The Baltimore City Fire Department is making some progress on a variety of efforts to dig out from under the burdens of abnormally high call volumes, a staffing crunch and public health challenges such as the opioid epidemic.
In a series of updates given to City Council’s public safety committee Wednesday, fire department leaders pointed to signs of slight improvement, particularly around restoring the depleted vehicle fleet and the ongoing challenge of long wait times that medics routinely face when dropping patients off at area hospitals.
But, overall, the department continues to face major challenges. The 911 call volume for the city is among the highest, if not the highest, per-capita rates in the country, with many calls for nonemergency medical situations that reflect the city’s broader health care challenges.
Medic shortages make it difficult for the fire department to staff its ambulances, and response times are slower than the national average. Part of that could be because of the city’s 911 call center, which sometimes takes several minutes to pick up and direct calls, a problem attributed to low staffing and the overwhelming call volume.
The goal is for calls to be answered within 15 seconds, but the 911 call center has not been in compliance with that goal for much of the summer, according to the call center’s director, Tenea Reddick.
“Right now we’re not in compliance, and I have no problem saying that because it means we need help,” Reddick said Wednesday, responding to questions from Councilwoman Phylicia Porter.
Ambulance response times can be particularly dangerous for conditions such as cardiac arrest, when every minute of delay could mean life or death.
Still, Dr. Jeffrey Nusbaum, an emergency physician at the University of Maryland Medical Center and assistant medical director at the fire department, said the clinical metrics remain “fairly steady to mainly positive.”
“We get there a little bit slower, but once we get there the work we do is quite good,” Nusbaum said.
One clinical metric that makes the city an outlier in Maryland is the rate of “bystander CPR,” or when people near someone who is experiencing a medical emergency perform CPR at the direction of 911 call takers. The city rate is about half that of neighboring counties such as Prince George’s and Howard County, about 21% compared to about 40% in other places, according to data presented to City Council.
Much of the efforts undertaken by the fire department center on the concept of “population health,” a philosophy that focuses medical interventions on large groups of people connected by a shared issue, as opposed to treating each case individually.
Along those lines, the department is working on diverting calls spurred by mental health issues that don’t qualify as medical emergencies. The department is also looking into different ways to respond to the ongoing opioid crisis. Overdoses are responsible for a good chunk of the medical calls for first responders.
Some City Council members, however, observed that many of the efforts by the city to respond to mental health and behavioral crises remain piecemeal and disconnected.
To that end, Councilman Mark Conway, who chairs the public safety committee, said he will consider calling representatives of Baltimore Crisis Response Inc. to the next quarterly fire department hearing. The nonprofit crisis center is the tip of the spear for many of the city’s efforts around mental health services.
Since July 2021, the fire department has credited the crisis center’s attempts to divert calls with saving 20,314 minutes of time for medics and firefighters. But there were still some 4,849 mental health incidents that drew a fire department response in that time. Of those, medics transported people to the hospital 2,125 times.
Nusbaum said the department is working with a state agency regulating ambulances to allow its members to use an iPad to link a patient to a physician in real time in the field, which would help avoid the transports by accomplishing things such as prescription refills without involving a hospital.
He said they are looking to “streamline” the processes by which the department responds to mental health calls.
Councilman Zeke Cohen observed that many of the ways the city responds to mental health crises feel “disconnected,” particularly around the crisis center.
“We fought in the previous budget cycle to fund them, but it’s still woefully underfunded,” Cohen said. “And sometimes it feels like we’re just piecemealing stuff together.”
Conway urged the department to collaborate more with area hospitals on the 100-200 people who are considered “frequent flyers,” those who frequently ride in ambulances due to a lack of health care access, mental health needs and other issues.
Deputy Chief James Matz, who oversees EMS for the department, said his team is pursuing those people but cautioned that their cases are complex and not easily resolved.
Nusbaum added another note of caution, citing his work in the emergency department of a West Baltimore hospital, where he sees people every day who have visited the emergency room more than 100 times.
“These patients are very complicated with complex psychosocial needs,” he said. “The first step is to get them to admit they need care. With the big super users, until they’re ready, we can’t really help.”