Faced with a rising senior population and surging demand for emergency medical response, Palo Alto Fire Department officials are exploring a new service model that would emphasize education, screening and other preventive measures.

The emphasis on "prevention" is a key recommendation of a new assessment that the city has just commissioned — a report that considers the both the current and the future needs of Palo Alto and Stanford University. The report concluded that because of the city's aging population, calls for emergency medical services from the city are expected to increase by between 25 percent and 34 percent come 2030. Calls for other types of services are expected to go up between 10 percent and 16 percent over the same period.

Jennifer van Stelle, the city's consultant, alluded to the "silver tsunami" in Palo Alto and elsewhere, noting that the city's population of older residents is to go up, even as the population of the youngest group is declining. Palo Alto currently has a higher proportion of adults 65 and older (17 percent) than Santa Clara County overall (12 percent), according to the report. Because older residents tend to account for more medical calls, calls for emergency medical service are expected to go up.

"Medical emergencies are really expected to increase between now and 2030," van Stelle, a consultant with the firm Actionable Insights, told the committee Tuesday.


The traditional method to address expected increases would be to add more 24-hour ambulances, the report states. This, however, is a costly method of addressing the problem. As such, it recommends considering various forms of "community paramedicine" and "mobile integrated health care" practice approaches, which are coming into vogue elsewhere.

The report describes the "community paramedicine" and "mobile integrated health care" approach as one in which "a community has a greater access to 24/7 non-emergency health care, including health education, outreach, monitoring and prevention, brought to the patient by inter-professional teams who are integrated into and/or partnered with local or regional health care systems and under appropriate medical direction."

The approach generally entails more partnership between the city and health care providers and an emphasis on patient outcomes rather than traditional metrics like response times, according to the report.

The report points to examples including one in Fort Worth, Texas, where frequent 911 users are enrolled in a program that includes home visits and phone support (call volumes from program "graduates" were shown to drop by 61 percent in the 12 months after the program). A similar program in Colorado Springs, Colorado, led to a 50 percent reduction in call volume from two-thirds of patients in the program's first two years.

"It's essentially taking the emergency-response vehicle or field personnel and getting out into those homes and trying to prevent emergencies from occurring," Fire Chief Eric Nickel told the Policy and Services Committee during its review of the new report Tuesday.

Nickel emphasized that mobile-integrated health care is a field that only came into existence about five years ago. As such, the city will have to consider any new liabilities that it would come with. He analogized the switch to a new model to the city's experiences in 1974, when leaders were debating whether to get into the paramedic field.

"Imagine a paramedic who is also a social worker," Nickel said. "There are some liability factors we'd have to consider. ... What are the legal issues out there? There are some things that could expand the scope of the paramedic and the scope of risk."

Nickel called the new report, and the upcoming evaluation of alternative models, as an opportunity for the department to "peer over the horizon."

"I am concerned about the silver tsunami," Nickel said. "As our citizens age in place, we do know from our data that they use our services and we want to be prepared for that.

"We are all about trying to reduce community crises and preventing emergencies from occurring."

The council committee voted unanimously to accept the report and lauded the department's forward-thinking approach, which Councilman Cory Wolbach said puts the city "ahead of the curve." Councilman Tom DuBois suggested that another way to aid the department's effort to prevent emergencies is the creation of a "dedicated senior shuttle" that would go to health care facilities.

"It may be a community shuttle but in the middle of the day, it can be used for other things," DuBois said.