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The HOME Team: Evaluating the Effect of an EMS-based Outreach Team to Decrease the Frequency of 911 Use Among High Utilizers of EMS

  • Niels Tangherlini (a1), Julian Villar (a2), John Brown (a3), Robert M. Rodriguez (a3), Clement Yeh (a1), Benjamin T. Friedman (a4) and Paul Wada (a1)...
Abstract Objectives

The San Francisco Fire Department’s (SFFD; San Francisco, California USA) Homeless Outreach and Medical Emergency (HOME) Team is the United States’ first Emergency Medical Services (EMS)-based outreach effort using a specially trained paramedic to redirect frequent users of EMS to other types of services. The effectiveness of this program at reducing repeat use of emergency services during the first seven months of the team’s existence was examined.


A retrospective analysis of EMS use frequency and demographic characteristics of frequent users was conducted. Clients that used emergency services at least four times per month from March 2004 through May 2005 were contacted for intervention. Patterns for each frequent user before and after intervention were analyzed. Changes in EMS use during the 15-month study interval was the primary outcome measurement.


A total of 59 clients were included. The target population had a median age of 55.1 years and was 68% male. Additionally, 38.0% of the target population was homeless, 43.4% had no primary care, 88.9% had a substance abuse disorder at time of contact, and 83.0% had a history of psychiatric disorder. The HOME Team undertook 320 distinct contacts with 65 frequent users during the study period. The average EMS use prior to HOME Team contact was 18.72 responses per month (SD=19.40), and after the first contact with the HOME Team, use dropped to 8.61 (SD=10.84), P<.001.


Frequent users of EMS suffer from disproportionate comorbidities, particularly substance abuse and psychiatric disorders. This population responds well to the intervention of a specially trained paramedic as measured by EMS usage.

Tangherlini N , Villar J , Brown J , Rodriguez RM , Yeh C , Friedman BT , Wada P . The HOME Team: Evaluating the Effect of an EMS-based Outreach Team to Decrease the Frequency of 911 Use Among High Utilizers of EMS. Prehosp Disaster Med. 2016;31(6):603607.

Corresponding author
Correspondence: Niels Tangherlini, EMTP, BA San Francisco Fire Department EMS Division San Francisco, California USA E-mail:
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This list contains references from the content that can be linked to their source. For a full set of references and notes please see the PDF or HTML where available.

N Tangherlini , J Villar , J Brown , RM Rodriguez , C Yeh , BT Friedman , P Wada . The HOME Team: evaluating the effect of an EMS-based outreach team to decrease the frequency of 911 use among high utilizers of EMS. Prehosp Disaster Med. 2016;31(6):15.

2. R Niska , F Bhuiya , J Xu . National Hospital Ambulatory Medical Care Survey: 2007 emergency department summary. Natl Health Stat Report. 2010 Aug 6; (26):1-31.

6. South Carolina Public Health Institute. A report on frequent users of hospital emergency departments in South Carolina. Columbia, South Carolina USA: SCPHI; February 2011.

14. R Okin , A Boccellari , F Azocar , et al. The effects of clinical case management on hospital service use among ED frequent users. Am J Emerg Med. 2000;18(5):603-608.

15. D Pope , C Fernandes , F Bouthillette , J Etherington . Frequent users of the emergency department: a program to improve care and reduce visits. CMAJ. 2000;162(7):1017-1020.

24. S Weiss , A Ernst , M Ong , et al. Effects of a social services intervention among 911 repeat users. Am J Emerg Med. 2005;23(4):492-496.

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Prehospital and Disaster Medicine
  • ISSN: 1049-023X
  • EISSN: 1945-1938
  • URL: /core/journals/prehospital-and-disaster-medicine
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