The Republic | azcentral.com Mon Apr 22, 2013 10:10 AM

Tom Morris and Brent Burgett are chatting at Mesa Fire Station 220’s kitchen table when the call comes in: Male subject, difficulty breathing, near the Colonade Motel.

The nurse practitioner and paramedic, respectively, are more than six months into their assignments on Mesa’s PA unit, a type of response vehicle the city’s Fire Department began pioneering in August.

When they arrive, the 25-year-old is in what the men call a “standing fetal position,” hugging himself against the steady drizzle of the chilly morning. He is unequipped for the weather in an oversized T-shirt that reveals tattooed arms and hands, his muddy sneakers and cropped red hair damp.

“What happened to you?” the officials ask, trying to eke out a response.

Nothing.

“What’re you upset about?”

Nothing.

After several minutes of cajoling, Burgett and Morris ease the man into the back of the unit and begin checking his vitals. He cries, showing an incomplete set of yellowing teeth.

“Write your name for me,” Morris says, handing him a clipboard and pen, patiently waiting as the man writes his first and last name in a jagged scrawl.

After more than 30 minutes of Morris pushing for responses and the man slowly answering, Morris confirms the man is suffering from depression and coming down from a cocktail of “weed, pills, Xanax, Somas,” as he writes at one point.

Psychiatric and behavioral patients make up a significant chunk of the cases handled by the PA unit, which is operated through a partnership between the Fire Department and east Mesa’s Mountain Vista Medical Center. The unit joined the Fire Department’s two-paramedic Transitional Response Vehicles, in rotation since 2006, to respond to “low-level” calls. Non-emergencies comprise about 65 percent of medical calls received by the Fire Department.

The TRV units have helped free up larger trucks and first responders to handle more serious situations, but they still have to transport patients to emergency rooms for simple procedures. Paramedics are not permitted to do as much as registered nurses or physician assistants in the field.

Those traveling aboard the physician-assistant unit can perform sutures and other small procedures and write prescriptions on-site, at a lower overall cost than a traditional, four-paramedic fire engine.

“It basically costs an average of 32 cents a mile to run a TRV, as opposed to $2.76” to run a traditional fire engine, said Mesa Fire spokesman Forrest Smith. Cost per mile includes fuel, maintenance and labor costs, as well as miscellaneous expenses.

The physician-assistant unit, which periodically has been rotated among stations to measure where it’s most useful, runs for 10 hours Tuesday through Friday and responds to an average of five to seven calls a day. Burgett said people call about everything from flulike symptoms and cuts to urinary-tract infections, back pain, strains and sprains.

“We can do labs for UTIs, sutures, slings. We have refrigerated flu and tetanus shots. If someone has a heart attack, we can do CPR. We have steroids, nausea meds, painkillers, antibiotics, emergency drugs,” Morris said. “There’s not much I don’t have here that I wouldn’t have in a traditional (urgent-care or ER) setting.”

Beyond fulfilling its initial goal of allowing traditional vehicles to devote time to real emergencies, the unit has provided some unexpected advantages.

“An unanticipated benefit has been the partnership with police,” Morris said. “Over the course of an arrest, sometimes a person says he’s injured. The police officer has to take them to the emergency room and sit with the prisoner, taking that officer off the street.”

“Having the ability to treat and release a suspect in custody back to the police officer saves them a great deal of time,” Smith said.

Professionals who staff the unit also have the power to give a medical clearance that allows police to take patients directly to treatment centers, such as regional behavioral-health authority Community Bridges, where the 25-year-old ultimately was sent.

PA unit staffers also try to help patients navigate the web of primary-care doctors and specialists to find appropriate contacts for their situations.

“We try to get them connected to someone who can help them. … We try to teach them that they can call us when they need us, but they really need to set up a relationship with a more regular practitioner,” Burgett said. “Especially with (cases involving) children, we try to teach the importance of setting something up with a pediatrician versus an urgent-care doctor who doesn’t know the child.”

In the months since it introduced the PA unit, the Fire Department has received calls and visits from municipalities in other states “who want to learn how we’re making it work,” Morris said. In the Valley, Scottsdale is considering the possibility of establishing a similar initiative.

“I don’t know of other places that have specifically employed the PA concept where they have the physician assistant, but many other places … are using paramedics with some specialized training to do some of that patient navigational work, referring patients to somewhere other than an ambulance or to the emergency room,” said Matt Zavadsky, at-large director at the National Association of Emergency Medical Technicians.

“Any coordinated approach to getting the right patients to the right help at the right time, and quite frankly, at the right cost, is better for the patient and better for the system,” he said.

In terms of the cost to patients, Mountain Vista has yet to share details about how billing will be processed.

“We’re still in the pilot and data-collection phase, so there has been no billing,” said spokeswoman Michelle Swafford. “(Any) savings are not quantifiable at this point.”

Mesa and Mountain Vista officials meet monthly to review the program’s progress and likely will take a more comprehensive look at what’s next closer to the one-year point, Smith said. Right now, the Fire Department has four smaller units in rotation vs. about 25 traditional engines.

“If the program continues to make a positive impact on our delivery of service, then we will look at the feasibility of expanding the program,” Smith said.