Texas community paramedics reduce 911 runs
Patients find comfort in the one-on-one care the community paramedic service provides
By Wendy Hundley
The Dallas Morning News
PLANO, Texas — Maybe doctors don’t make house calls anymore, but Plano Fire-Rescue is filling the gap.
The city’s new Community Paramedic Program provides in-home health care services to residents with chronic illnesses. The pilot project focuses on helping patients manage their medical conditions so they don’t have to return to the hospital or call 911 often.
“In fire prevention, we want to prevent fires,” Battalion Chief Chris Biggerstaff said. “This is medical prevention. We don’t want these patients to get to the critical level where they have to call 911.”
This type of service is a growing trend around the country.
The McKinney Fire Department’s Community Healthcare Paramedicine Program started in June 2013 and focused on frequent 911 callers. Since then, the city has seen a 69 percent drop in 911 calls by this group, Emergency Medical Services Chief Jason Hockett said.
Decreasing the number of 911 calls frees up ambulances for higher-priority calls, he said. “But,” Hockett said, “the biggest benefit of the program is the health of patients.”
Plano residents are referred to the free program by local hospitals, health care providers or social workers. They may also be identified by frequent 911 calls for recurring medical problems.
The program, which began in November, was serving 12 patients by mid-December.
Carole Young, 75, considers herself lucky to be one of those patients.
She suffers from congestive heart failure and diabetes. She’s had to dial 911 several times.
The last time was on Nov. 18 when she began having difficulty breathing while driving her car. Plano Fire-Rescue paramedics found her unconscious next to her car.
When she was ready to be discharged from Medical Center of Plano, a facilitator referred her to the newly created Community Paramedic Program.
Paramedic Josh Clouse began making house calls a couple of times a week.
He’s helped her organize and manage her myriad prescription pills. He’s educated her about the need to reduce her sodium intake. He’s conducted a safety check of her home to prevent injuries and falls.
On each visit he checks her vital signs, asks about her diet and takes readings on an electrocardiogram machine. He records information on his computer, where he has access to her medical records and can relay information to the hospital and her physician.
He takes blood samples and can read the results in two minutes. “You’re getting a little anemic,” Clouse said on a recent visit. “But your sodium, potassium and sugar [levels] look good.”
The visits make Young feel confident that her medical conditions are being monitored and managed.
“It makes me feel more comfortable about being alone,” Young said. “They can detect something before it happens.”
After 90 days without having to be rehospitalized, she will be reassessed for her need for regular visits.
Before she was referred to the Community Paramedic Program, Young had tried to find a similar home health care service but was unsuccessful. Clouse said other programs may require patients to be housebound or to meet certain financial qualifications.
“Our patients fall into the gap,” he said.
Currently, Clouse is the only paramedic assigned full time to the program, and Plano Fire-Rescue is absorbing the costs.
In the future, fire departments may get reimbursement from Medicare, Medicaid and private insurance companies, said Mark Gamber, an emergency room physician at Medical Center of Plano.
He said congestive heart failure is the most expensive diagnosis for Medicare. Hospitals that readmit a patient for the same condition within 30 days may not be reimbursed.
If this program prevents rehospitalizations, “it’s not only better health care [for patients], but it helps the financial viability of hospitals,” said Gamber, who also serves as medical director for Plano Fire-Rescue.
He’s confident that community paramedicine will become commonplace. “This is the tip of the iceberg.”
Plano Fire-Rescue officials are also sure the pilot program will become a permanent service and say it may expand to include pediatric asthma patients.
In the meantime, patients like Young find comfort in the one-on-one care the service provides.
“It’s like a security blanket,” she said.
©2015 The Dallas Morning News