The Proactive Services Division is one of two divisions within the Medical Response Branch under the Deputy Chief of Operations. The division is staffed by a division chief and is comprised of three main program areas:
- Medical Friendly Shelters
- Community Education
- Community Paramedicine / Mobile Integrated Healthcare
Medically Friendly Shelter Program
The Medical Friendly Shelter program was functionally established in 2011 to begin to address concerns related to special needs populations and the government’s supporting role during emergencies. These concern have been long debated issues within the City. Policy and planning assumptions have stressed the need for individuals to be aware of the challenges associated with special needs populations. The identification of support groups and the creation of a family support network are critical necessities during emergency situations. The Hurricane Katrina response was a benchmark that once again highlighted the sensitivity and lack of progress in the emergency planning area where all levels of government found themselves reviewing their response to larger scale emergencies and led the City to a planning effort to better accommodate the special needs issues associated with disaster response and realize the need and demand in the community.
Designed to only activated for a Category 2 or greater hurricane or as directed by the City Manager the MFS is for people who, during periods of evacuation or emergency, requires sheltering assistance due to physical, mental or cognitive impairment, or a sensory disability that exceeds the basic level of care provided at a general population shelter, but does not require the level of care provided at a skilled medical facility. The MFS is not for people who have significant medical problems, injuries or illnesses and/or that require total dependence on others for care. The EMS Chief is the lead for management of this program under the Emergency Support Function (ESF-8), Public Health and Medical Services capability. The Health Department and Human Services Department are critical partners in the ESF-8 and ESF-6 (Mass Care, Housing and Human Services) capabilities and the success from activation to services requires the assistance across City departments, private partners, contractors, not-for-profits and volunteers. Two sites are designated within the City to operate as a medically friendly shelter with one as an alternate. The Virginia Beach Field House is designated as the large Medically Friendly Shelter and Kellam High School is the combined general and small medical friendly shelter. Salem High School is currently listed as the alternate facility.
Community Education Program
The Community Education program was established in the fall of 2018 to bring together four main outreach programs that engage the citizens as partners for a more resilient community:
- Hands Only CPR
- Stop the Bleed
Sudden cardiac arrest and life threatening hemorrhage require immediate interventions and are a community-based issues that requires a community-based response. The survival of patients in these categories requires a community willing to assist and not just a reliance on the emergency response system.
Community Paramedic Program
EMS partners with City and community agencies to connect citizens with services and build a more resilient community. The Community Paramedicine Program (also known as Mobile Integrated Healthcare) was established in the FY18-19 budget process with City Council funding the Division Chief position over the Proactive Services position to research, develop and ultimately improve health, reduce reliance on emergency services and reduce or limit the growth of EMS calls for service.
Crisis Intervention Teams (CIT)
EMS has partnered with the Police Department and Human Services Department in the launch of the Mobile Co-Response team; a collaborative human services, medical, and law enforcement program serving the City of Virginia Beach in responding to individuals in crisis and has started the process to train its workforce in CIT principles. The next phases of this program
expected to be piloted in FY19/20 are those of developing an EMS centric CIT educational program and redirecting non-medical CIT clients from the ED and directly to behavioral health services.
The emergency vaccinator program was established in 2007 as an outcome to the Pandemic Flu plan of 2006 to assist in mass vaccinations. Since then it has developed into a proactive health preventative care program offering immunizations with select EMS and rescue squad paramedic providers that have undertaken additional annual training and practical skills verification overseen by the Virginia Department of Health and endorsed by the operational medical director.
November 2018 EMS assisted the State Office of EMS, Norfolk Department of Public Health and the Hampton Roads Medical response team by providing vaccinators for a flu vaccination clinic held in conjunction with the EMS Symposium in Norfolk. This is in addition to the ongoing partnership with the Virginia Beach Public Health Department for annual public flu vaccination clinics.
Field Medic Referral Services
Field medics many times have the unique opportunity and access to assess not only the patient but the environment and physical situation that may have led to the call for emergency services. Field providers may make a referral to the Chief Community Paramedic that will be evaluated and followed up upon. These referrals provide a real time looking glass into the community and the social and medical needs and constraints and also provide the client with communication and coordination across the care continuum. Current efforts are focused in connecting clients to City and healthcare resources and following up on those connections. Eight referrals with recorded in 2018. Additional evaluation tools are being developed and services considered with applicable resources.
Healthcare Community Engagement Partner
EMS has evolved from the public health safety net and provider of medical transportation to that of a partner and stakeholder in identifying the medical needs of the community and developing meaningful strategies in addressing those needs. The Department seeks to provide adaptable and innovative patient centric health delivery solutions in a socially equitable, safe, effective, cost efficient method and to deliver medically appropriate care to the client at the right location, at the right time and with the right resources to improve the community’s health, sustain the EMS system and contain costs. Efforts are focused on educating the health care community on the community paramedicine and mobile integrated health concepts, opportunities and benefits.
High Utilizer Client Services
The highest utilizers of EMS services place significant demand on the emergency response, healthcare and social services systems. EMS reviewed the top 10% of clients calling for medical assistance in 2017 and 2018. The top 20 clients both years generated approximately 1% of total EMS service calls.
There are many issues surrounding the frequent use of EMS. These frequent service calls to EMS have a downstream action that can obligate multiple emergency units from different agencies as well as health care and social services. EMS may be the connective link to these and other services and retrospectively, in the majority of these cases reviewed, a single EMS resource could have adequately handled the call for service.
EMS will continue to seek avenues to reduce the inappropriate use of emergency services for primary care, chronic and non-emergent conditions and divert patients from emergency department admissions to more appropriate healthcare options.
- APS / CPS referral and follow on services (does not relieve providers of their legally mandated reporting requirements)
- Bariatric patient evaluation and emergency services planning
- Fall hazard assessments – piloting with hospital readmission prevention services
- High utilization medical facilities education – addressing SNFs currently
- Hospital readmission prevention services – May pilot
- Integrated Care Management (ICM) services – integration with SVBGH
- Psychiatric Emergency Response Services (PERS) – integration with SVBGH
- Population health initiatives – integrated with public health, HSD and SVBGH
- Post-discharge in home evaluations – piloting with hospital readmission prevention services