1. San Diego Police and Fire-EMS Innovation to Address Recidivism
Jim Dunford, MD, FACEP
City EMS Medical Director
Professor Emeritus (Emergency Medicine)
UC, San Diego Medical Center

2. City of San Diego 1.3 million population 8th largest U.S. city
4th largest homeless population

3. SD Homeless Outreach Team
SDPD
HHSA
PERT

4. Serial Inebriate Program (SIP)

5. SIP partners
Police Department Fire-EMS Mental Health Systems Sheriff’s Department Alcohol and Drug Services City Attorney Public Defender Superior Court Medical Clinic

6. SIP approach Convict - 647(f)PC Treatment in lieu of custody
Case manage w services
Positive support groups
Negative reporting

7. SIP funding 2001-2003 2003 - present Alcohol & Tobacco Settlement
City - housing
County - treatment

8. SIP: acceptance vs. duration of sentence
Dunford JV et al. Impact of the San Diego Serial Inebriate Program (SIP) on use of emergency medical resources. Ann Emerg Med. 2006;47(4):

9. Average charges per month, serial alcoholics: accepted (156) vs
Average charges per month, serial alcoholics: accepted (156) vs. declined (112) treatment
Dunford JV et al. Impact of the San Diego Serial Inebriate Program (SIP) on use of emergency medical resources. Ann Emerg Med. 2006;47(4):

10. SIP: graduation and completion rates
Completion remain sober x 6 months
attend 4, 90-minute sessions/week
show effort to obtain housing and employment
Graduation “ “ and become financially stable and procure drug-free housing
Dodson J. The effectiveness and efficiency of SIP. The Sage Project. San Diego State University. Spring 2016

11. Resource Access Program (RAP)

12. RAP community paramedics

13. RAP alerting registry HIE StreetSense
RAP is a paramedic-based surveillance and case management system.
Identify frequent callers or other patients requiring additional resources
Monitor EMS activity of patients on a watch list
Intervene with appropriate public safety partners

14. RAP: real-time situational awareness
Screen shots – case management, ranked users by week > year, by problem type (psych, homeless), by individual chief complaint

15. Effect of RAP: contacts and charges
n = 51 clients
Tadros AS, et al. Effects of an emergency medical services-based resource access program (RAP) on frequent users of health services Prehosp Emerg Care 2012 Oct;16(4):541-7.

16. Effect of RAP: Fire-EMS resources
Tadros AS, et al. Effects of an emergency medical services-based resource access program (RAP) on frequent users of health services Prehosp Emerg Care 2012 Oct;16(4):541-7.

17. Project 25 36 individuals Homeless High impact Selected by: SDPD
SD Fire-EMS
Mental health

18. Project 25: impact on public services
2010 Base to 2013
* Includes crisis houses, detox centers, homeless shelters, legal assistance, Psychiatric Emergency Response Team
Reaser L. Project 25: Housing the most frequent users of public services among the homeless. Fermanian Business and Economic Institute. Pt. Loma Nazarene Unversity. 2015

19. Project 25 results
Reaser L. Project 25: Housing the most frequent users of public services among the homeless. Fermanian Business and Economic Institute. Pt. Loma Nazarene University. 2015

20. Spice awareness: EMS vs. Poison Center §52
Spice awareness: EMS vs. Poison Center § San Diego Municipal Code

21. America’s Finest City