By Kaitlyn Karmout, ESO
It’s a Thursday afternoon, and Don Thorton is preparing a bag, affectionally known as his “Uh-oh” bag, to carry with him in his trusty midsize SUV. This bag contains basic medical supplies that may be needed when responding to a sick patient before the ambulance arrives. Don also carries an on-the-go Narcan box, an AED, community resource pamphlets, and valuable information about his patients.
Don is visiting Janet, a 75-year-old woman suffering from Chronic Obstructive Pulmonary Disease (COPD). Janet once called an ambulance three times within a month due to breathing difficulties, resulting in trips to the emergency room each time and significant costs for both her and the healthcare system. That’s where Don comes in.
During his visit, Don emphasizes that successful community paramedicine programs adapt to the specific needs of each community. Just a short 20 miles away in Austin Travis County, there is a large homeless population and an increased number of drug-related 911 calls, shifting the focus to opioid overdose prevention.
Don arrives at Janet’s house, nestled in a Williamson County, Texas suburb. Janet, frail and immobile, relies on cords attached to her breathing system. Don delves into discussions about her medications, ensuring she has been consistently using her nebulizers. Janet reveals her dislike for the side effects, which make her jittery and sleep-deprived, but not taking the medications led to her hospitalization.
Struggling with her short-term memory, Janet finds it challenging to recall which medications she has taken and when to take them again. She also expresses frustration with doctors changing her prescription providers. Patiently, Don examines each medication, explaining dosages and emphasizing their importance for Janet’s wellbeing.
Janet’s skepticism often leads her to refrain from taking her medication when her blood pressure appears too low. Don, a gentle listener, patiently waits as Janet tries different blood pressure devices, evaluating which one feels the softest, is easiest to put on or provides the most accurate readings.
Even with decades of experience in the EMS service, Don recognizes that his role is constantly evolving. He strives to keep learning, continuously expanding his knowledge in case management, avoiding complacency, and attentively listening to patients to understand their needs.
As Don’s visit with Janet concludes, he takes out her trash and checks her mail, leaving her with a light-hearted comment about not planning a trip to Hawaii anytime soon.
Williamson County neighbors Austin, Texas. The county captures the essence of Texas, while proudly maintaining its distinct identity separate from its neighbor, Austin Travis County. As time has passed, these two regions have become increasingly interconnected, with county lines merging and the once sprawling farmlands gradually transforming into bustling developments.
But if you delve deeper and talk to the long-term residents living in Williamson County, you’ll discover that both counties hold unique characteristics, ways of life and community challenges.
Within Williamson County, pockets of newly built neighborhoods and apartment complexes have emerged from the vast farmlands. Today, it’s considered a technology hub with the largest expansions of Apple and Samsung in the U.S. The rural charm of the past remains, but it’s not nearly as predominant.
As a dedicated long-time resident who has devoted his life to caring for the community, Don Thornton has witnessed the remarkable transformation of the area. Don’s journey began as a paramedic in Williamson County, responding to emergency calls and transporting patients to the hospital. However, he now finds himself in a different role as part of a three-person team, pioneering a distinct approach to emergency medical services.
This is the role Don had always dreamed of – a community paramedic.
In the past, various obstacles such as limited resources, lack of community partnerships, inadequate technology, and insufficient support from government officials hindered the realization of his long-time vision.
But in 2014, a realization dawned upon the Williamson County EMS program and the legislative bodies of Williamson County – a way to reduce 911 calls from residents with non-emergency related issues.
Their modern-day answer looked a little like medicine from the past century – the house call. With determination and perseverance, Don’s team overcame the challenges of resources and buy-in, making strides in establishing a robust community paramedicine program.
Williamson County has maintained its community paramedicine program since 2014, continuously evolving with the expansion of community resources and the adoption of new technologies.
The county uses ESO‘s Electronic Health Record tool to identify patients who have made multiple non-emergency calls to EMS within a 3-month period. These individuals often face challenges such as mental health crises, drug overdoses or, like Janet, chronic diseases.
When a patient is flagged in ESO’s system, Don and his team engage with them by knocking on their doors or making phone calls. Creating a robust community paramedicine program wasn’t an overnight achievement for Williamson County. It required buy-in from legislative officials, financial resources, and unwavering passion and dedication to drive change.
By leaning into data, technology and community resources, Williamson County’s program has witnessed a remarkable average reduction of 80% or more in frequent EMS visits for non-emergency situations. This improvement allows for better management of chronic diseases through increased education and navigation toward appropriate services.
When patients enter the program, Williamson County commits approximately 30 days to ensure they receive the necessary resources. This may involve connecting them with mental health support organizations like Bluebonnet Trails, which provides mental health services to adults and children, or offering comprehensive education on their overall health and wellbeing.
Community paramedicine programs have become a vital aspect of many communities, aiming to overcome challenges such as staffing shortages and limited access to other healthcare services. While widely adopted in places like Canada, Finland, Ireland and the United Kingdom, they haven’t received widespread adoption in the United States.
Undoubtedly, some communities face disadvantages and lack the necessary funds to implement a robust community paramedicine program, especially in rural areas with a larger aging population.
So, what’s the solution?
Most community paramedicine programs receive funding through the EMS service, hospitals, grants or insurance providers. However, achieving more, like Williamson County, requires dedication and focused efforts.
If your team is exploring ways to fund a community paramedicine program, consider applying for grant programs. You can find more information here on funding approaches.
Top 10 MIH or community paramedicine program funding sources
These sources of start-up and long-term funding can help launch and provide economic sustainability for mobile integrated health care