Community Paramedicine-- Reaching the Underserved

 
An elderly wife calls 911.  Her husband has fallen and she can't lift him.  When the paramedics arrive, they notice the home is in disarray.  This couple needs help beyond the immediate assistance to lift the husband off the floor.  Jesse Ebersole, Fire Department Captain, presented the community paramedicine program-- the first in the State.  A team of paramedics, physicians, and social service providers identify and assist underutilizers of the healthcare system, particularly elderly, to connect them with services and prevent more serious injuries or sickness.  The team also regularly strolls through homeless camps to tend to wounds and other needs.  They use a computer program to identify frequent 911 callers and assess their needs.  When they are called to a home and notice potential fall hazards, they perform an assessment and provide preventive aids such as slip-resistant mats or shower chairs.  The goal of the community paramedicine program is to save overall healthcare costs by proactively preventing people from using the emergency care system as their primary care.
 
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Our County is in a fortunate position to leverage the skills of paramedics to address broader healthcare needs.  No other fire department in the State provides emergency medical services (EMS), which the State Department of Health contracts with our County fire department.  All firefighters are trained at least to EMT; several are trained to paramedics. Over 50% of EMS calls are for elderly (60+ years old). We are the first county in the State to implement the community paramedicine program.  It is a proactive program to IDENTIFY, ASSESS, and CONNECT overutilizers, vulnerable, and homeless with appropriate services. This group uses a disproportionate amount of healthcare cost and resources, and diverts emergency response from more serious emergencies.  
 
Frequent Flyers are those who call 911 3+ times over a 6 month period-- 289 individuals account for 10% of EMS calls. Of the frequent users, 25% are homeless. One problems is the high percentage of drug and mental health issues that are difficult to address.  A team visits homeless encampments monthly to assess needs. The team usually does wound care, which can quickly worsen to systemic infections in the conditions they live in.
 
Falls are a leading cause of accidental injury and death for the elderly.  The average cost of falls is $34,000.  Anyone may call for a home fall assessment. Grants have generously paid for fall prevention tools such as non-slip mats and booties, shower chairs, etc.
 
Other initiatives by the program include providing events teams to quickly respond to emergencies in crowds (e.g., Ironman), providing cardiac arrest survival training (hands-only CPR & AED training).  In response to a question from the audience regarding health care directives, Jesse noted that  paramedics are trained to honor such directives and would not resuscitate if instructed by the directive.  So have these directives readily available.