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The Changing Face of the First Responder: Emergency Services and Proactive Paramedicine

Author: Steven Orusa, Chief, Fishers Fire and Emergency Services

Copyright: Copyright 9-1-1 Magazine, Feature Content

Date: 2017-06-12
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Improvements in fire safety have caused a significant decline in the number of fires in the United States, making the job description for the modern firefighter much different than it was 30 years ago. The Fishers Fire Department of Indiana has taken this shift in stride, renaming themselves Fishers Emergency Services.  The WeCare community paramedicine program is one way Fishers is redefining the modern fire department. Often, patients who call 9-1-1 with health issues like hypertension and heart failure will likely need emergency services again. If these patients are readmitted, the federal government penalizes the hospital. To remedy this issue, Fishers firefighters will visit patients who are at risk for rehospitalization and help manage medications and doctor's appointments. 

According to the National Fire Protection Association, recent improvements in fire safety have caused a significant drop in the number of fires in the United States. Some of those improvements include new mandated fire suppression systems, extinguishers and smoke detectors, fire-resistant building construction materials and fire-retardant fabrics.

Since 1980, the total number of fires in the United States dropped from 2,988,000 to 1,345,500, a decrease of nearly 55 percent. With significantly fewer fires to fight, firefighters have had to evolve, taking on more responsibility and additional job-related tasks than ever before. Thus, the role of the firefighter modern firefighter looks much different today than it did 30 years ago.

Fishers, Indiana, named one of the best places to live by Money magazine, is a fast-growing suburb just north of Indianapolis. Our firefighters have taken a unique approach to redefining their job description to address the variety of situations to which they respond. In 2012, the Fishers Fire Department officially changed our name to Fishers Fire & Emergency Services, the first step in a rebrand that focuses on holistic emergency services and paramedicine, not just firefighting. As the first responders for water rescues, hazardous materials, gas leaks and medical emergencies, the new label encompasses our ever-evolving function in serving the Fishers community.

A new program implemented by the Fishers Fire & Emergency Services department further depicts our commitment to bettering the community beyond traditional firehouse services. Called WeCare, the hospital-partnered program leverages our staff of trained paramedics to assist in reducing hospital readmission rates through community education, home visits and hospital discharge referrals.


What is the WeCare program?

The goal of our WeCare program is to improve health and wellness in our city by proactively addressing the healthcare needs of our citizens, enhancing community access to social services and offsetting some of the financial challenges associated with healthcare reform. With the creation of the WeCare program, the Fishers Fire & Emergency Services department can act as a safety net for those most at risk of readmission within the community. There are three main pillars to WeCare: the hospital discharge referral program, increased awareness and community education, and consistent, helpful home visits.


#1: Hospital discharging referral program

Because of the Affordable Care Act (ACA), hospitals do not receive reimbursement for any patient who is readmitted within 30 days of discharge. “Section 3025 of the Affordable Care Act added section 1886(q) to the Social Security Act establishing the Hospital Readmissions Reduction Program, which requires CMS to reduce payments to IPPS hospitals with excess readmissions, effective for discharges beginning on October 1, 2012,” as noted by the Centers for Medicare & Medicaid Services.

This incentivizes hospitals and communities that take a proactive approach to providing patient care, to minimize the chance of any patient’s condition deteriorating once they are home. The goal of the program is to reduce the number of cardiac patients readmitted to participating hospitals following their initial stay. To achieve this, members of the Fishers emergency services team visit all high-risk patients within 24-72 hours of being discharged from the hospital. Together, the patient and the paramedic identify and resolve issues that, if left untreated, might lead to another hospital stay. The program is growing quickly, and currently includes two hospitals Indianapolis area hospitals.


#2: Increased awareness through community education

A vital piece of our WeCare program is the community education and awareness component, the goal of which is to increase awareness of undiagnosed conditions, including hypertension and diabetes. To help our community learn about these conditions, Fishers Fire and Emergency Services offers residents the opportunity to stop by any Fishers Fire station to obtain a free blood pressure check. Additionally,

these residents will receive a free card for tracking blood pressure readings that may be shared with their physician. Firefighter paramedics can provide education and awareness to citizens who may not know all the issues that could come with undiagnosed blood pressure-related health problems.


#3: Home visits

Studies prove that home visits, particularly in connection with congestive heart failure and cardiac surgery, are a powerful tool in reducing readmission to the hospital. In fact, a recent survey by The Society of Thoracic Surgeons showed patients who received home visits following hospital discharge had a significantly lower rate of readmission when compared with those who did not. In the 30 days following cardiac surgery, the study showed a 41% reduction in the rate of readmission when home visits were implemented. Following that methodology, the WeCare home visit program is designed to proactively reduce readmission.

Fall Prevention

Injuries resulting from in-home falls are the second most common cause of EMS responses that lead to hospitalization (motor vehicle accidents are the first). 63 percent of those injured by an in-home fall are more than 60 years of age. In those patients, hospitalization occurs 81 percent of the time. According to the National Council on Aging, “falls are the leading cause of fatal and non-fatal injuries for older Americans. They threaten seniors’ safety and independence and generate enormous economic and personal costs.”

To reduce the risks associated with tripping hazards, our team conducts regular in-home safety audits, as well as medication reconciliations. WeCare Fishers firefighter/paramedics will follow up with a phone call to all patients who have been the result of a fall at home, and offer to provide a safety audit to help identify potential fall hazards. Our goal is to reduce the number of fall-related injuries that result in hospitalization by 15%.


Social Service Referral

In 2009, there were approximately 36,700,000 EMS responses in the United States. Those responses resulted in more than 28 million transports in the same year, according to the National Association of State EMS Officials. In Fishers, we respond to more than 3,800 EMS incidents annually. On these calls, our firefighters often observe conditions and situations that could benefit from assistance from social service agencies. In the past 5 years, Fishers has noticed an increase in the number of citizens in need of these services.

Through a new partnership with the Central Indiana Council on Aging (CICOA), Central Indiana United Way’s 2-1-1, and area hospitals, we are increasing awareness of the WeCare program through an advanced information network. Patients identified by 9-1-1 response crews as needing services, can also be referred to the program from the scene by submission of a digital notification form that immediately notifies the program coordinator.  The EMS Division will contact individuals who request information on the availability of services for their needs, as well as those that are identified as “at risk.” Following a phone interview and home visit, we can better identify exactly what type and level of assistance will be required and coordinate the needed resources to assist our citizens in need.


Frequent System Use

Due to unfamiliarity with the health system, many individuals in the Fishers community continue to dial 9-1-1 in effort to learn which health services are available in non-emergency scenarios, or even just to gain the non-emergency dial-in information. Many times, these individuals and their family members are not familiar with the services that are available to meet their medical or social needs.

To identify those individuals, the Fishers Fire & Emergency Services reviewed call data and segregated those residents that dialed 9-1-1 three times or more in a 30-day period. From there, a paramedic/firefighter can contact them to assist them in identifying what their needs are, and help them find the proper resources.



According to the CDC, the administration of a flu vaccine reduces the risk of flu illness by about 50% to 60% among the overall population during seasons when most circulating flu viruses are active. In order to ensure the safety of our at risk and elderly population, the Fishers Fire & Emergency Services department is creating an initiative to offer free vaccinations to all city employees and at risk elderly population for flu, and identified vaccines in case of a pandemic, as part of the WeCare program.


Measurable results

As a department, the objective of Fishers Fire & Emergency Services is to maintain a high level of care for all patients and residents. We achieve this by utilizing technology in conjunction with evidence-based medicine, and measure results by collecting patient feedback and readmission statistics.

Since the WeCare program launched in 2014, we are pleased to report that readmission rates to participating local hospitals have decreased from 22 percent to 7 percent. This has directly led to lower healthcare costs and a healthier Fishers community. It is our hope that cities nationwide will leverage their existing fire departments to adopt similar programs, proactively saving lives and impacting community wellbeing for the better.


Steve Orusa has served as the Fire Chief for the Fishers Department of Fire and Emergency Services since 2011. His day is spent supporting our men and women in harm’s way with leadership and resources to safely, effectively, and efficiently serve our community. This includes setting the vision and ensuring we are value driven and mission focused. Maintaining a culture where change remains an institutional value and that change agents are our leaders of tomorrow. In this way we increase our value proposition to our community by continuing to develop and improve our ability to serve with the highest degree of integrity, honesty, professionalism, and accountability. For more informastion on the department, see:

Photos via Fishers Department of Fire and Emergency Service



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