Imagine this: You're a first responder, and every day you're stretched thin, dealing with emergencies. But what if many of those calls weren't true emergencies at all? That's the reality in Anchorage, where a groundbreaking mobile health program is stepping in to ease the burden on our dedicated first responders and, more importantly, to help vulnerable residents get the care they truly need.
Let's dive into how this innovative approach is making a real difference.
Jennifer Pierce, a mental health clinician with the Anchorage Fire Department, recently found herself at the doorstep of a mobile home. The reason for her visit? To check in on a family after their brother had called 911 the previous night, suspecting a stroke. This isn't about a medical emergency in the moment, but about addressing the lingering needs of those left behind. She spoke with a woman in her 90s, gently inquiring about her well-being: who was handling the cooking, if she'd seen a doctor lately, and if her breathing machine was being maintained. These are the crucial, often overlooked, details that can prevent future crises.
Pierce is at the helm of a one-year pilot project within the fire department called Community, Outreach, Referral and Education, or CORE. This isn't your typical emergency response. It's a dynamic duo – a mental health expert and a paramedic – working collaboratively to reduce unnecessary 911 calls and, crucially, to connect individuals with complex needs to vital health care and substance use treatment services.
“They’re kind of getting stuck in the system,” Pierce explains, highlighting a critical flaw. “They’re going to the emergency room because something’s being missed.” This is where CORE steps in, acting as a bridge to ensure people receive the right kind of help, at the right time, and in the right place.
The CORE team is already proving its worth. By addressing community members' needs directly in their homes, rather than relying solely on hospital visits, the program is seeing early success. In fact, it's set to expand in March. In its initial two weeks, Pierce reported receiving over 20 referrals, a clear indication of the unmet need.
How does the CORE team know who to visit? Their daily schedule is fueled by referrals from experienced emergency medical services crews. These are the paramedics and firefighters who have become intimately familiar with individuals who frequently call 911 – some as often as three times a month! These frequent callers often have intricate challenges that go beyond immediate medical emergencies. Instead of a hospital bed, they might need assistance with scheduling or attending medical appointments, accessing higher levels of care like assisted living, or simply require additional mental health support.
Joshua Browning, Pierce’s paramedic partner on the CORE team, offers a poignant perspective: Many people dial 911 because they're unsure of their options and it becomes their “last line of defense.”
Consider a recent day: Browning spent four hours in a primary care office with a resident who had been repeatedly visiting emergency rooms and required hernia surgery. Later that afternoon, the pair made their third home visit, attending to an older adult experiencing chronic chest pains. These are not typical 911 responses; these are interventions designed to provide sustained care and prevent future emergencies.
Pilot Program Relaunched: A Look Back and a Leap Forward
Over the past decade, Anchorage has seen a significant increase in 911 call volumes. Michael Riley, one of CORE's original founders, notes that many of these incidents involved situations where paramedics and firefighters felt they weren't the ideal resource or lacked the necessary training. For years, however, alternative solutions were scarce.
The municipality first launched CORE in 2018 to address the clear gaps in how residents accessed the medical system. Many individuals, unsure of how to navigate it, would call 911 for transport rather than for an actual emergency. This period also saw thousands of calls related to mental health crises, leading to the creation of the Mobile Crisis Team in 2021.
CORE unfortunately dissolved in 2021 due to a lack of grant funding, and the Anchorage Fire Department shifted its focus to supporting the Mobile Crisis Team. However, with a recent $175,000 state grant, CORE has been relaunched this month. Riley emphasizes that its absence over the past few years has been deeply felt.
But here's where it gets controversial... When non-emergency or “low acuity” calls flood emergency rooms and strain the capacity of an already stretched fire department, it impacts everyone. Fire Chief Douglas Schrage reported a nearly 40% rise in “basic life support” calls between 2014 and 2024. These low-acuity calls now represent a larger portion of the overall call volume – a national trend where individuals opt for 911 instead of seeking direct medical attention. Contributing factors are complex, including limited insurance coverage and gaps in community care services.
Before programs like CORE and the Mobile Crisis Team, residents faced a stark choice when an ambulance or firetruck arrived: go to the hospital or stay home. As community needs evolved, the fire department recognized the necessity for more adaptable solutions. Pierce, who now manages both of AFD’s programs, explains that while the Mobile Crisis Team is incredibly busy, it was only part of the answer.
Advocating Across Alaska: A Growing Movement
The CORE program is a vital part of Alaska's expanding network of “mobile integrated health” (MIH) programs. These initiatives are not unique to Anchorage; they are also flourishing in communities like Juneau and Ketchikan.
Josh Jubb, Program Director for Juneau MIH, explains that these programs effectively bridge the often-perilous gaps that occur between an emergency situation and the subsequent follow-up care with a physician. These systemic breaks, he notes, have always existed for patients but have widened due to a “menagerie of reasons,” including the cost of health insurance, access to coverage, and the prevalence of mental health disorders and substance use.
“There’s just a lapse, that pathway doesn’t work for many, many people,” Jubb states, underscoring the profound impact of these systemic failures.
For Browning, the Anchorage pilot project has offered a crucial opportunity to “look behind the curtain” at a healthcare system that is often disjointed and incredibly challenging to navigate, regardless of a person's age or health status.
During the week, Pierce often works from her gray Ford Explorer, a laptop balanced on her lap, as she conducts home visits. These aren't sterile clinic rooms; they are living rooms and kitchen tables where healthcare options are discussed openly.
At residents' homes, Pierce actively seeks out subtle clues that might help prevent the next 911 call. She recalls a woman from the first CORE iteration in 2020 who struggled with managing her diabetes and mental health. While she claimed to be taking her medications, Pierce’s visit revealed alarmingly high blood sugar levels and scattered, hard-to-find medications throughout a cluttered home. “You could just see the struggle when we’re there in the home,” Pierce shared. “Then we could advocate for her.”
And this is the part most people miss... In March, the CORE team will begin accepting opioid response referrals. When EMS responds to an overdose, they typically administer naloxone (often known by the brand name Narcan). While life-saving, this can also trigger withdrawal symptoms. The enhanced CORE program will now have the capacity to administer buprenorphine. Josh Engle, crisis services program manager at True North Recovery, explains that this medication can alleviate withdrawal symptoms, thereby increasing the likelihood that an individual will continue seeking help rather than relapse. He notes that the window of opportunity with someone struggling with substance use is incredibly small, and programs like CORE can potentially widen that crucial window.
What do you think? Is it time for more cities to adopt these mobile integrated health programs? Do you believe the current system adequately supports individuals with complex health and social needs, or are we leaving too many people behind? Share your thoughts in the comments below!
