NC community paramedics hit the streets

Two paramedics received training to visit patients' homes as part of a program to reduce high-frequency utilizers and hospital readmission rates

By John Hamlin
The News & Observer 

SMITHFIELD, N.C. — After months of preparation, Teresa Wall and Bradley Chestnut could not wait to punch the clock this week as Johnston County’s first community paramedics.

“I think everybody involved is very eager for us to get started,” Wall said.

Whereas most EMS employees respond to emergencies, the community paramedics will spend their days working to prevent health crises from occurring, said Johnston EMS chief Josh Holloman. That work will run the gamut, Holloman said, and include helping patients understand their doctor’s instructions and making sure they take the right medications.

“We think there will be medical needs, and we think there will be social needs,” Holloman said.

Chestnut said it’s all about educating the community and giving people the resources they need to lead healthy lives. Much of that will involve connecting people with community services they might not know about, he said.

On Tuesday, Wall and Chestnut began trading off working 12-hour shifts, from 7 a.m. to 7 p.m. seven days a week. Both have worked as Johnston EMS paramedics for years, and they underwent about a month of additional training to prepare for their new roles. During that time, Chestnut said, they got instruction from outside agencies, such as Community Care of Wake and Johnston Counties and Johnston Health’s Home Care and Hospice division.

Johnston EMS re-purposed one of its SUVs for the program and labeled it CP-1 for “Community Paramedic One.” The truck will not routinely respond to emergencies, but it does have a full set of equipment in case it is needed on a call. That gear includes a heart monitor, kits to aid children and burn victims, oxygen bags, blood-pressure cuffs and medicines.

“If need be, we’re response ready for an emergency,” Chestnut said.

Wall took the first shift, and she had a list of names ready to begin calling, she said. Once the program gets fully underway, Wall said, Johnston Health will begin recommending patients to the program, and they will start making visits to people’s homes.

The program will primarily target three populations: high-frequency EMS users, defined as people who call 911 four times in 30 days; high-frequency emergency room visitors; and people discharged from hospitals who have a high risk of coming back within 30 days. Holloman said many people fall into two or three of those categories.

The goal is to reduce the size of those three groups by 20 percent, Holloman said. Wall and Chestnut feel confidant they will do even better, they said.

Johnston EMS won a $350,000 Duke Endowment grant to start the community paramedic program, Holloman said, and that funding runs through November 2016. Among other things, it covers fuel, medical supplies and equipment, laptop computers and paychecks for Wall and Chestnut.

By the time the grant expires, Holloman said he expects to have data showing the program saves more money than its costs. That should give Johnston EMS a strong case to continue the program when it asks the Johnston County Commissioners to pick up the funding, he said.

“If we can prevent a medical condition before it gets worse, that’s the cheapest way, and not to mention the best way, for both the patient and the system,” he said.


©2015 The News & Observer (Raleigh, N.C.)

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