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In the Bay Area, 911 Call Data Inspires a Firehouse Redesign

The Firehouse Clinic at Fire Station No. 7 in Hayward, California (Credit: Tiburcio Vasquez Health Center)

In the three and a half years since Garrett Contreras became Hayward, California’s fire chief, he has watched the number of health-related 911 calls grow: Nearly 85 percent are now medical, not fire-related. Call volume is increasing by about 1,000 calls a year.

“In our community [lack of] access to primary care is really the reason we’ve become the pseudo primary care provider to a large segment of our population,” says Contreras.” If we’re going to be the primary care provider we need to get [patients] into the appropriate setting, which is a clinic environment.”

To that end, the city of Hayward, which is about 18 miles south of Oakland, and Alameda County are piloting a program that co-locates health clinics with fire stations, recognizing the role that emergency medical services already play in the continuum of care.

The first Firehouse Clinic opened last month at Fire Station No. 7 in South Hayward. A collaboration among the city, Alameda County Health Care Services Agency (HCSA) and Tiburcio-Vasquez Health Center, the clinic bridges a critical gap.

“There are so many people who now qualify for health insurance … but the challenge we are facing is that eligibility on the first level does not necessarily lead to enrollment,” says Kristel Acacio, Firehouse Clinic program specialist at HCSA. “Then on the next level, enrollment doesn’t necessarily mean access to care.”

In Hayward, residents are currently served by few clinics and one hospital, after a second hospital, owned by Kaiser Permanente, recently closed. According to a report by San Francisco-based Public Architecture on access to healthcare in Alameda County, three- to four-month wait times for clinic appointments are not unusual in Hayward. Among the most common ailments bringing patients to emergency rooms: asthma, urinary tract infections, severe ear/nose/throat infections, and diabetes.

“Continuing … to respond to every incident with the same level of response is just kind of arcane and not very productive or very efficient,” says Contreras. “Everyone who calls 911 does not need an ambulance ride to a hospital.”

Because fire stations are both well distributed in communities and enjoy high levels of public trust, they can serve as portals to health in other ways.

All of Hayward’s fire personnel are trained paramedics. In the original vision for the co-located clinics, paramedics would serve as the healthcare providers. But after a “philosophical disagreement” with the California Nurse’s Association, as Contreras phrases it, Tiburcio Vasquez Health Center came on as the clinic’s operating partner instead.

“When [HCSA] approached us we were excited to engage in a project that will create more access for our clients, ”says David Vliet, CEO of Tiburcio Vasquez. In most respects, he says, Firehouse Clinics operate no differently than any other.

Ten medical personnel from Tiburcio Vasquez — including a general practitioner, nurse practitioner and dentist — staff the clinic, offering primary, preventative and integrated behavioral health care services.

During the first Firehouse Clinic’s soft launch, the facility will be open 20 hours a week. Patients are guaranteed an appointment within 72 hours of request. Eventually, the clinic will be open every weekday from 8 a.m. to 8 p.m., and will aim to provide appointments within 24 hours.

Efficiency is the key to offering such streamlined services, says Vliet. “We’re trying to really move past the model where you hire providers, fill up their schedule and no one can get in for two weeks. That’s no longer acceptable.”

Contreras says these extended hours are also vital to making healthcare accessible to working people.

“The traditional clinic environment has a bit of a stigma with long wait times and not being available when customers need it,” he says. “The patient’s time is valuable. If you make it such a burden to go see the doctor that it discourages people from making that appointment, then their medical situation gets worse and it ends up being a 911 call eventually.”

This, agree Contreras, Acacio and Vliet, is the true innovation of the firehouse clinics: leveraging two systems of healthcare provision that don’t always work well together.

Ultimately, the county is aiming for greater data integration between emergency and traditional medical services, and a blending of the unique capabilities of both. Fire departments, for example, can provide follow-up visits to patients, and even conduct home inspections for health and safety dangers. Clinicians can advise patients on insurance options, and provide coaches to steer patients toward healthy lifestyles before medical problems become emergencies.

Acacio says the dream for such an integrated system would be an ability to divert a non-emergency medical 911 call to a clinic, but she recognizes, “We’re not there yet.”

Alameda County has already seen success co-locating health centers in elementary, high schools and community colleges. From that program, Acacio says the county learned the value of integrating healthcare into trusted public sites, where staff can also help patients navigate other health resources, like insurance plans (an area in which cities across the country are getting creative.)

At Hayward’s Fire Station No. 7, the Firehouse Clinic and fire station share a plot of land, but not a building or staff. Other approaches are possible, and all partners involved in Hayward’s pilot hope that their model serves as inspiration across the U.S.

The Firehouse Clinic name, logo and concept are designed to be independent, not agency- or city-specific. Public Architecture has developed a set of building guidelines for future sites.

“Our goal [is] making this pilot a relatively easily repeatable project in our community or in any other community,” says Contreras.