By Anne Snabes
The Detroit News
DETROIT 鈥� The call came shortly after lunch earlier this month to one of Detroit鈥檚 dozens of EMS crews who work the city each day responding to emergencies: A patient was dizzy and needed an ambulance.
In less than seven minutes, paramedic Curtis Lowe and Emergency Medical Technicians Royce Mentor III and Bicari Stanley with the Detroit Fire Department arrived at a nursing home in Detroit鈥檚 Poletown East neighborhood. A resident, a senior who鈥檇 been feeling lightheaded, was given a blood sugar test and then transported to Detroit Receiving Hospital.
A decade after Detroit was sharply criticized for having the worst response times to emergencies in the nation, the situation is different. Firefighters cross-trained as medical first responders, along with an infusion of more ambulances, have allowed the fire department to slash its response times to Code 1 emergencies, or those considered life-threatening, nearly in half since 2014.
Now, the fire department is gearing up a 鈥渘urse navigation鈥� program to launch later this year that city officials hope will further reduce response times by enlisting nurses to speak with patients experiencing minor medical issues.
Instead of city EMS crews responding to many Code 3 runs, such as a sprained ankle or knee pain, a third-party vendor would handle those calls. A nurse would call the patient or their family member, talk with them and coordinate transport to the hospital if needed.
The nurse could also help the patient set up medical appointments and do follow-up calls. The city is in the process of hiring a vendor for the $650,000 program.
鈥淲hat that would do is actually free up our ambulances from going to these Code 3 medical calls,鈥� said Detroit Executive Fire Commissioner Chuck Simms.
The plan to use nurses to filter out non-emergency calls comes as the Detroit Fire Department has already nearly cut in half the department鈥檚 Code 1 medical response times. Code 1 medical response times 鈥� or the amount of time it takes the city to respond to a potentially life-threatening emergency 鈥� went from an average of 13 minutes and 28 seconds in 2014 to an average of 7 minutes and 22 seconds in 2024, according to Detroit Fire Department data.
Simms attributed the decrease in large part to the department鈥檚 training of firefighters as medical first responders in 2015, allowing them to respond to Code 1 calls. In 2024, firefighters responded to more than 45,800 Code 1 calls alone.
The fire department also essentially doubled the number of ambulances in its fleet in 2023 and increased the number of private ambulances that respond to medical calls in the city.
鈥淭hat helped out drastically,鈥� Simms said of the training the fire department鈥檚 roughly 1,100 firefighters as medical first-responders.
Substantial decrease in response times
The national average for an emergency medical service unit to arrive on the scene after a 911 call is 7 minutes, according to a 2017 study by the American College of Emergency Physicians, the latest available. The response time in rural settings is much worse: The median time in those areas is more than 14 minutes, with nearly 1 of 10 encounters waiting almost a half-hour for the arrival of EMS personnel, the study found.
Mayor Mike Duggan acknowledged during his State of the City address in March that Detroit once had the worst response times in the country. To change that, the city bought more ambulances, cross-trained all of its firefighters and hired more emergency medical technicians.
鈥淭hey have all now been cross-trained as medical first-responders, a great commitment that they made,鈥� Duggan said.
On the day Lowe and his colleagues helped the dizzy patient, the crew 鈥� which is based at a fire station in Eastern Market 鈥� spent more than two hours waiting for a run. The time off gave them a chance to chat with each other and pick up food from McDonald鈥檚 and a sports bar for lunch.
Then, all of a sudden, the call came in for the patient experiencing dizziness. It was a Code 3 medical run, so the crew didn鈥檛 turn on the vehicle鈥檚 flashing lights.
Lowe, Stanley and Mentor wheeled the patient out of the nursing home on a stretcher and used a power lift to hoist him into the vehicle. Once inside the ambulance, Stanley, one of the EMTs, asked to see the man鈥檚 finger and then pricked it, testing his blood sugar. They then drove him to Detroit Receiving Hospital.
The amount of downtime that Stanley and Lowe鈥檚 crew had that day was different from what EMS crews in Detroit experienced in the early 2010s.
Lowe, who has worked for the Detroit Fire Department since 2011, remembered that when he started his career, he and his colleagues would sometimes get to a location on a Code 3 run, and the person would say 911 was called the day before.
鈥淚t was horrible back then,鈥� Lowe said of the response times. 鈥淲e didn鈥檛 have a lot of units.鈥�
Medical first-responder training
Before Detroit made the switch to require firefighters to undergo medical first-responder training, Detroit was one of the only major fire departments in the country without cross-trained firefighters. When Duggan took office in January 2014, the average response time was close to 20 minutes.
Today, DFD engine companies and squad companies 鈥� the fire department staffs more than 30 fire companies a day, and they are often closer to a patient鈥檚 location than an ambulance 鈥� can now respond to Code 1 calls. When those calls come in, the Fire Department dispatches one of those companies and an ambulance.
Shortly after the fire department鈥檚 firefighters were cross-trained, Code 1 response times dropped to 10 minutes and 18 seconds in 2015 and then dropped to 8 minutes and 43 seconds in 2016, according to the Fire Department. And for each year from 2017 to 2022, the average Code 1 response time remained between 8 minutes and 8 and a half minutes. The time dropped to 7 minutes and 50 seconds in 2023 and then 7 minutes and 22 seconds in 2024.
Another factor in improving response times in Detroit has been buying more ambulances. A $25 million boost to the Detroit Fire Department鈥檚 budget in fiscal year 2023 allowed the department to increase the number of ambulances for runs from 13-18 a day to 26 ambulances a day. The number of contracted, private ambulances also rose from three to five a day to 18 a day.
Simms said he has worked for the Detroit Fire Department for nearly 40 years. Over the years, he practically never saw an ambulance housed at his fire station. He would only see it at the beginning and end of the day.
鈥淏ut they were gone all day long,鈥� Simms said. 鈥淪o for me to even ride past fire stations now and see our ambulances sitting in quarters, it makes me feel good.鈥�
The Detroit Fire Department wants to make sure its personnel 鈥渟tay healthy,鈥� he said.
鈥淲e鈥檙e a big advocate on health and wellness,鈥� Simms said, 鈥渁nd having them run all day is not healthy for anyone.鈥�
The vision for nurse navigation
Detroit had more than 158,469 EMS responses in 2024, up 4.8% from 151,237 in 2023, which includes Code 1, Code 2 and Code 3 calls. The agency鈥檚 firefighters, meanwhile, had 70,037 2024 fire apparatus responses in 2024, nearly two-thirds of which, or 45,842, were medical first-response runs for Code 1 calls. The other calls were for fires, accidents, elevator entrapment or trench rescue.
But the number of EMS responses will likely change when the department鈥檚 new 鈥渘urse navigation鈥� program for Code 3 runs gets launched.
Under the program, a nurse would call the patient or a patient鈥檚 family member to find out what鈥檚 wrong and give advice. If the patient still wants to go to the hospital, the nurse may call an Uber or a Lyft for them, instead of using an ambulance. The nurse will also follow up with the patient.
The Fire Department 鈥� which has approximately 700 EMTs and 130 paramedics 鈥� is in the process of choosing a company to provide the nurse navigators, Simms said. He expected his department to pick a company by July or August and likely start the program in September.
Detroit Fire Department Director of Media Relations Corey McIsaac said many people call 911 because they don鈥檛 have a primary care physician.
鈥淪omething that nurse navigation will be able to do is to actually work with the residents to establish a relationship with a primary care physician for the residents so that they are able to utilize the medical system really the way it鈥檚 meant to be utilized,鈥� McIsaac said.
Getting the appropriate care
Despite the focus on response times, ambulance services officials are finding that patient outcomes are 鈥渃linically not necessarily dependent on response times,鈥� said Angela Madden, the executive director of the Michigan Association of Ambulance Services, which advocates for ambulance services across the state and serves nearly 80% of Michigan counties.鈥� In certain circumstances, she said, 鈥渁 timely response is important for that patient鈥檚 clinical outcome,鈥� but those aren鈥檛 the majority of emergency medical service calls in Michigan.
It鈥檚 important to 鈥渄ispatch the appropriate response鈥� to a medical emergency, said Madden, whose organization primarily represents non-fire department ambulance companies. In some instances, that鈥檚 an advanced life-support unit, which provides some emergency room care to a patient before getting to the hospital. In other instances, the right response is a basic life-support unit, which provides a level of care below that of an advanced life-support unit, but greater than that of basic first aid, she said.
鈥淲hat we are finding is that true medical dispatch is more important than time as it relates to a patient鈥檚 clinical outcome,鈥� Madden said.
By 鈥渢rue medical dispatch,鈥� she means when a dispatcher is trained in various medical options, such as CPR and first aid, and knows what questions to ask to learn more about a patient鈥檚 status.
鈥淲hen we are sending the correct resource to the correct patient, it absolutely opens more of the advanced life-support resources to go to those more critical patients,鈥� Madden said. 鈥淩ight now, we are having to send higher levels of care to lower acuity patients because of a lack of information, in most instances.鈥�
Greg Flynn, who chairs the EMS section for the Michigan Association of Fire Chiefs, said clinical outcomes are 鈥渆ven more important鈥� than EMS response times.
鈥淚f you鈥檙e the patient suffering from a traumatic injury or a medical emergency, that outcome is what鈥檚 most important to me,鈥� said Flynn, who serves as West Bloomfield Township鈥檚 fire chief.
For example, if EMS personnel are able to restore blood flow to a patient having a heart attack more quickly, they will have a better outcome, he said. Their physical health will be better.
Flynn also said that more fire departments in large cities are adopting nurse navigation. Seattle has a program, and the Washington, D.C., Fire and EMS Department has what it calls the 鈥淩ight Care, Right Now鈥� nurse triage line.
鈥淭his is something that large cities 鈥� cities like Detroit 鈥� are finding as a best practice,鈥� he said.
Nurse navigators will help keep EMS resources available for high-priority calls, Flynn said. The navigator can follow up with callers and route them to a primary care physician for a medical issue that 鈥渋s not best treated in an emergency room,鈥� he said.
鈥淚 applaud them for what they鈥檙e doing,鈥� Flynn said of Detroit.
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