Calif. fire departments apply for community paramedicine pilot program
Two departments hope to allow 20 paramedics to make home visits to patients; nurses unions are loudly objecting
By Rebecca Parr
The Daily Review
HAYWARD, Calif. — Paramedics could have a bigger say over where 911 emergency patients are treated and aid in their recovery after hospitalization under a proposal to expand their health care roles -- a move opposed by nurses unions.
Currently, paramedics must send patients who call 911 to a hospital emergency room, a costly ride that may be unnecessary for people who really have a mental health issue or an ailment treatable at a less expensive urgent care or other health clinic.
Fire departments in Hayward and Alameda have applied to take part in a test of expanded duties for 20 of their paramedics, which also could include home visits to patients after their hospitalization to make sure they're OK, taking their medicines and even taking blood samples.
Nurses unions are loudly objecting, saying paramedics don't have the training necessary to make those assessments.
The two East Bay fire departments have applied to join a statewide pilot project evaluating whether expanded paramedics' roles would improve health care and reduce costs. The paramedicine proposal includes 12 projects throughout California.
Patients who have called 911 for help flood into emergency rooms, which by law have to treat all who show up. Ambulances called out on 911 emergencies carried about 120,000 patients to emergency rooms in Alameda County from June 1, 2012, to Aug. 30, 2013.
The total cost of each trip is $7,603 to $9,895, including ambulance, paramedics' response and emergency room expenses, according to Alameda County Emergency Medical Services. Nearly a third of the patients could have been treated at less expensive medical facilities, according to the Alameda and Hayward fire departments.
"The pilot program will be aimed at people who have called 911 for medical problems at least four times over 30 days, said Alameda Deputy Fire Chief Doug Long. They're the "patients with pneumonia, breathing problems, hypertension, diabetes, that have a high risk of readmission to the hospital," he said.
The callers may not have insurance or have behavioral or substance abuse problems and so rely on the emergency room for treatment, he said.
"Some call 911 because they don't know what else to do, but frequent users of 911 are an incredible burden on the system," Hayward Fire Chief Garrett Contreras said.
The paramedics would ease the burden the callers put on the emergency rooms at Alameda and St. Rose hospitals, both of which have struggled financially for years. St. Rose treated 30,189 people in its emergency room in 2013.
The nurses aren't happy with the idea of firefighter paramedics doing jobs they traditionally handle. The paramedics won't have enough training to make good decisions, they say.
"CNA is strongly opposed to approval of this pilot project," said Vicki Bermudez of the California Nurses Association. The union contends there are not enough safeguards for patients and there is no need to expand paramedics' role.
"We think the money is better spent on existing services we know work," she said.
A spokeswoman for another major nurses union was equally dismissive.
Even with additional health care training, "they're still not licensed registered nurses, not licensed physicians, not licensed mental health professionals," said Tricia Hunter, executive director of American Nurses Association/California.
The nurses are also looking askance at the new post-hospitalization role for paramedics, following up with patients in their homes after hospitalization.
The nurses' opposition is frustrating for Hayward's fire chief, who says almost all of his firefighters are paramedics.
"They're wrong. Paramedics provide exceptional patient safety and care day in and day out," said Contreras.
Often patients leave the hospital with several prescriptions and written instructions, Contreras said. "They're tired; they just want to go to bed. They don't want to deal with anything or read through all that. So they may toss the pile of paperwork in a drawer and not fill the prescriptions," he said.
The plan is to have the paramedics visit the patients within 72 hours of discharge to check vital signs, draw blood and make sure patients are taking their medication and following instructions. The paramedics also would consult with the patients' primary care physicians.
St. Rose sees a lot of patients who would benefit from the follow-up care, said Kristen Gallegos, the hospital's emergency department manager.
"We serve a very high-risk population that has a lot of readmissions. We take care of many indigents and people with chronic conditions," she said.
Patients trust paramedics, Gallegos said.
"If we can prevent people from having to come back to the hospital for things that could easily be solved working with these guys, it's a good thing," she said.
The pilot program is awaiting state approval, which is expected in November. Based on results, legislation could be introduced to expand paramedics' authority and responsibility.
Hayward and Alameda fire department staffers visited paramedicine programs in other states, including MedStar, which provides emergency medical services in the Fort Worth, Texas, area. MedStar's trained paramedics work with frequent 911 and emergency room users to devise long-term treatment plans.
MedStar's records for 94 frequent 911 and emergency room patients over a two-year period showed 1,680 fewer emergency room visits and 911 calls, for a savings of about $2 million.
"It's pretty dramatic," said Matt Zavadsky, MedStar public affairs director.
©2014 The Daily Review (Hayward, Calif.)