A new 911 Nurse Navigation program launched in June by American Medical Response and Stanislaus County aims to reduce the number of non-emergency ambulance runs to hospital emergency rooms by referring those patients to other forms of medical care.
Two neighboring counties are also expected to have Nurse Navigation in place in the coming months, perhaps by the end of 2026.
Last year, Stanislaus County received about 86,000 medical-aid calls through its 911 system – including thousands for situations that were lower-acuity, non-emergency cases for which an ambulance trip to a hospital was not medically necessary, said Chad Braner, director of the Stanislaus County Emergency Medical Services Agency.
“Not every medical call or complaint that goes to the 911 system requires an ambulance or transport to the emergency department,” Braner said in an interview with the Central Valley Journalism Collaborative.
Stanislaus County EMS dispatchers already go through a list of screening questions when they answer a 911 call to assess the severity of a case and prioritize the urgency for which an ambulance may be needed. Now they have an option, on seemingly non-urgent calls, to connect those callers to 911 Nurse Navigation, where a licensed nurse can further talk to the patient and provide them with guidance on a more appropriate level of care, from referrals to nearby urgent-care clinics, mental-health resources, telehealth or even self-care at home for minor cases, Braner said.
The program provides another layer of triage to help sort through potential non-emergency 911 calls, Braner added.
“Nurse Navigation … is more directed at making sure that the individual, based on their medical complaint, is receiving the right care at the right time in the right place,” he said.
In just the first 10 days of the program, Braner said, at least 10 callers were referred to nurse navigators who were able to walk them through the process of caring for their ailments at home without any additional services.
Diverting at least some 911 calls to nurse navigators relieves some strain on hospital emergency rooms and ambulance crews, “saving those resources for the more emergent calls within the system,” he said.
Braner said that of the 86,000 medical aid calls to 911 in 2025, almost 13,400 were the type of low-acuity cases that would have been eligible for nurse navigation, according to the county’s protocols. Because those happened before 911 Nurse Navigation, he said, all of those received an ambulance response.
Daniel Iniguez, American Medical Response’s regional director for the northern part of the San Joaquin Valley, told CVJC in an interview that Stanislaus County’s 911 Nurse Navigation is the first in the San Joaquin Valley. But he added that plans are in the works for Nurse Navigation to be put in place in neighboring San Joaquin and Merced counties, possibly as soon as the end of this year.
Nurse Navigation programs are already being used in other parts of California and across the United States, Iniguez said, and are not unique to areas served by AMR.
AMR provides the lion’s share of ambulance runs in Stanislaus County, including the Modesto metro area.
The company’s data shows “that a lot of people call 911 because of either just not understanding how the emergency health care system works,” Iniguez said, “or not having access to care in their areas because they’re in more rural areas, because they don’t have a car to get to an urgent care clinic, maybe urgent care clinics are not open in their area.”
Iniguez said that based on AMR’s experience in other areas, the first year of Nurse Navigation operation in Stanislaus County is expected to divert between 3% and 7% of 911 calls away from ambulance response. That estimate increases to 15% or more by year three and beyond as residents become more accustomed to the system and more often refrain from calling 911 for non-emergency situations.
Iniguez said the new system will be an adjustment for callers and that public education is needed for the new system to yield the maximum benefit.
For callers, “it might feel different, and it might in some cases take more time with the dispatcher,” Iniguez said. “In the end, we think we can get the community to a better place and have better options … because a lot of people call 911 because they’re scared at the moment, and can we talk them down better. Can we give them other pathways to healthcare, other than an expensive ambulance ride, an expensive ER trip?”
For those callers who don’t have transportation, nurse navigators can also set up rides with Uber or Lyft, at no charge to the patient, to an urgent-care facility or other medical care short of an emergency room.
During the program’s initial stages, both Iniguez and Braner said, the choice to refer a call to a nurse navigator is up to the caller. Based on the initial screening of medical criteria, a dispatcher can tell the caller they are eligible for nurse navigation and ask if they wish to be connected.
“If the patient or the caller on the other end wants an ambulance outright, they’ll get an ambulance right then and there,” Braner said. “Even if they get routed to the nurse navigator and they still want an ambulance, they will get rerouted back” to the 911 dispatcher to re-triage the patient and send an ambulance.
The county already has a set of protocols and policies for emergency medical situations that establish the priority for sending ambulances out on calls depending on the severity or acuity of the conditions described by a caller to a 911 dispatcher.
Iniguez told CVJC that Global Medical Response, the larger company that operates AMR, has 911 Nurse Navigator call centers in Texas and Arizona. When a local 911 dispatcher in Stanislaus County transfers a caller to Nurse Navigation, they are connected to a nurse who is licensed to practice in California and assigned to the county. The nurse’s computer system includes a complete list of medical resources – hospitals, clinics and other health facilities – to which a caller can be referred based on which is closest to the caller’s location.
But the remote location of the nurse navigators from Stanislaus County can give rise to concerns about delays in care. Earlier this year, in an investigation into gaps in the Nurse Navigator system, The Seattle Times reported on the case a 71-year-old woman who called 911 and was transferred to an AMR nurse navigator in Texas for severe knee pain; she waited for 10 hours for a nurse-ordered ambulance and was found dead when an ambulance crew finally arrived.
Braner said he was aware of the Seattle case, but told CVJC that he’s confident that the policies and protocols required by Stanislaus County provide sufficient safeguards to prevent that from happening – especially the requirement that if a caller tells the nurse navigator that they want an ambulance, or there are particular symptoms described by a caller, the navigator must redirect the call back to the county’s 911 system.
Three ambulance services, serving more rural areas of Stanislaus County, are not yet included in the 911 Nurse Navigation system. Those are Oak Valley Ambulance serving the communities of Oakdale, Waterford and Riverbank; and Patterson District Ambulance and Westside Ambulance, both covering western portions of Stanislaus County along the Interstate 5 highway corridor.
“They are interested in nurse navigation, but I believe they are waiting for a little more data on our end to see if it’s something they want to participate in,” Braner said.
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