpaid ambulance transport fees. The department also needs staff in its EMS division to administer that program and help "spearhead" that effort for other emergency medical services agencies in New Mexico, according to Cliburn.
The department also hopes to join a national "emergency triage, treat and transport" pilot program run by Medicare that would study how EMS agencies can better serve Medicare enrollees when they have called an ambulance but it is then determined that they don't need to go to an emergency room. The fire department would arrive, assess the patient, consult with a medical practitioner and decide whether to take them to urgent care, their primary care physician or nowhere.
The program would allow the ambulance company to recover the cost of that service from Medicare. Currently the fire department is only paid by Medicare if it transports someone to the emergency room, according to Cliburn.
"There's just so much that we can do, around quality, around improving our services, around doing better cost recovery, and more," Cliburn said. "Keeping us clinically up to date. Just delivering better services in a smarter way."