Pueblo Triple Aim

Fire Department

Weird smell, broken pipes, electrical issues, “I’ve fallen and can’t get up”, medical alarm, can’t light the water heater, car broke down … If the dispatcher doesn’t know who to call they send the fire department.
Sometimes the call is, “My house is on fire!” Then, it’s obvious.

None of us plan on leaving our irons on (or pressing the wrong button when microwaving popcorn, or finding our cat stuck in a tree), but it’s comforting to know the fire department is prepared for when we do. Firefighters serve everyone, but not many people know much about them beyond what they’ve learned from movies and TV.
I know some firefighters and have found this to be true: It is a calling, not a job. Their days may not look quite like Hollywood portrays, but too many times they run into danger: car wrecks on busy highways, power lines struck down in the crash, taking care of medical patients strung out on drugs, trauma victims at the scene of a shooting, or rescuing someone from a burning building.
The firefighters I know are some of the best people in my world. Not the least of which is Chief Shawn Shelton, Chief of the Pueblo Fire Department. Here are his words about Pueblo’s grass roots DOTS (Directing Others to Service) program – which is saving people one life at a time.


Written by Shawn Shelton
In my 30 years in the fire service, I have witnessed several evolutions of the services we provide to our community. The American Fire Service is steeped in tradition that goes back more than 200 years; those traditions are what define us as firefighters. Our core tradition of providing protection of life and property is still the fundamental principle of the modern fire service. What has changed is the way we deliver services to our community.
Our roots lay in providing protection from fire and performing certain rescue operations. In the 1970s we began to expand that role to include the delivery of emergency medical service (EMS). This service came to maturity in 80’s and is now so ingrained in the fire service that most firefighters do not remember a time when it was not the largest part of what we do. The fire service of today embraces emergency medicine with the same vigor and commitment as any other part of our job.
The community’s expectation of the role of the fire service in emergency medicine has also evolved. Today citizens have come to expect a very high level of service through the 911 emergency response system. So much so that now many use the 911 system as an access point to fulfill all of their medical needs. While I would argue that this is not the appropriate use of the 911 system it is where evolution has brought us.
Perhaps our greatest strength as firefighters is our resiliency and ability to adapt. We are excited by the prospect of facing a challenge and finding a solution that has a positive outcome. To that end, we are currently faced with an ever-increasing volume of calls for service, so many, in fact. that we will not be able to sustain our self-imposed and expected high level of service much longer. We have been searching for solutions to this problem and have identified several courses of action. One of those is the creation of our Directing Others to Service program (DOTS).
Our DOTS program is a form of “community paramedicine” and as such, it differs from traditional EMS delivery in that it is proactive. Our DOTS team reaches out to patients that have exhibited a high dependency on the 911 system. We offer them the opportunity to voluntarily participate in a program that can help them help themselves. These patients are assessed to determine their needs and we help them access the care they need. This could be anything from identifying medical hardware needs to enrolment in the community health care program or other social services programs to making arrangements for help from their family. Perhaps the most significant aspect of the program is the heavy emphasis on working with them to become more self-reliant and take responsibility for their own health.
Our DOTS program has been in existence for a little over a year now and the initial results are encouraging. We have seen a positive change in the clear majority of people that have been enrolled in the program. We have also seen significant declines in emergency room visits and 911 responses for these individuals. The long-term effects of this program are still to be determined but we are encouraged enough to continue along this new path and see where it take us.
The Fire Department is not alone in this effort, the success of this program is grounded in the cooperative effort of many agencies. To direct others to service we must first determine what services are available and how to access them. The creation of this program required many interactions with a wide verity of community partners, many of which are part of the Pueblo Triple aim network. The sustainability of the DOTS program is directly tied to the ongoing cooperation of the community partners that created it.
The continued evolution of the fire service will undoubtedly take use down paths that we have not even imagined yet. The path of community paramedicine is a new one for us but I believe it will someday be as common as EMS response is today.

Shawn Shelton
Fire Chief
City of Pueblo, Colorado

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