Detroit Fire Department Is Using Data for the Greater Good
Can a major city fire department use data to drive change and improve care … in the middle of a municipal bankruptcy, to boot?
Yes, says Robert B. Dunne, MD, FACEP, FAEMS, Medical Director for the Detroit Fire Department. And he can prove it.
Detroit’s July 2013 bankruptcy filing sent shock waves across the country, but according to Dunne, bankruptcy actually created opportunities for improvement. “A lot of walls started to break down,” making change possible, he said. For starters, fire units started doing medical first response, for the first time in the city’s history. DFD also began reaching out to other cities, to learn and adopt ideas. And EMS record-keeping moved from three-part carbonless patient care reports to ePCR, using SafetyPAD® (now part of ESO). The move to SafetyPAD opened up new access to data, which Dunne said is “what really drove our changes.”
The news at the time may have been filled with reports about Detroit’s financial woes, but the city did have an advantage when it came to data: Much of its public safety data, including DFD’s clinical quality data, is managed through a partnership with Wayne State University. Plus, all of the hospitals in the city are affiliated with Wayne State as well, which, according to Dunne, makes it easier to work with them on initiatives involving data.
That data drives numerous improvement projects, several of which are described below:
Targeted Community CPR Education
“We knew that our bystander CPR rates were some of the lowest in the country,” said Dunne, and in an effort to improve bystander CPR, the improvement team took data from CARES and Detroit’s SafetyPAD system, along with Census tracts. Using ARC-GIS and GIS, they identified key areas where there were a lot of cardiac arrests, with a low chance of having bystander CPR. “These were areas we wanted to start targeting with bystander CPR training, because [no lack of bystander CPR] correlated with people — not surprisingly — not surviving,” Dunne said.
In 2014, with help from a FEMA grant and other funding, the team put out CPR training kits and trained more than 1,000 people in targeted areas through a partnership with Wayne State University’s Center for Urban Studies that helped them reach community activists. They also did door-to-door outreach after looking at 911 data, focusing on areas where, despite pre-arrival instructions, it was difficult for 911 call-takers to get people to do CPR.
The result? An increase in bystander CPR rates that will be detailed in a forthcoming peer-reviewed paper.
Specific Responses to Opioid Use
“We’ve always had an opioid crisis in Detroit,” Dunne said. “[But] once it was suburban kids who were coming to Detroit and overdosing, then it was a ‘crisis.’”
“We started using EMS data to characterize this problem. Prior to 2017 we were looking at the effect on our own agency [tracking use of naloxone]. We also had a grant to do some tracking of community naloxone programs similar to what we did with CPR and with some of the same partners.” The team is also starting to feed some cluster-related data to drug-trafficking officials at the DEA. As a result, several illegal fentanyl manufacturing operations and similar “pill mills” have been closed down.
Heat-mapping opioid cases has also been valuable. Dunne’s team tracks geographic data based on both the patient’s location and the hospital they were transported to, which aids in outreach to hospitals. And in Detroit, an older city that’s characterized by distinct neighborhoods, tracking opioid cases and naloxone administration on a neighborhood-by-neighborhood basis helps foster an understanding of the opioid crisis as it unfolds.
Community Asthma Clusters
Data showed that two geographic areas have experienced an increase in pediatric asthma calls.
“We don’t have the resources to do mobile integrated or community health…but we’re partnering with some of our public health systems to look at some of these areas [to] target better treatment, better medication compliance for some of our pediatric asthma patients.” Dunne noted that EMS data is driving this activity, adding, “We had a lot more data than any individual health system.”
Weekly Peer Reviews
Using SafetyPAD’s Case Flow function, people on the peer review program receive “pushed” info about relevant runs for review, in a HIPAA-secure space. “We also use this for routine follow-up with crews [to find out what happened to the patient],” Dunne said. The same function can be used to “ping” crews when quality issues arise, for documentation improvement or clarification, corrections for billing, or when additional training is needed.