ER overcrowding solution: Community paramedicine

Paramedics, known for responding to medical emergencies and treating patients on the way to the hospital, are expanding their roles in some communities.

Instead of just reacting to medical emergencies, some paramedics and emergency medical technicians (EMTs) fill in community care gaps by proactively treating patients on then scene when patients aren't sick enough to warrant an emergency department (ED) visit, Hospitals & Health Networks reported.

The trend is called community paramedicine or mobile integrated healthcare-community paramedicine (MIH-CP), according to HHN. The idea is to "reduce inappropriate use of local emergency care resources and improve the overall health of communities" by filling gaps in existing healthcare services.

A survey for the National Association of Emergency Medical Technicians found that 8 out of 10 MIH-CPs have reduced costs related to frequent 911 callers, the publication reported. Examples include reducing ED admissions by triaging patients who frequently call ambulances by checking vital signs and determining whether the patient needs to go to the hospital. If they don't, paramedics and EMTs can take steps such as calling the patient's primary care physician and determining an in-home treatment plan, according to the article.

In another example, Mesa, Arizona staffs "transitional vehicles" with a paramedic and a nurse practitioner or physician assistant to provide in-home primary care, HHN reported.

Community paramedicine programs also can make house calls to proactively manage patients with chronic conditions who might end up in the emergency room if their conditions aren't managed. "This expanded paramedic service not only benefits the hospital through reduced ED visits and hospital readmissions, but also benefits the patients, as the delivery model will help to improve their overall health and ability to care for themselves," according to the article.

Earlier this year the UCLA Center for Prehospital Care, along with the Los Angeles County Emergency Medical Services (EMS) Agency and the Glendale and Santa Monica fire departments, launched two community paramedicine pilot programs, FierceHealthcare previously reported. "The thought was maybe there were other patient care delivery options these very well-trained professionals could perform," said one of the officials who designed the programs.

In 2012 North Memorial Health System in Minneapolis started sending community paramedics to visit patients who visited the ED at least nine times per year. They focused particularly on patients with chronic conditions such as diabetes. Costs appeared to be significantly less than the cost of treating the patients in the ED, officials said.

To learn more:
- read the HHN article