Firefighters typically conjure images of brave rescues from burning buildings, but many today spend more time on medical calls, helping citizens to stand up, walk down stairs or even bathe as gaps in services to handle America's aging population widen.
Recent spikes in "non-emergency" 911 calls — including calls from fully staffed senior living facilities — have fire departments across Hamilton County scrambling to help those in need on top of putting out fires.
"A lot of times, they use us as a form of health care just because they don't know who else to call," said Capt. Skyler Phillips, EMS coordinator at the Chattanooga Fire Department. "We're all firefighters here. This is not something that we ever thought we'd be dealing with."
While firefighters already respond to most 911 calls, including medical emergencies, increases in what Phillips calls "non-emergency lift assists" for seniors who are uninjured but need help getting up and "citizen assists" for tasks such as reaching a medicine bottle are affecting fire departments across the country.
The national trend is a result of limited services and funding for programs to meet the demands of a rapidly growing older population. In the tri-state region, high rates of obesity and chronic disease, combined with the area's appeal as a retirement destination, mean more services are needed to meet that need.
All first responders grapple with the issue, but ambulances respond only to medical calls, leaving non-emergencies to fire departments.
Last year, the Chattanooga Fire Department received 1,320 calls for non-emergency citizen assists, which include lift assists. That's a more than 300% increase from 435 calls in 2013, according to department data. The number of calls in fiscal year 2019, which runs from July 2018 through June 2019, already has surpassed last year with nearly 1,400 as of Friday.
Not only is the trend alarming, it's expensive. It costs the department on average $224 to respond to each call, and unlike an ambulance ride to the hospital that cost cannot be billed for or reimbursed.
Time spent performing lift assists also can slow response time for other emergencies. Phillips said that is the main reason he started looking to health care and social service providers for answers.
In January, the fire department began working with the Regional Health Council and its Senior Health and Aging Committee to brainstorm possible solutions. Some of the other organizations involved include United Way, the University of Tennessee at Chattanooga social work program, the Southeast Tennessee Area Agency on Aging and Disability and St. Alexius.
"Our goal is not necessarily to reduce the calls so much as it is to make the person healthier, that way our resources remain available for anything that comes up," Phillips said, adding that the department never discourages people from calling or seeking help.
Much of the effort has involved finding agencies that specialize in senior care and connecting them to the callers who need their services. For example, one frequent caller who fell and missed her doctor appointment was able to get the wheelchair she needed through Goodwill, he said.
Unfortunately, most programs have waiting lists and aren't equipped to deal with "emergent" needs.
"We don't know all the resources, and a lot of resources don't know what we go through on a daily basis," Phillips said. "There's that gap in between. How do you reach out to those people you don't see?"
Over the past year, the Health Council's Senior Health and Aging Committee has focused on three priority areas: barriers to housing for older adults, transportation and health services.
Phillips and representatives from three other fire departments in Hamilton County convened at the committee's May meeting to share stories from the front lines.
The Dallas Bay Volunteer Fire Department serves the Hixson area, which Deputy Chief Jack Brellenthin said is home to a "significant" number of aging people. Citizen assists account for 15% of their calls, and most of those are for lift assists, he said.
"While we don't have a lifting machine, we do have aids that help us — stair chairs, lifting sacks, back boards — but it's still primarily a muscle exercise," he said. "There's not a lot of physical devices you can use, especially to get into tight places. It's hard to lift somebody out of a bathtub without getting in there."
Brellenthin said it's not uncommon to detect other issues, such as potential strokes, with someone who has fallen.
One weekend, they helped a woman get from her car to her home after hip surgery, he said.
"After we got her in the house, she asked us if she owed anything," he said. "We don't change for our services."
The next day, she gave the department a check for $300.
There are no senior living facilities in Dallas Bay's coverage area, but Eric Mitchell, chief of the Signal Mountain Fire Department, said changes in corporate policies at many independent, assisted living and nursing home facilities also are contributing to the call increases.
"Used to be, when someone had a little fall — slip out of a chair and they were uninjured — the security personnel, even maintenance folks, would help," he said. "Now, they're not allowed to do that because of liability issues."
Instead, staff are instructed to call 911.
The Signal Mountain department serves a population of 9,000 and responded to 942 total calls last year: 270 calls were citizen assists, and 200 of those calls were lift assists, with 130 occurring at one senior facility, records show.
Like the other department representatives who spoke, Mitchell said he understands the liability firsthand.
"I've seen career-ending injuries from lift assists," he said. "I have one firefighter now who just had back surgery from a lift assist call, but it is a public service."
Mitchell wants to purchase an inflatable lift that slides easily under people and helps get them out of tight spaces and down stairs, but they cost about $5,000.
"Everything is expensive, but I try to weigh it against what that back surgery costs," he said.
Duane Pitts, chief of the Collegedale-based Tri-Community Volunteer Fire Department, said the issue is more than just financial.
"It's a problem with overburdening agencies that aren't designed to do this. We're supposed to be a fire department. We're an everything department," he said.
Pitts said there are other agencies better suited for the task.
"My view is, some of them need to gear up to meet the need that has evolved," he said.
Two or three years ago, lift assists accounted for 2-5% of their calls. Now, they're 10% and growing, according to Pitts.
He said more than half of their calls are medical related. For some of the heavier patients, up to three stations may be taken out of service in order to provide necessary manpower, he said.
On top of that, the calls make it hard to recruit firefighters.
"All of our worker bees are completely volunteer, and getting and maintaining these volunteers is a problem," he said. "Our call volume is 2,200, 2,400 calls per year, and that's right at the edge where volunteers say, 'I'm tired of being woken up for calls I don't necessarily need to go on.'"
Despite the challenges, all the speakers said they're dedicated to helping those in need and responding whenever called.
Through meeting with the Health Council and getting the word out, Phillips hopes more groups will jump in to assist, because data shows the need only will grow.
There were about 77,000 adults age 70 and older in Hamilton County and the 12 surrounding Tennessee and North Georgia counties in 2010. That number is on track to reach 114,000 by 2020 and 157,000 by 2030, according to a report from the Southeast Tennessee Development District.
Since the issue isn't unique to Chattanooga, the aging committee and fire department are looking across the country for models. One is a fire department in Lexington, Kentucky, that reduced non-emergency calls by about 30% after creating a community paramedicine program, Phillips said.
Trained staff from the program visit people who are repeat callers to determine their needs. For example, if someone doesn't have a primary care provider, staff pick up the phone, schedule an appointment and make sure that person gets there. The program requires buy-in from the whole community, including hospitals, housing and transportation services.
Other possible solutions include creating a centralized resource list or place where departments can connect those who call with other organizations that can help.
Assigning master of social work interns to the fire departments to facilitate interventions was another idea proposed at the aging committee meeting, as was buying more lift machines for the departments and finding people to check on isolated seniors.
Health officials said establishing a "medical home" for callers that isn't 911 or the hospital emergency department and improving transportation options so people don't delay care also are key.
"If they need us, we're coming. But what we want, too, is to prevent them from having to call us," Phillips said. "This will benefit the ERs, this will benefit the ambulances, this will benefit the whole community."
Similar to fire prevention, he said raising awareness and education makes life safer, because it's easier to prevent fires on the front end than to fight them. Something as simple as adding a non-slip mat under a rug or eliminating stray power cords can mean the difference between a safe trip to the bathroom and a 911 call.
Contact staff writer Elizabeth Fite at firstname.lastname@example.org or 423-757-6673.