Expanding the LAFD Advanced Practitioner Unit
Posted by Councilmember Englander on October 13, 2017 at 1:50 PM
This week, due to the overwhelming success of the Nurse Practitioner Response Unit (NPRU) Pilot Program, initiated by my February motion, Council unanimously approved the Advanced Provider Response Unit (APRU) for the Los Angeles Fire Department (LAFD).
The APRU is a safe, effective, and innovative model to intervene with patients earlier in their course of emergency care, prevent unnecessary Emergency Department visits, provide transport to alternative destinations, and refocus prehospital encounters to identify unmet needs and link patients to primary and preventative care. The Emergency Medical Services (EMS) Advanced Provider’s broader scope of practice opens the door to more advanced out-of-hospital care delivery, including immediate treatment and release, medical clearance, and patient navigation to non-emergent medical and non-medical services.
Advanced Providers have a broader scope of practice, can function autonomously, have training in health promotion and recognizing social determinants of health, and can treat/release patients on scene. The APRU’s specific missions include:
- Mobile urgent care: The APRU augments standard deployment of 911-resources to patients with low-acuity conditions, offering on-scene evaluation, testing, medication, immediate care and referral for follow-up
- Comprehensive assessment of EMS super users: The APRU proactively engages EMS super users, offers a needs assessment and refers patients to Partners in Care - a non profit organization that specializes in linkage to care
- Medical clearance of select mental health patients: Patients with primary mental health complaints who meet certain criteria are medically cleared by the EMS Advanced Provider on scene, and then transported directly to a psychiatric urgent care
- Medical clearance of select inebriated patients: Patients who are publically inebriated, particularly the serial inebriates, who meet specific clinical criteria will be medically cleared by the EMS Advanced Provider on scene, and then transported directly to the DHS Sobering Center
Public-private partnerships funding additional APRUs would leverage the resources of community health partners and payers with the expertise and community presence of the LAFD in order to help patients get the right care at the right time at the right location. Kaiser Permanente has provided a donation of $200,000 to the Fire Foundation for this purpose.
Partnering with healthcare organizations, who already have the infrastructure and relationships established within each neighborhood will allow the LAFD to leverage its prehospital infrastructure together with existing local resources to help get patients the care they need. Healthcare organizations, like Kaiser and Dignity Health, would provide the Fire Department with funding for an LAFD-employed EMS Advanced Provider, while LAFD would provide the specialized ambulance, paramedic, and medical oversight.
Both public and private entities would work together to create mechanisms of referral for APRU patients that would be unique to that specific community.
With nearly 350,000 EMS calls coming into LAFD each year and the number of emergency room beds failing to keep pace, this advanced practitioner program provides a service for those who need on-site treatment and assessment. The APRU is an efficient coordinated response to address both superusers and individuals with minor health care needs making it possible to reduce unnecessary and expensive emergency transport.
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