Rising calls for 911 service ‘epidemic’ for fire departments

DeKALB – The DeKalb Fire Department responded to more calls for service in 2019 than ever before in its 150-year history, and it seems the record-breaking numbers are because of a growing phenomenon: people using 911 in lieu of traditional health care providers.

“It’s an epidemic,” Chief Jeff McMaster said on Wednesday. “We’re the one constant. 911 is always going to be there.”

According to the department’s unaudited numbers, DeKalb firefighters responded to 6,700 emergency calls for service in 2019, marking a 20% increase over the past three years. Most of those calls aren’t for fires, however, McMaster said.

Emergency medical service calls have risen 23% in the past two years, McMaster said. They make up the majority of time DeKalb firefighters spend during shifts, and range from helping someone reach the remote and getting off the toilet to more serious matters, such as when a patient stops breathing.

In 2019, McMaster said one household in DeKalb called 911 to request EMS 40 times for basic needs such as helping them out of bed. In the past two weeks, that same caller has called 10 more times to begin 2020. Only one of those calls actually has resulted in that person being taken by ambulance to the hospital.

Much goes into a decision to call 911 for service, regardless of level of crisis.

McMaster said his department has observed people calling for a variety of reasons: lack of job and health insurance, lack of knowledge in understanding there are clinics or other health services available to them, family politics or domestic violence situations, senior citizens not wishing to give up their independence.

Is it an abuse of the 911 system? Or is it the rising cost of health care, lack of access or transportation to medical facilities, people not knowing how much an ambulance ride costs?

“I think it’s all of the above,” McMaster said. “We’re finding that people don’t have primary health doctors anymore. People call 911 out of fear. We have seen a dramatic increase in helping people with mobility issues, the disabled and senior citizens. They don’t want to leave their homes.”

Joe Long, a paramedic who has been with the DeKalb Fire Department for seven years, responded to two calls Wednesday morning: one for a domestic violence incident involving a broken nose, and another for someone at a gym with a dislocated finger.

“Just last week, we went to the same place within an hour and a half of each call,” Long said at Fire Station 1, 700 Pine St., standing in the back of Ambulance No. 1. “It takes us out of service.”

Long’s assigned as an ambulance paramedic, and often is ready and out of the fire station within two minutes of a call. His goal is to reach a patient within four to six minutes, because if a patient isn’t breathing, a brain without oxygen begins showing signs of damage within that window.

The increase in EMS calls has other implications, too. In 2017, revenue from fees collected from residents using DeKalb Fire Department ambulances brought in $1.2 million. In 2019, that number rose to $2.2 million, according to the fiscal 2020 city budget.

McMaster said the numbers are inconsequential compared with the department’s $11.4 million budget. The fire department isn’t here to make money, it’s here to help people, McMaster said.

It costs $1,800 to take an ambulance to the hospital, whether you’ve stopped breathing or you’ve got a paper cut. If the patient chooses to be transported, the rate is a flat $1,800, based on industry standards, unless they sign a service refusal waiver on the scene. About 25% of EMS calls end in refusals, McMaster said.

It's been a year since the DeKalb Fire Department began implementing a new fee structure for its ambulances, budget documents show. On Jan. 1, 2019, ambulance costs went from an a la carte type payment structure – where patients were charged based on what medications and other services were administered to them – to the flat rate.

Patients aren’t expected to pay right away. Some can work with their insurance provider to determine what is covered or set up a payment plan with the department’s billing services contractor, Andres Billing Services.

McMaster said when he worked on an ambulance 20 years ago in the DeKalb department, demographics weren’t what they now are in the city. He said reductions in state and federal funding for mental health services means more mental health and behavioral issue calls are going out.

“We went from being a middle- to upper-income community with a large college population,” McMaster said. “Now we’re a low- to middle-income demographic, and our college student population has decreased. The needs have changed.”