Deployment of Alternative Response Units in a High-Volume, Urban EMS System

Faced with increasing demand for their services, Emergency Medical Services (EMS) agencies must find more efficient ways to use their limited resources. This includes moving beyond the traditional response and transport model. Alternative Response Units (ARUs) are one way to meet the prehospital medical needs of some members of the public while reducing ambulance transports. They are non-transport vehicles tasked with very specific medical missions. These can include acute management of low-acuity complaints, ongoing home care for chronic medical conditions, preventive medicine, and post-hospital discharge follow-up visits. Their focus can be tailored to the individual needs of the agency. The Philadelphia Fire Department (PFD) operates one of the busiest EMS systems in the country. It has added additional staff and ambulances in recent years yet continues to face an increasing call volume. In an effort to reduce ambulance transports, the PFD recently introduced two ARUs. The first unit, AR-1, is deployed on a university campus and responds to students with low acuity medical complaints or mild alcohol intoxication. It provides many of these a courtesy ride to one of two university emergency departments for further evaluation, eliminating the need for ambulance transport. The second unit, AR-2, works in an area heavily impacted by the opioid crisis. It responds to individuals who have overdosed, been revived with naloxone, and refuse ambulance transport but are interested in long-term treatment for their opioid use disorder. The staff of AR-2 has successfully placed some of these individuals in treatment programs the same day. The AR-1 program is financially supported by the university while AR-2 is funded by the PFD and a federal grant. Both have the potential to decrease ambulance transports or reduce 9-1-1 calls. Whether these or other ARU programs can be financially sustained long-term is unclear. It is also unknown if ARUs represent a better investment than using the money to purchase additional transport vehicles. However, as health care evolves, EMS must innovate and adapt so it can continue to meet the prehospital needs of the public in a timely and cost-effective manner.