Executive Summary
A community assessment of the Frogtown and Summit communities along the University street corridor revealed several health disparities and flawed processes in the way care is delivered to these populations. One of the most pervasive problems is not accessing the correct level of health care when illness, injury or disease occurs. There are many factors for this occurrence. These include a lack of awareness, different cultural norms about health, language barriers and an ineffective or absent health care triage system. The identified problem is knowledge deficit of accessing appropriate health care related lack of knowledge related to accessing proper level of health care as evidenced by inappropriate use of emergency services for non emergent care needs.

Background and context
Four intrepid nursing students from St Catherine University undertook a community assessment of University Avenue from Snelling Avenue east to the capitol buildings otherwise known as Frog Town.
Conversations occurred with stakeholders including paramedics and local citizens at a Salvation Army. One disturbing trend that was identified is the use of emergency medical services and emergency rooms for routine care needs such as stomach flu. This occurs and is reinforced for several reasons. One of these is the 1986 legislation EMTALA that enforces that all hospitals must see and treat everyone regardless of their ability to pay. This is an unfunded mandate which means no reimbursement is provided shifting the cost onto society in the forms of increased cost for other services. According to Consumer Health Reports, the average cost of an ER visit is $1300 (2009). While the ER provides for a catch all safety net it does not provide timely effective and appropriate care to citizens.
Since all emergency calls must be responded to, the individual who may need emergency care could have delayed response from a paramedic who is seeing a patient with a non emergent medical need. Usually the secondary response must come from another area, delaying their response time further. Now the second area has the potential for delayed response time. This puts an even larger population at risk during a life threatening emergency. The cost of an ambulance ride can be over two thousand dollars (Los Angeles Times, 2011).
The same dynamic exists in the emergency room. Instead of seeking out appropriate levels of care in the community, the uninsured and underinsured use the ER as a clinic. The New England Health Institute determined that inappropriate ER use costs Massachusetts over one billion dollars each year (2008). Part of this is knowledge deficit of the resources available. It is also influenced by the inability to properly triage care prior to accessing the most expensive parts of the health care system.
The viewpoint of our stakeholders was validated by research. A study concluded that socio economic factors were the number one determinant in inappropriate access of ambulance services (Society of the Academy of Emergency Medicine, 1999). Several other studies, including research based in Australia and Japan, have found a direct correlation with decreased socioeconomic status and increased inappropriate use of emergency services.

Description of Options
1. Increasing funding directly to the number of emergency services locations and ER staffing
2. Education of the residents on accessing the levels of care. This would include free health clinics, self treatable ailments and other options. Community and civic leaders would be part of this education. It could include self assessment of heart attack and stroke symptoms as well as signs of lesser symptoms such as short term nausea and vomiting. It would identify the importance of not using critical services so they are available when needed.
3. Triage emergency calls and set up a system with community health care to evaluate and properly route healthcare services for non emergent needs. This would include referrals to social services, housing, chemical dependency counseling, and other resources. For non-emergent medical calls, a nurse practitioner or similarly qualified staff would phone triage and if necessary do follow up in the community.
4. Do nothing
5. A combination of 2 and 3
Analysis of Options
1. This option would improve response time to emergency calls but perpetuate the current practices of using the expensive system to treat minor health care needs. It would not find support in the current restricted budgeting cycle when more effective and efficient ideas need to be implemented. It is difficult at any time to increase spending to the disenfranchised of a society. Having little or no political power, advocacy for this group can be difficult.
2. This option should decrease inappropriate use of emergency services. Making people aware of the different options would allow for better use of resources.
3. This option would decrease inappropriate use of emergency services. Having a hard stop in the system would prevent some of the chronic use of ambulance calls. A similar system would be needed for ER visits.
4. Doing nothing would continue inefficient use of the health care system. It could lead to a backlash of frustration against the community by surrounding areas seeing their resources diverted. It will endanger the residents of all the affected areas who continue to have less than desired emergency response times.
5. This option provides for the most complete approach to correcting the current problem. Education would provide a foundation of understanding and triage would enforce this process for those who wish to continue to use emergency services. This also would provide for the greatest amount of savings to the tax payer while keeping needed resources available for emergencies.