San Diego Emergency Medical Services (EMS) has recognized a small population of individuals who use emergency services in disproportion to the general public. These individuals often suffer from difficult health or social circumstances, such as chronic medical conditions, mental illness, substance abuse or chronic homelessness. Their underlying issues may remain unaddressed as they seek primary assistance from ill-suited acute care services. The resulting episodic, uncoordinated care is of lower quality and higher cost and simultaneously consumes valuable public safety and acute care resources.
The Resource Access Program (RAP) is the strategic social arm of San Diego Fire-Rescue Department. Implemented in 2008 within the Emergency Medical Services (EMS) division of the fire department, RAP uses analytics in real-time to identify vulnerable 911 callers experiencing social difficulties such as chronic homelessness, mental illness, substance abuse disorders, or difficult social or medical situations. Once identified, specialized staff provide intervention and service navigation.
RAP primarily focuses on high 911 utilizers, who are known to be especially vulnerable and suffering from complex medical or social difficulties. Data show that one percent of the population generates approximately 20% of the EMS call volume. RAP seeks to reduce dependence on EMS and acute care services by linking the individual with appropriate resources for their underlying medical, mental health, and social needs. Approximately 80% of RAP clients are homeless.
RAP was highlighted in 2014 as a best practice by the United States Health and Human Services Agency for Healthcare Research and Quality (AHRQ) and has served as a model for other programs across the United States.