DOTS began as a response from the Pueblo Fire Department to the ever-rising burden of increased calls to emergency services. These calls impact the availability of first responders for true emergency purposes and put an immense strain on resources that are already stretched thin across the community while attributing to the rising cost of care.

Identify potential participants: A person with more than ten EMS calls in a twelve-month timeframe is eligible for referral into the program. Referrals are accepted from the Fire Department, American Medical Response and the two local hospitals through the Emergency Department. A referral form was adopted to ensure proper information is being shared with the Fire Department from the various agencies who are referring.

Assess individual needs and strengths: Through a collaborative approach, each participant works with a navigator and outreach personnel to complete an assessment of the living area and medical history. Barriers are identified on an individual basis and through numerous community partners, resources are secured to address the barriers. Oftentimes, it's something as simple as removing rugs that create fall hazards around the house or installing a bar in the bathtub to ensure safety when bathing. Outreach personnel are able to interact with participants in their home environment, which aids in identifying and addressing issues that arise. It also helps participants to feel more comfortable and that leads to a more open and honest conversation.

Provide wrap-around care: A wrap-around model of care is instituted through the use of the outreach personnel that volunteer their time off to participate in the DOTS program. One-on-one conversations are pivotal in ensuring patient goals are clearly identified and barriers to achieving those goals are addressed.

The entire process is geared toward identifying the interventions that make the participant's life a little easier and ultimately reduce the burden placed on first responders. Many times, the interventions are something very simple...removing fall hazards, installing assistive devices or connecting with primary or behavioral health services. Some interventions aren't as easy to implement such as reconnecting a participant with family who can provide caregiver support. This often takes a longer time and requires more intense intervention.

Length of Stay in Program: Program participants are able to remain in the program as long as they are making progress and barriers still need to be addressed. Participation is completely voluntary and can be ceased at any time. Once adequate solutions have been found to the most pertinent barriers, a participant can be graduated out of the program and referred back to their primary care physician. Goal is to reduce the number of EMS calls and creating an overall safer environment for each participant to live and thrive.