By Gary Warth
The San Diego Union-Tribune
EL CAJON, Calif. 鈥� A program credited with reducing trips to emergency rooms and saving patients and emergency services more than $700,000 over the past 20 months is significantly expanding in East County.
El Cajon became the first city in the state to participate in the nurse navigator program when it was launched as El Cajon Community Care in 2023.
La Mesa and Lemon Grove joined last month under the name East County EMS Nurse Navigation Program, and Santee soon will join along with other areas within the Grossmont Healthcare District鈥檚 sphere of influence, including San Diego County Fire Protection District, San Miguel Consolidated Fire Protection District, Alpine Fire Protection District, Lakeside Fire Protection District, Bonita-Sunnyside Fire Protection and the service areas of the Viejas, Sycuan and Barona Indian reservations鈥� fire departments.
The expansion will see the program grow from serving about 100,000 people in El Cajon to 600,000 residents in East County, making it one of the largest communities in the nation to participate in the program.
Under the program, 911 calls are answered by the Heartland Communications Facility Authority, where dispatchers ask a series of questions to determine the seriousness of the caller鈥檚 situation.
Most calls result in a medical crew dispatched to assist the person, who then may require a trip to an emergency room. Other calls are forwarded to Texas, where they will talk with a California-licensed nurse trained to manage 911 medical calls.
The new approach can reduce the number of patients in emergency rooms, free up crews to respond to more calls, save wear and tear on fire department resources and save patients thousands of dollars in medical bills.
鈥淚t helps the transport agencies, but really the biggest help is to the caller, because they鈥檙e getting the most appropriate care,鈥� Heartland Fire & Rescue Chief Bent Koch said Wednesday at Heartland鈥檚 communications dispatch center in El Cajon, where the expansion was announced.
The expansion comes at a time when El Cajon is considering charging licensed care facilities in the city for what officials consider an excessive number of 911 calls for non-medical emergencies, despite having the nurse navigator program in place.
The program could have a bigger impact in El Cajon next year, as more calls are expected to be diverted to nurse navigators.
Paul Forney, regional director of the ambulance service American Medical Response, said just 7% of calls were diverted to nurses since the program鈥檚 launch in El Cajon, but that is expected to increase to 10% or 15% as the program reaches maturity in another year.
Paul Larimore, director of Emergency Services and Critical Care at Sharp Grossmont Hospital, said the program could provide some much-needed relief at emergency rooms. At Sharp, the number of ER patients increased by 5,000 over the past year to reach about 180,000, he said.
According to data from American Medical Response, the program generated savings of about $735,000 in El Cajon over the past 20 months by avoiding emergency care cost, including for patients, the city and responders.
Of 776 callers who were connected to a nurse navigator, 38% did not require an emergency response or visit to an ER, 31% were treated in their own home, 21% were treated with nurse advice only, 5% were treated with virtual telehealth care, 5% were treated with a visit from a mobile urgent care unit, 5% were directed to an alternative destination such as urgent care, 43% required a not-time-sensitive response from AMR and 15% required basic life support, a response without lights and sirens from emergency medical technicians rather than paramedics.
Just 30 of the 776 calls required a traditional 911 advanced life support response after the nurses determined their condition was more serious than originally appeared.
The Nurse Navigator program was launched in Washington, D.C., in 2018 by Global Medical Response, owner of American Medical Response. The program is in nine states, with new California participants planned for Contra Costa, Santa Clara, Stanislaus and Riverside counties.
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