Mobile Integrated Health Care in Los Angeles: Upstream Solutions to Mitigate the Covid-19 Pandemic

NEJM Catalyst Innovations in Care Delivery reports, The Los Angeles Fire Department leads the city’s 911 emergency medical service with a focus on preventive and proactive care delivery methods to improve patient clinical outcomes and systemwide efficiency. Several years of novel collaboration with local hospital systems to create a new model of prehospital care delivery yielded positive results early in the Covid-19 pandemic.

Innovative collaborations between a 911 emergency medical service (EMS) and local health care leaders helped foster a prehospital Mobile Integrated Health Care strategy that enhanced patient care while also mitigating the impact of Covid-19. Incorporating novel skill sets, alternate-destination pathways, safe and selective nontransport policies, and telehealth into upstream care has helped divert low-acuity patients from hospital EDs and optimally match patient need to location of care. In the City of Los Angeles, these strategies bought time for hospitals to stage for a patient surge, while the EMS bureau created the first Covid-19 testing sites for health care workers and, eventually, the public at large. Challenges such as cost, the need for increased medical oversight, EMS mission creep, and integrating this comprehensive EMS response into the community’s health care system have led to broader discussions with health care executives about unlocking the upstream value of prehospital patient navigation.

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