People typically associate paramedics with ER, CPR, and high-speed ambulance trips to the nearest hospital with blaring sirens. But that image is changing.

Across Michigan, communities, healthcare plans, physician groups and healthcare systems are adopting a new, more proactive model: Integrated Community Paramedicine (IPC). The CIP employs paramedics to perform basic non-emergency clinical tasks on-site at people’s homes. CIP’s goals include reducing hospital admissions and readmissions; decrease in emergency room visits; and expanding access to health care to populations who lack insurance coverage, transportation, or the ability to establish healthy relationships with their own primary providers. In other words, CIP can help close the health care disparities that plague Michigan communities, especially among people with income issues.
Kristine Kuhl.
“Community paramedical services can fill gaps in the existing health care system,” says Kristine Kuhl, community paramedic coordinator for the Michigan Department of Health and Human Services (MDHHS).

IPC can improve outcomes, build community relationships, and reduce disparities in health care. MDHHS’s goal for the CIP is to build an infrastructure that moves modality into the Michigan Emergency Medical Services Systemstandardized structure. The Michigan Health Endowment Fund provided grants to the state to carry out this process.

In February 2020, we reported that nine agencies in eight counties in Michigan were using CIP to reduce costs and improve outcomes for residents of their communities. Some have used a mobile integrated health model, sending paramedics on scheduled visits to educate and help those at risk for medical emergencies or hospitalization. Others have followed a community paramedic model, where paramedics interface with the 911 system to answer low-priority 911 calls in an attempt to reduce hospitalizations.

“Community paramedical programs are starting to show their value. We have seen it all over the country and even around the world, ”says William Brodin, North-West Regional Medical Control Authority specialist. “The benefits are an overall reduction in health care costs, better access to health care and help to fill gaps in health systems. “

Brodin is involved in community paramedical programs in Kalkaska, Green Lake and Missaukee County. He notes that the Kalkaska program saved the Kalkaska Memorial Health Center approximately $ 15 million over a three-year period.
Mike Berendsohn, EMS director at Kalkaska Memorial Health Center, with a smaller vehicle often used for community paramedics.
“It’s a small community hospital, nothing big. They have reduced readmissions, reduced the number of visits by frequent users of the health system, reduced stays and admissions, ”explains Brodin. “They have also provided access to health care to some of those in northern Michigan who are far from a lot of things, including health facilities. Sometimes, especially in winter, it is difficult for [home health care to reach] patients who have difficulty moving. The community paramedical care programs here help fill these gaps. “

Likewise, a community paramedical program run by St. Joseph Mercy Oakland Hospital, Bloomfield Township Fire Department, and EMS star resulted in a 70% reduction in hospital readmissions. A 2016-2018 Washtenaw County study on Emerging health partnersThe CIP pilot program found that out of 2,000 patients seen, 53% were treated on-site and could stay at home, saving $ 2-2.5 million, or about $ 500 each for the hospital transportation and $ 1,500 to $ 2,000 each in emergency costs.

Currently, 17 community paramedical programs are operational in the state. Three more will be on board by January 2022. Two more should be launched in early 2022, particularly in the region of the counties of Marquette-Algiers, which will be the first in the Upper Peninsula. And more are on the way. Brodin also works with Munson Healthcare’s Paramedic Training Program, where a certified emergency medical technician can advance their certification to include community paramedics. The 11-week program includes online courses, reading assignments, and hands-on clinical experience.

“They go out and practice community paramedical skills with home health workers, hospice staff, different areas of case management, community mental health and some of the primary health care providers,” he says. “They learn how everyone interacts with health care systems and frame the gaps and offer, ‘This is how we can help and this is my number. Call us.'”

Community paramedics can visit patients who have returned home after hospitalizations or surgeries. They can help them understand and follow their care plans more closely, reconcile their medications to rule out contraindications and ensure proper dosages, and check for sepsis, proper wound healing, oxygen levels. or water weight gain. During the visit, they may perform home safety checks for smoke and carbon monoxide detectors, trip and fall hazards, and dangerous clutter. They can also take a look around the kitchen to make sure the refrigerator is working and that patients not only have access to healthy food, but also the capacity and the means to prepare it. Community paramedics can also attend to patients who have not been hospitalized but who are living with chronic illnesses such as congestive heart failure, COPD, diabetes, or substance use disorders.
Andrew Brown.
“Community paramedics can help high-risk, high-use patient populations who are going to be older; have one, two or more comorbidities; and sought care through the emergency department or other means, ”said Andrew Brown, vice president of stakeholder integration for Medstar, Southeast Michigan’s largest provider of emergency medical and mHealth services, serving Bay, Clinton, Eaton, Genesee, Ingham, Lapeer, Macomb, Oakland and Wayne counties. “Community paramedical programs are really focused on improving the health care system so that these patients do not have to seek treatment. Community paramedics can visit these patients and attend to minor needs at home and alleviate their need to be seen in a facility.

Community paramedics can take vital signs, check weight gain, listen for lung sounds, draw blood for the lab, or perform diagnostic tests like EKGs. They are also trained to administer intravenous fluids to treat dehydration, replace Foley catheters, change ostomy bags and dressings, and provide wound care.

The CIP may be particularly relevant to Michigan’s aging population, particularly in rural areas of the state where hospitals and doctor’s offices may be on hours. For example, after surgery, an older adult may need extra help understanding and following a care plan, managing medications, or meeting follow-up appointments.

“We have also started working with the Veterans Administration, researching how to use EMS,” Kuhl said. “Paramedics are already asking if anyone has served. We are looking to use community paramedical services to go further, to take the time to establish security mechanisms for suicide prevention. … 911 paramedics may not have time for these prolonged conversations.

In rural Michigan, where pregnant women may live hours away from the nearest doctor or maternity ward, paramedics will soon serve as the liaison between the OB / GYN and the expectant mother to ensure she is is on the right track and has the resources it needs. for a healthy pregnancy. Community medicine is also a very effective way to fight the opioid epidemic in Michigan.

“Community paramedics have a level of trust and sometimes existing relationships with people who are dealing with substance abuse disorders,” says Kuhl. “These are not unfamiliar faces. We have noticed that people with substance abuse disorders are quite open to the intervention of community paramedics and help them either directly or by connecting them with a warm transfer to the appropriate resources.

The COVID-19 pandemic has also been a driving force for community paramedics. Overcrowded hospitals and the need to socially distance have made routine trips to a doctor’s office or hospital emergency department much less available. Some community paramedics connect patients with providers by video conference during home visits. Others intervene with basic clinical services that had been relegated to doctors’ offices and health care facilities. For example, Medstar paramedics provide at-home monoclonal antibody infusion therapy for people diagnosed with COVID-19 and living with chronic obesity, hypertension, kidney disease, COPD, or diabetes. The goal is to reduce the severity of their symptoms and help them avoid hospitalization. After giving the IV drip for 15 to 30 minutes, the paramedic stays to monitor the patient for an hour afterwards.
Medstar Mobile Health Paramedic Nicole Plauman demonstrates an IV monoclonal antibody therapy setup at home.
“Community paramedicine advances care in homes and in the community rather than in doctors’ offices or hospitals. The pandemic has really intensified the integration of this model, ”said Brown. “These programs will only benefit the model of health care delivery within the state and the communities we serve.” This will be the new way EMS provides medical help. “

A freelance writer and writer Estelle Slootmaker is happiest writing about social justice, wellness and the arts. She is the editor-in-chief of development news for Fast growing medium and L’Arbre Amigos chairs, Wyoming City Tree Commission. His greatest achievement is his five incredible adult children. You can contact Estelle at [email protected] Where www.constellations.biz.

Northwest Regional Medical Control Authority photos by John Russell. Medstar photos courtesy of Medstar. Photo by Kristine Kuhl courtesy of MDHHS.