History of Contemporary Community ParamedicineA community paramedic is a state licensed EMSA...

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History of Contemporary Community ParamedicineHistory of Contemporary Community Paramedicine

NCSL Legislative SummitGary Wingrove, Mayo Clinic Medical Transport

© 2012 North Central EMS Institute. Community ParamedicTM. All rights reserved

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IRCP 2013

• Warwickshire, England, United Kingdom• May 20-23, 2013

• 2014 In USA

www ircp infowww.ircp.info


Filling an Unmet Need with Untapped Resources


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Filling an Unmet Need with Untapped Resources


Expanded Services

• Primary care• Primary care• Emergency care • Public health • Disease management • Prevention• Wellness• Wellness • Mental health• Dental care


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Keys to Community Paramedic Program

Flexible Resourceful

Rural and Remote Centric

Gap-filling


Working Definition

A community paramedic is a state licensed EMSA community paramedic is a state licensed EMS professional that has completed a formal educational program through an accredited college or university and has demonstrated competence in the provision of health education, monitoring and services beyond the roles of traditional emergency care and transport and in conjunction with medical di ti Th ifi l d idirection. The specific roles and services are determined by community health needs and in collaboration with public health and medical direction.


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© 2012 the North Central EMS Institute Community Paramedic. All rights reserved 9


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Figure 3: Primary Care Services to be offered by the Respective Community Paramedic Programs

STATE:

PROGRAM:

SERVICES Patient History/Physical Assessment x x x x x x x x x x x x x x x x Weight Checks‐Adult and Pediatric x x x x x x x x x x x x x x x Well Child Checks x x x x x x Vital Signs x x x x x x x x x x x x x x x x Blood Pressure Screening x x x x x x x x x x x x x x x Cholesterol Screening x x x x x Routine Follow‐up 12‐Lead EKG x x x x x x x x x x x x x x x x Blood Glucose Checks x x x x x x x x x x x x x x x Pulse Ox Monitoring x x x x x x x x x x x x x x x x Set Up CPAP x x x x x x x x x x x x x x Ultrasound x x x Lab Specimen Collection x x x x x x x x x x x x x x x Lab Specimen Testing (Inc. I‐STAT) x x x x x x x x x Neurological Assessment x x x x x x x x x x x x x x x Post Stroke Assessment x x x x x x x x x x x x x Ophthalmoscope x x x x x x x Chronic Disease Management (heart disease, asthma, COPD, diabetes) x x x x x x x x x x x x x x x x Managing Surgical Drains x x x x Managing Tracheostomies x x x Managing Catheters x x x x Managing PICC lines x x x Peripheral Intravenous Lines x x x x x x x x x x x x x x IV Catheter Changes x x x x x x x x x x x x x x


Antibiotic Infusions x x x x x x x x Suture Removal x x x x x x x x Treatment of Minor Injuries x x x x x x x x x x Post Partum Home Visits x x x x x x x Infusion Therapies x x x x x Wound Care x x x x x x x x x x x x x x Wound Vacuum x x x x x Medication Monitoring/Reconciliation x x x x x x x x x x x x x x x x Immunizations x x x x x x x x x x x x x x Fluoride Varnish for Children x x In‐Home Lifestyle/Safety Evaluation x x x x x x x x x x x x x x x x

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Curriculum Distribution


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The Models

P i H lth• Primary Healthcare• Substitution• Community Coordination

Blacker, N., Pearson, L., & Walker, T. (2009). Redesigning paramedic models of care to meet rural and remote community needs. The 10th National Rural Health Conference, Cairns, Australia, May 17‐20, 2009. (Accessed via http://10thnrhc.ruralhealth.org.au/papers/docs/Blacker_Natalie_D4.pdf on November 30, 2011).


Province of Nova Scotia

Primary Healthcare:Primary Healthcare: Long and Brier Islands (NP/CP)Substitution: Collaborative Emergency Centres (RN/CP)Community Coordination: Nursing Home Care (CP)


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Province of Nova Scotia: Results

P i C• Primary Care:Reduction of doctor visits by 28% and reduction in trips to the emergency department by 40%

• Substitution: Pending (Expanded to 5)• Community Coordination: Early –Community Coordination: Early

68% (Expanded to 17)• System: $2,380 to $1,375 (-42%)


City of Saskatoon

Primary Care Model: Health Bus y(NP/CP) Monday 19th Street/Avenue C

Tuesday Safeway Parking Lot(Avenue D & 33rd St)

Wednesday (20th Street/Ave M)

Thursday Shell Service Station(22nd Street/Ave P)

Friday Giant Tiger (22ndStreet/Ave F)

Saturday Appleby Drive

Sunday Affinity Credit Union(20th Street/Ave P)


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City of Saskatoon

C ll b ti M D A b l C t l• Collaboration: M.D. Ambulance, Central Urban Metis Foundation, First Nations, Saskatoon Health Region, Provincial Ministry of Health

• Results: According to the province, during g p , g2009-2010, approximately 5,936 visits to the Health Bus were recorded, where 43% were repeat clients.


Province of Alberta

R i b L k NP/CP CP l• Rainbow Lake: NP/CP or CP alone operate clinic

• Calgary/Edmonton: CREMS• Medicine Hat: Night and weekend

home health


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Scott County, MN

C t P bli H lth• County Public Health• Mdewanketon Sioux


Minneapolis

• North Memorial Healthcare• ACO Model

• North/Allina/HealthEast• MnSCU training grant

One stop number for health plans• One stop number for health plans


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Western Eagle County, CO

• Diagnosis (Patients may have more than on diagnosis):

• • 68% cardiac, 36% diabetes, 32% respiratory issues, 23% 68% cardiac, 36% diabetes, 32% respiratory issues, 23% neurological issues, 18% psychiatric issues

• Co-Morbidities and Risk Factors:• All patients were considered medically vulnerable due to

co-morbidities and risk factors:• • 60% of patients had more than one health issue (e.g., diabetes,

hypertension, asthma)• • 60% of patients were over age 65 and had underlying health 60% of patients were over age 65 and had underlying health

conditions• • 14% of patients were recently discharged from the hospital, and

had an unrelated, underlying medical condition or risk factor (such as hypertension or being elderly)

23© 2012 North Central EMS Institute. Community ParamedicTM. All rights reserved


• Services Ordered:• In 65% of visits, medication compliance and reconciliation

was ordered• In 46% of visits, a blood pressure check was ordered• In 29% of visits, a blood glucose test was ordered• In 22% of visits, an oxygen saturation test was ordered• In 9% of visits, a home safety inspection was ordered

In 6% of visits a social and/or adult protection• In 6% of visits, a social and/or adult protection evaluation/assessment of alcohol usage ordered


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• Higher Level of Service Utilization Prevented:• Prevented an average 2.5 doctor visits per patient, an

ambulance transport in 36% of patients, an emergency room visit in 36% of patients, a hospital admission/readmission in 5% of patients, and kept one client out of skilled nursing for 26 weeks

• Initial Cost Savings:• Initial Cost Savings:• $1,507 average savings per visit• $4,451 average savings per client/patient


Resources

• IRCP: www ircp info• IRCP: www.ircp.info• Document repository• Monthly conference calls (many

archived)A l ti• Annual meeting

• Toronto’s CREMS and Calgary’s Health Assessment Programs


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Resources

• www.communityparamedic.org• Paramedic requests for FAQ• College requests for curriculum• Agency requests for program manual



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CP Program Manual


G’Day Mate!


History of Contemporary Community ParamedicineA community paramedic is a state licensed EMSA...

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