A small group of residents drives a large share of non-emergency EMS runs. Assigning a paramedic to the same 20 people is case management. A municipal telehealth line is different: the whole town gets a clinician to call before the next dispatch.
Last reviewed: September 2026.
Who counts as a frequent 911 caller?
There is no single federal definition. EMS agencies set a local threshold (say, three or more dispatches in 90 days) and pull names from CAD. AHRQ described the same pattern in hospitals: a small share of patients account for a large share of visits and cost (AHRQ super-utilizer brief, 2014).
Treat the list as a symptom, not a diagnosis. People on it mix chronic illness, no primary care, housing problems, substance use, and after-hours gaps.
Why does case management of the same 20 callers stall?
Community paramedicine and “super-utilizer” teams work one household at a time. They help those households but do not cover the next 200 residents who join the list when a clinic closes or a panel freezes.
Staffing is the constraint. A mobile integrated health visit needs a credentialed clinician, a vehicle, and a protocol. NHTSA’s EMS office has long treated that work as an expansion of EMS practice, not a primary-care substitute (ems.gov).
With only last quarter’s list, you are always late. The prevention move is upstream access for everyone, then a short list for those who still call.
What is the difference between coverage and case management?
| Resident telehealth (coverage) | Community paramedicine (case management) | |
|---|---|---|
| Who is eligible | Every household the city enrolls | People already flagged in CAD or by a hospital |
| When it runs | Before the 911 call, for low-acuity needs | After repeated dispatches, often in the home |
| City staff needed | None for clinical work | Medics or nurses, plus medical direction |
| What it cannot do | Lift assists, trauma, stroke, cardiac arrest | Replace a primary-care panel for the whole town |
Fund both if you can, but do not wait on a paramedicine hire to offer a resident line. TAP is the coverage layer. It does not send a medic to the house and does not claim to be community paramedicine.
What does a prevention playbook look like in practice?
- Measure the list. Pull 12 months of CAD. Count unique addresses with three or more medical calls that were not lights-and-siren. Do not mix lift assists into a telehealth target.
- Give every household a non-911 option. Ferris, Texas later reported 20% fewer non-emergent EMS runs and more than 50% resident adoption (City Manager Brooks Williams). That is one city’s observed result, not a model for your CAD file.
- Keep 911 for emergencies. Chest pain, stroke signs, severe bleeding, and trouble breathing still go to 911. The resident line is for the visit that would have been a taxi to the ER.
- Revisit the frequent-caller list after coverage exists. Those still on it may need housing, behavioral health, or a true mobile team. That is a second program and budget.
CMS’s Emergency Triage, Treat, and Transport (ET3) model paid EMS to treat in place or transport to an alternate destination instead of the ER only (CMS ET3, model years 2021 to 2023). ET3 was a payment experiment, not a citywide primary-care benefit; do not copy its language onto a resident telehealth contract.
How should you talk about money?
Observed. Ferris: 20% fewer non-emergent EMS runs (Brooks Williams). TAP book: 93% of encounters resolved without another claim; 9.9/10 resident rating; 780+ public-sector partners. Algonquin, Illinois: 70% household retention after notice and a decline window.
Modeled. TAP’s range of $450 to $900 per avoided non-emergency dispatch is a cost-to-serve estimate. Method: local fully loaded cost per response (or a published municipal range), applied only to calls you can defend as low-acuity and avoidable. Do not multiply Ferris’s 20% by your entire 911 volume.
AHRQ’s 2014 brief covers the hospital side, not municipal EMS rates. Use local CAD and your own ambulance cost model.
What should fire chiefs watch for?
- Protocols that try to divert true emergencies.
- Vendors that want the fire department to staff the line: a new FTE in disguise.
- Programs that only enroll the current super-utilizer list. You will miss the next cohort.
- Claims that telehealth replaces community paramedicine. Different job, different patients.
Want a local frequent-caller read?
To have TAP read your CAD pattern, start here: Partner with TAP Health.
