Wave of the Future

Audrey Fraizer

Audrey Fraizer

ACE Achievers

CONFIRE JPA approached COVID like a fire, and if you know anything about their agency’s battles over the past few years, the “fire” is literal and figurative and everything in between.

No pun intended.

CONFIRE JPA, aka “Comm Center,” provides communications, dispatch, and geographic information to its 10 members and 3 contract agencies. These agencies represent over 100 fire stations serving communities covering the most residents and businesses within the county of San Bernardino, California (USA).  It operates two fire/EMS communication centers that share a common phone system and a common radio system.

Anyone can access the brief descriptions from the news pages or the CONFIRE JPA website and dig deeper using the available links. The online account, however, is far from the whole story for emergency dispatch in this section of Northern California. Every season seems to bring new challenges to a system running fire and medical calls. In 2020, Comm Center dispatched over 225,000 incidents—a volume that continues to increase every year.

The enormity is mind-boggling, particularly considering the incidents. Wildfires. Torrential rain and flooding down the tunneled scars of wildfires. Emergency dispatchers in the Medical ACE triage calls with various emergency services. Incidents run the gamut from every single Chief Complaint in the fire and medical protocol systems—with or without prevailing environmental conditions.

Then, there came COVID.

The two communication centers already simmering in four-walled pressure cookers were confronted—like everyplace else in the world—with the unknowns of the viral pandemic. “Our backs were against the wall,” said Leslie Parham, EMS Nurse, Chino Valley Fire District, Chino, California (a CONFIRE member). “We were desperate for a solution.”

An understatement.

The Comm Center and their affiliated fire departments were running toward a cliff and not sure how far they’d go before crashing into the water below. “We definitely had a sense of urgency,” said Comm Center Director Art Andres.

Where would a path of discovery lead in solving an EMD’s impact on the problem?

Parham believed the power lay in the purview of a nursing model. A fire department could run their ambulances full tilt and, from COVID projections, never meet the demand and the same applied to emergency rooms. The nursing piece was not a new concept in Parham’s thinking. “I had been talking about an emergency nurse program for several years,” she said.

Fortunately, there was buy-in. A 16-member representative Ad Hoc Committee was created to address emergency room overcrowding and the “domino effect” of having ambulances waiting to transfer patient care to emergency room staff. The committee wanted an alternative to maximize available resources and minimize emergency responses to calls that don’t warrant an emergency level of response.

“Chaos breeds solution,” Parham said, although with the caveat of well-established working relationships. “There was a way around the can’t.”

The San Bernardino Council of Governments (SBCOG) approved a contract to implement the solution selected—the Emergency Communication Nurse System (ECNS)—within CONFIRE’s existing 911 county network. It was modeled after the Regional Emergency Medical Services Authority’s (REMSA) use of ECNS. Undoubtedly, selling points included data from January 2013–June 2016 showing that the use of ECNS avoided 635 ambulance transports and 4,414 emergency department visits. Based on average payments for emergency department visits and EMS transports, ECNS saved REMSA more than $5.75 million.

ECNS in San Bernardino County went live Dec. 21, 2020. Funding was through a $600,000 grant from the CARES Act for part-time coverage through nurses within the San Bernardino County EMS network.

As Parham explained, EMS nurses employed by most fire agencies in San Bernardino County were involved in discussions and participation was voluntary on a part-time basis. During peak hours, nurses dedicate six hours of their normal shift to CONFIRE’s Rialto center. At the time of the selection, 911 calls determined non-emergency during initial Medical Priority Dispatch System (MPDS®) questioning was projected to be approximately 12% of the calls processed by EMD.1

Parham said “taking the ball and running” away from the cliff—and developing a public education campaign explaining ECNS before and during the program—proved the successful strategy.

“You don’t change the way you do business without letting the public know,” Parham said. “We emphasized that ECNS was an evidence-based protocol, and the proof was in the ability to transfer calls using resources created through ECNS. We can do this safely.”

They opened ECNS to all calls, not only those COVID-related. “We went for it,” Parham said. No negative outcomes have been reported.

If there’s anything good to say about COVID, it connected people to a common problem.

The viability of multiple stakeholders pulling together garnered a “Cutting through the Red Tape Award” to SBCOG in the category of “Cooperation Among Cities, Counties, or Agencies.” The Inland Empire Economic Partnership award recognizes policies and programs that cut through bureaucratic red tape, which during this past year included alleviating the negative impacts of COVID-19.

Parham and Andres believe ECNS is the future of emergency communications.

“We are leading the pack in California,” Parham said. “This has been a huge success.”

Although Andres pushes hard and doesn’t often take “no” for an answer, he credits Parham for the program’s success. He said it proves the valuable place nurses have in EMS and, with the ECNS, they were the front line. “They understood what it could do. They were the driving force.”

Backers are trying to secure future funding sufficient to provide ECNS full time. CARES Act funds allocated expired at the end of December. CONFIRE along with Ad Hoc Committee are working on a business plan to find steady funds, including private funds through health care providers.2

Andres remains optimistic. “I hold a firm belief that ECNS is a better way,” he said. “This is the wave of the future. No doubt, it will become standard practice.”


1 “San Bernardino County to Roll Out Emergency Communication Nurse System.” San Bernardino County Transportation Authority. 2020; Dec. 3. https://www.gosbcta.com/san-bernardino-county-to-roll-out-emergency-communication-nurse-system/ (accessed Dec. 16, 2021).

2 See note 1.

A note about ECNS

  • The recently released ECNS Version 5.2 includes:
  • New protocol questions
  • New interim care instructions
  • A brand-new protocol, Cold Exposure or Cold Injury (217)

Provides awareness to possible injuries and life-threatening conditions caused by exposure to the cold, such as hypothermia, chilblains, frostbite, immersion foot, acute mountain sickness, and snow blindness

  • Current protocol question text
  • Clinical rationale of questions
  • Question logic
  • Current interim care instructions
  • Updated dispositions