Kelsey Gray, mobile integrated health coordinator for the Greenwood Fire Department, poses by her SUV in front of fire headquarters/Station 91 on Tuesday. Noah Crenshaw | Daily Journal.
The fire was devastating but the resources first responders provided after made it easier to deal with.
About three weeks ago, an elderly couple in Greenwood’s Northern Park neighborhood lost their home in a fire. After returning from a food bank, a man put food on top of a stove without realizing he turned the burner on. The house caught fire.
Jonathan Myers, EMS division chief for the Greenwood Fire Department, was assigned to do victim assistance that day. He discovered quickly that the couple, along with their grandson who lived with them, lost a lot — insulin, medications, a CPAP machine and more.
Luckily, a Greenwood Fire’s part-time mobile integrated health coordinator, Kelsey Gray, was on the scene. She was working her full-time job as a paramedic with the White River Township Fire Department. After Myers spoke with a White River Township Fire battalion chief, Gray came over to help the victims.
Gray worked quickly to help the fire victims. She got their medications replaced, worked with the nonprofit Fire Angels and their health insurance to get them put up in a hotel for two weeks, got them new clothes and more, Myers said.
“That wouldn’t have happened pre-Kelsey. We would have handed them off to Fire Angels,” he said.
It wasn’t that Greenwood Fire wouldn’t have wanted to help; it’s just that they’ve never been trained and had the skillset to put these resources together. There are lots of great resources available, but lots of times there’s difficulty connecting people with the resources, said Brad Coy, assistant fire chief.
This is where the department’s mobile integrated health, or MIH, program comes in. Using a patient-centered model of care delivered in a patient’s home or in a mobile environment, the program bridges gaps between public safety, public health and health care. It is funded with money the city is receiving through an opioid lawsuit settlement.
The fire was not the typical use of the MIH program, but the resource connections are proof of its benefits in Greenwood.
From the first responder standpoint, they’ve known for a long time there was a need for MIH, but weren’t sure how to fill it. The concept is still relatively new, with fire departments in Crawfordsville and Bloomington leading the way, Coy said.
Now, White River Township Fire, Bargersville Fire and Greenwood Fire are starting to pick up the concept, he said. White River Township Fire has had an MIH program since at least last year. In May, Bargersville Fire announced its plans to have an MIH program through a partnership with Johnson Memorial Health in Franklin.
“We never knew how to connect resources to the people who needed it. There are great resources in the county, but there really wasn’t a way to connect all of them,” Coy said.
Myers describes MIH as the fire prevention side of EMS. Like the fire side, there is a proactive side, like fire marshals doing code enforcement, and a reactive side, responding to fires. EMS has traditionally been reactive, like responding to a heart attack, but with MIH, they can get proactive, like going out to help individuals understand new medications or help connect them to resources, he said. This, in turn, will help with 911 resources.
Growing program
Greenwood Fire’s MIH program the been in place for the last year on a “low level,” but now it’s becoming a more full-fledged program, said Tyler Swardson, public information officer. Earlier this year, the Greenwood City Council granted a request from Fire Chief Jayme Washel to add a part-time mobile integrated health coordinator to run the program and assist those in need.
Gray was a perfect fit for the job. She’s been in EMS for nearly 10 years, working in both rural and more urbanized areas. She joined White River Township Fire about a year ago, transitioning from an ambulance role to a mobile integrated health role with that department. Now she’s doing it part-time for Greenwood Fire, too.
“I’ve had a passion just for obviously helping people,” Gray said. “But being able to help with the resource management after that initial 911 call has been huge because it’s easy to transport someone to the hospital and go into their home and say, ‘Boy, they need other resources, they have other needs, but we’re not meeting those.’ There’s a gap there but what do you do? So being able to do that now is nice.”
For example, Gray can go into a home and see the reasons why someone is in the hospital. If someone has repeatedly gone to the hospital for falling, she can go into the person’s home and see the cause of the falling — like if someone is slipping in their socks and needs to put shoes on, or if there is a rug that they keep tripping over that needs moved, she said.
“It’s just simple things. The hospital doesn’t get to see the big picture of that,” Gray said.
As the MIH coordinator, Gray will receive referrals from fire crews, Greenwood Police and even area hospitals like Community South and Franciscan Health Indianapolis. Depending on the individual’s need, she can help get them connected with food pantries, insurance and Medicaid resources, getting a primary care provider or finding mental health or substance abuse help. She can also help with home health needs or food delivery, she said.
Since starting at Greenwood Fire more than six weeks ago, she’s hit the ground running. Gray has over 20 people that she’s actively helping — mostly through word of mouth, since the program has not really been widely publicized.
As the department worked to create the program, they struggled to find fully-written policies from other agencies to help define the program and Gray’s role. For example, White River Township Fire has their MIH person integrated with another role, whereas Greenwood is specific to mobile health, Swardson said.
But Greenwood Fire is working to establish its own full-fledged policies for the program. For example, for initial visits or situations where safety issues could be involved, Gray will have someone else with her — whether it is a firefighter, paramedic or an administrator, Swardson said.
“It’s not that we’re reinventing the wheel. We are inventing the wheel when it comes to these kinds of policies,” he said.
Benefits evident
Fire officials say the MIH program is worth it. Myers, who used to run the program before Gray was hired, saw the benefits from the moment it started. But with his other responsibilities, he couldn’t do the program justice like Gray can, he said.
“I mean, just in the last two weeks, the upload of clientele that we’ve seen is just unbelievable,” Myers said. “It helps that we’re getting the buy-in from the police, the hospitals, the crews — so yeah, there’s an absolute need.”
Most of the people in need are those who don’t have the financial resources. Officials do their best to keep it no-cost for the patients, which is aided by the settlement money, he said.
“In the long run, they’re already tax-paying citizens, so we have to be fiscally responsible in how we do stuff and how to keep that at no cost to them,” Myers said. “Even if we have billing capabilities, I don’t think it’s responsible of us to bill them, because they financially just aren’t able to usually pay for it anyway.”
A lot of the patients are also not “one-time 911 calls.” If not in the program, they can continue to call 911, but if someone is having a mental breakdown, for example, sending a fire truck and ambulance is overwhelming to them, Myers said.
“Instead of calling 911, they can call her; they can call the peer recovery coaches,” he said. “It prevents that 911 call, saves our resources for the emergencies, and it still gets the people the help that they need.”
Future plans
Right now, the only dedicated MIH employee is Gray. But the end goal is to have full-time employees, maybe even with part-time support. MIH is not going anywhere, Myers said.
In the meantime, he’s already discussed with Washel the need to add another part-time MIH employee. Greenwood Fire is trying to do the best for citizens while being fiscally responsible with tax dollars, which they can do with only part-time employees for now, he said.
But the department is also still waiting to see how the effects of Senate Enrolled Act 1, which brought property tax cuts to Hoosiers at the cost of cutting future local government revenue, roll out. The department can’t just “go off the cuff” and start hiring people, Myers said.
If you need or know or someone who needs assistance, the MIH program can be