Community Risk Reduction
f o r d I love to use the Anaheim, California, case study for community risk reduction (CRR) for several reasons. First, it provides a specific example of
how changes in emergency response can help reduce
risks for the community. It is also a reminder that the
process steps for CRR may be applied to risks other
than fire. And it’s a great way for us to collectively
demonstrate how helping our community manage
risks can help us get ahead of the call.
Fire Chief Randy Bruegman and Paramedic Captain
Dave Barry have been helping our collective efforts to
increase the use of CRR concepts locally by sharing
this example of their Community Care Response Unit
(CCRU) and how it came about. It is a nontransport
unit that is staffed with a paramedic and a nurse
practitioner to respond to low acuity calls, providing
assessment and care directly in the field. It is modeled
after a pilot program in Mesa, Arizona, but also arose
out of a realization that the Affordable Health Care
Act provided Anaheim with an opportunity to partner
with local hospitals to find better and less expensive
ways to provide service.
Anaheim’s risk assessment, like many others, showed
a very high incident rate for medical calls in the community, and the responders knew the numbers were only
going to climb because of an aging population. They also
had impetus to put the program together because of a
report released in 2012 from the Orange County Grand
Jury. This rather unique aspect of a grand jury is new to
me but driven by state law in California. The civil, or
“watchdog,” responsibilities of the grand jury include
the examination of all aspects of county government,
including special districts, to ensure the county is being
governed honestly and efficiently and county monies are
being handled appropriately.
The report helped provide the impetus for change
in Anaheim, which Bruegman leveraged into support for the plan to implement a Mobile Integrated
The goal of the program was to increase advanced
life support (ALS) availability, test mobile health care
integration, create a hospital-fire-ambulance partner-
ship, and reduce trips to the emergency room. The
partnership was formed with the Kaiser Permanente
of Orange County and CARE Ambulance service.
They secured a private ambulance and equipped it so
that they could (among other things) bandage, suture,
clean wounds, prescribe certain medications, conduct
blood analysis, and communicate directly with primary and urgent care facilities.
True to our model of CRR, their efforts include an
evaluation component to demonstrate the results they
have achieved. Between May 2015 and May 2017,
they have documented a number of improvements
that show the value of this program, including the
• 1,709 dispatches.
• Saw 554 patients.
• Ran on an average of 23 calls per month, 5. 4 calls
Anaheim CARES Unit
A specialized care vehicle that treats
low acuity calls in the field
Above: The CCRU is a nontransport unit that is staffed with a
paramedic and a nurse practitioner to provide assessment and
care directly in the field. (Photos by Anaheim Fire & Rescue.)
Below: This model provides them with the opportunity to integrate
ourselves into the broader public health arena, where they are
viewed as an integral part of the overall medical system.