In January 2016, the LAFD launched its first Nurse Practitioner Response Unit (NPRU), which was christened in South L.A.—taking for its home Fire Station 64 in Watts, one of the busiest and toughest EMS jurisdictions in the country. This station houses the LAFD’s Battalion 13 which has a scarcity of healthcare providers compared to other sectors of the city and contributes to many residents without access to a doctor using 9-1-1.
From 2012–2015, EMS volume in this jurisdiction increased 39%—accounting for 35% of the LAFD’s citywide growth—and the majority of this growth was for low-acuity calls. Battalion 13 also contained the largest number of housed adult frequent 9-1-1 users, and was the second-fastest-growing sector of the city for police placement of involuntary mental health holds. The NPRU was initially funded by an Innovation Grant from the City of Los Angeles, and in July 2016 was folded into the regular LAFD budget.
The NPRU is a converted ambulance with CLIA-waived point-of-care testing capabilities through use of the i-STAT System, a next-generation Sonosite iViz ultrasound and ED materials facilitating immediate treatment of patients with low-acuity medical complaints. It’s staffed on a four-day, 10-hour-per-day schedule by Terrance Ito, DNP, FNP-BC, an NP with both prehospital and L.A. County ED experience, and Aaron Guggenheim, MPH, NRP, a firefighter/paramedic with broad prehospital experience and a public health degree. Together they offer a unique skill set bringing enhanced clinical expertise, diagnostic tools and network capability directly to the patient.
The mission of the NPRU is threefold:
- Mobile urgent care offering immediate on-scene evaluation, treatment and release of low-acuity 9-1-1 callers with primary or urgent care complaints;
- Comprehensive assessment of 9-1-1 super-users, and linkage to follow-up care, including being visited by a social worker within 24 hours; and,
- On-scene medical clearance of select mental health patients, with the option of direct transport to a psychiatric urgent care facility.
All patients receive the appropriate complement of response resources based on the dispatch code; however, in addition, the NPRU may either electively buy into the incident while monitoring radio traffic or be summoned on-scene by other responding units. Frequent users can be referred at any time by LAFD field units, and after an on-scene consent and screening process by the NPRU, the individual is referred to Partners in Care—an award-winning social service organization providing close follow-up and linkage to both medical and nonmedical resources.