For the city of Long Beach, Calif., the challenge of emergency management is clear: A small number of people are making too many 911 calls for medical assistance.
It’s a problem Long Beach and cities across the nation struggle with as a minority of callers and care facilities — also known as “911 super-users” — congest phone lines and stretch emergency resources. Financially, it's a problem for providers, governments and even the callers themselves. Yet more pressing is the impact on first responders, where a minute's delay could determine life or death.
To deal with the problem, Long Beach officials partnered with the civic tech group Code for America to create AddressIQ, a Web app that combines fire, police and business licensing data to reduce calls from 911 super-users. The tool connects addresses to both the number and type of emergency dispatches. The information enables emergency workers to collaborate on high-usage locations and assist callers through education, social outreach, or — in worst cases — enforcement measures.
Long Beach paid $180,000 to participate in the CfA 2014 Fellowship Program, which built the tool with help from developers Molly McLeod, Dan Getelman and Rhys Fureigh.
“AddressIQ is one of the many ways the city is using technology to improve efficiency and communications,” said Long Beach Mayor Robert Garcia. “And what’s especially exciting about this app is that it actually has the potential to improve health outcomes and really get the most out of every dollar of our public safety budget.”
According to city records, in 2013 the police and fire departments tallied more than 1 million inbound-and-outbound calls — 850,000 for law enforcement and 162,000 for the fire department staff, whose calls are 85 percent medical. However, 22 percent of all medical emergency calls originated from one percent of the addresses in the database, while the top 10 percent of addresses made up 52 percent of the calls.
“Part of what AddressIQ does, is it gives us a very easy way to compile information from a number of different legacy systems and gives us a much easier tool to query where our public safety resources are being utilized so we can better plan and create strategies,” said Tom Modica, assistant city manager.
Following the start of the AddressIQ initiative in November 2014, work is under way to integrate the app into daily workflows and ensure there are no gaps in compliance with the Health Insurance Portability and Accountability Act (HIPAA) for medical confidentiality.
“We’ve got to make sure we restrict medical information only to fire departments,” Modica said. “That’s a challenge that we’re working on. We need to be compliant and we will be.”
AddressIQ could help alleviate overcrowded emergency rooms and paramedics. A U.S. study by the National 911 Program, part of the National Highway Traffic Safety Administration, reported that despite a dramatic fall in 911 calls that receive busy signals — 42.4 percent in 2007 to 4.5 percent in 2012 — the rise in 911 accessibility through technology has increased usage. The study showed 70 percent of consumers dial 911 on cellphones, compared to 25 percent who use landlines. Other contributors include emergency mobile apps, VoIP and multi-line telephone systems. Of the 39 states that participated in the study, it was estimated that in 2013 there were more than 150 million 911 calls.
The impact and cost of 911 super-users can be staggering. Martha Rigsby, a Washington D.C. resident, averaged seven to 13 calls to dispatchers per month over a 30-year period and, despite having health insurance, owed more than $61,300 to the D.C. Fire and Emergency Medical Services for ambulance transportation.
Though frequent callers are one reason for high usage, McLeod said data revealed there are other sources as well.
“Sometimes it’s people with chronic health conditions or people with mental health issues, but we’ve also found — from the city of Long Beach’s data — that they’re also businesses or facilities, like senior centers,” McLeod said.
Modica said the discovery prompted the city and CfA to focus on helping low-income residents find health care.
“In a lot of those cases they are residential care facilities.” Modica said. “So the strategy adapted to identifying more of where those location are so we could implement a case-by-case solution.”
For care facilities, it might involve classes on fall prevention for seniors and those with disabilities, or increased code inspections for facility safety. The open source app could be deployed in other cities but more analysis needs to be done based on metrics and various technical requirements, according to Nicole Neditch, CfA’s Fellowship director.
“We have a couple cities that are interested in what an AddressIQ pilot would look like in their city, but it takes a little bit to sort of figure out how to launch this application for a particular city and thinking about how it would scale to others,” Neditch said.