You and your family may have experienced paramedics showing up at your home for a medical emergency. But soon those same medics, in Ohio, could be making house calls without light and sirens just like doctors did many years ago.
The practice is called community paramedicine and it has been around for about a decade in some parts of the country including Texas and Minnesota.
"I happen to look at it as preventative maintenance, trying to stop the accident before it happens," said Chris Anderson, a community paramedic with North Memorial Hospital in Minnesota.
Anderson has been involved in emergency medical services for more than 30 years and has been a medic for much of that time.
"I've been thinking, there are a lot of these patients that just didn't need to go into the hospital if someone had stepped in you know an hour or two or day or two earlier just taking care of something simple like you know fixing up their medications," Anderson said.
Now Anderson visit and provides care to four to eight patients a day. He said an important part of the process is the social interaction with those he is treating.
"When you visit your doctor, you know you're kind of in there, you get your 15 to 20 minutes with the doctor and he's trying to catch up on basically everything since your last visit while he's there,” Anderson said. “Ambulance call, we're there in a middle of an emergency, and 10 minutes for us is forever there. With a community paramedic, in the model that we have set up at North Memorial, we allow basically two hours per patient."
That is correct. He can spend up to two hours with each patient.
Community paramedics often provide routine services in the home like checking blood pressure, checking blood sugar, changing wound dressings, and assisting with daily medications.
The goal of paramedicine is to get the person to the right healthcare setting.
Community paramedicine will soon be available for some Ohio residents. As part of the recent state budget, lawmakers included language to allow paramedics to provide both “emergency” and “non-emergency” care.
The University of Cincinnati has already held several seminars on the topic and has another one set for August 21st. Larry Bennett, who chairs the fire science and emergency management program, said there are two models for community paramedicine. One deals with what emergency responders call “frequent flyers.”
"The person who keeps calling 911 and gets delivered to an emergency room and then calls 911 and gets delivered to an emergency room,” Bennett said. “So community paramedicine has developed around the nation to help those folks find local resources so they don't call 911."
That care delivered in an emergency room setting is much more expensive, and often could be better handled in a primary care setting.
Bennett said the other model deals with patients who have recently been released from the hospital.
"Who don't have home care insurance and so they're without home care or their insurance has lapsed,” Bennett said. “And in that second model, around the nation, hospitals are now beginning to use paramedics and EMT basics to render home care service."
To be clear, community paramedicine is not designed to compete with existing home care services.
Local fire departments and EMS providers are exploring there options for community paramedicine.
Monroe Fire Chief John Centers is ready to form a partnership with a nearby retirement home. He called it a groundbreaking concept.
"It allows us to do follow-up on patients that we typically wouldn't get to see other than their 911 transport,” Centers said. “So when you get back to the station you wonder, you know I wonder how this person did or that person did. We'll have the capability to do follow-up with them."
Centers also called community paramedicine a “proactive, local, healthcare option.”
The Cincinnati Fire Department is also exploring the idea. Fire Chief Richard Braun is more interested in dealing with the frequent flyers. He said he sees it as a way to triage medical calls coming to the city's 911 communication center.
Braun is working on a business plan to present to city council, and said the program must be self-supporting.
“We don't have in our budget to add people that we wouldn't be getting reimbursed to sustain the program,” Braun said. “And that again would be part of our business plan, this is how much we project it would bring in, this is what we project it would cost."
Braun said some funding could come from insurance reimbursements, and Medicare or Medicaid. He said community paramedicine in the city could begin as a pilot program using overtime to see if it works.
UC's Larry Bennett said the idea is good for a number of reasons including allowing communities to better use healthcare resources.
"It's a good thing because it's going to reduce the misuse of emergency departments,” Bennett said. “And it's a good thing because it's going to tie community resources to patients who need them."
Ohio regulators must still decide some of the rules for community paramedicine.
Those regulators could write state requirements for the concept or allow local medical directors for fire and EMS departments to decide what community paramedics will be allowed to do.
Chief Centers said he is hoping to have a program operating in about two months. Cincinnati's Chief Braun said he wants a pilot operating by the end of the year or first part of next year.
