From left are Firefighter/Paramedic Kendall Weld, Mobile Integrated Health Advanced Provider Kaleigh Byrnes PA-C, and Battalion Chief Scott Perryman, PA. Perryman is at the forefront of the Mobile Integrated Health movement. Photo courtesy of the Sacramento Metropolitan Fire District

MATHER, CA (MPG) - In 2010, Scott Perryman was a firefighter/paramedic for Sacramento Metropolitan Fire District and was also in physician assistant school. With the swine flu pandemic of 2009-2010, he said, the medical system needed changes. By 2014, working with representatives from Cosumnes Fire, Sacramento City Fire, Metro Fire, and each of the health systems, the launch of Mobile Integrated Health seemed closer but progress was slow.

When COVID-19 hit in 2020, “There was a nursing home, their whole second floor was all COVID positive,” said Perryman. “They called County Health and said, we’re going to send these people, and there were over 10, to the emergency room unless you can do something for us. That would have been 10 ambulances, that would have been 10 isolation rooms. There wasn’t the real capacity.”

Sacramento County Public Health Officer Olivia Kasirye, M.D., was aware of Mobile Integrated Health and called up the Sac Metro Fire Chief. Within one to two weeks, Mobile Integrated Health was happening.

“We already had the framework; we just needed the red tape to be removed . . .” Perryman said. “We did thousands, tens of thousands of COVID tests in the most vulnerable of the population.” 

Sacramento Metropolitan Fire was quickly joined by Cosumnes Fire and Sacramento City Fire to address the problems.  

During the last 20 years in Sacramento County, there has been a 67% increase in 9-1-1 calls and only a 9% increase in population size. Many 9-1-1 calls are for minor issues because patients cannot get an appointment with their primary physician or could not make the trip to an urgent care within their range.

The increase in 9-1-1 calls has often resulted in emergency room ambulance/patient offload delay. Ambulances and personnel can be tied up for hours waiting for a bed to open, unable to respond to other emergency calls. Mobile Integrated Health takes evaluation and treatment to the patient, when appropriate, instead of taking the patient to the emergency room.

High utilizers of 9-1-1 might only need a lift assist after falling at home but repeated falls can eventually result in injury. Perryman, now battalion chief, tells of an individual who had called 9-1-1 10 times in one month. He was not injured but needed a lift assist because he couldn’t get up.

“We found out he falls during this time of day and this time of night,” Perryman said. “We just provided him with a bedside urinal, so all he had to do was just roll to the side, and not at 3 in the morning fall out of bed because he can’t find his glasses and it’s dark because he turned off the light and he trips over the rug that he will not get rid of because it’s his favorite rug.”

Virginia Wilson of Antelope was a repeat caller. She lived with her son in a second-floor apartment with no elevator.

“I’m in a wheelchair and I was on the second floor and I had to call (9-1-1) to come and get me and carry me down the stairs,” Wilson said. “The little bus, paratransit, came and got me and took me to the doctor . . . Then I had to call when I came home and (the responders) had to put me back up the stairs.” 

Her son has multiple sclerosis and is also in a wheelchair. Metro Fire and congressional candidate Christine Bish worked with Wilson and apartment management to help her get a first-floor apartment.

Elizabeth Rhose of North Highlands presented with another type of 9-1-1 call. She recently tried to intervene when she saw two dogs fighting and had an injury to her arm. Metro Fire responded to her 9-1-1 call and called the Mobile Integrated Health team.

“MIH just came in my apartment,” Rhose said. “I didn’t have to sit for six hours in the waiting room, waiting to be stitched up, in constant pain . . . They were done within an hour or two and they just left. They even ordered my medication for me and had it delivered.” 

Challenges in the 9-1-1 system include an increase in opioid overdoses and calls for behavioral health issues. With Mobile Integrated Health, quick delivery of Narcan directly to the patient can save lives. Behavioral health patients can get to the correct place the first time, not preceded by a long emergency room wait.

“Last year (the pilot program) saved the system over $2.4 million,” Perryman said. “We’re bringing the care to them, in their own environment, and we can do it for over 50% savings.”