Community Paramedicine: Case Study of UCLA Pilot Projects
By Gary E. Seidel, fire chief, retired
Community paramedicine programs are designed to address local healthcare problems by taking advantage of the relationships among emergency medical services, healthcare and social service providers. The growing interest in this program has shown that it can improve the quality of healthcare in a community, as well as reduce the costs of healthcare services.
In November 2014, the California Office of Statewide Health Planning and Development granted approval to the Emergency Medical Service Authority to pilot community paramedicine in 12 sites across California. This article focuses on two projects conducted under the University of California at Los Angeles (UCLA) Center for Pre-Hospital Care.
The two community paramedicine pilot project concepts being conducted at UCLA Center for Pre-Hospital Care are:
- “Transportation to Alternative Destinations” – pilot project manager is Dr. Baxter Larmon, Ph.D., MICP
- “Post Hospital Discharge Follow-Up for Patients With Congestive Heart Failure” – pilot project manager is Dr. Steven J. Rottman, M.D.
Prior to the implementation of these two projects, UCLA Center for Pre-Hospital Care provided additional training to all paramedics involved. This additional training focused on patient assessment, clinical skills, familiarity with the other healthcare providers and social services available in the local communities; which would lead to a more integrated community healthcare system. These two projects under the auspices of UCLA Center for Pre-Hospital Care were implemented in the summer of 2015.
The transportation to alternative destinations project involves the EMS providers in Santa Monica, Glendale and Pasadena. The paramedics in these communities have the ability to offer patients with less serious medical complaints transportation to one of several approved urgent care centers rather than a hospital emergency department. Thus, reducing the burden on overcrowded hospital emergency departments.
The post hospital discharge follow-up care for patients with CHF project involves the EMS providers in the Burbank and Glendale. Working in concert with UCLA and the Glendale Adventist Medical Center, CHF patients are offered home visits by paramedics after they are discharged from the hospital. These home visits include a review of the patient’s post discharge instructions and the patient’s medical progress. The paramedics also review the medications being taken and other evaluations needed to reduce the need for readmission back into the hospital, including making sure the home environment is conducive to quality rehabilitation. In addition, these paramedics have received additional training on assessing and evaluating the patient’s symptoms, ensure the patient is taking their medication and eating a heart healthy diet.
Dr. Baxter Larmon reports that wait times in overburdened hospital emergency rooms for patients with minor illnesses/injuries can be up to six hours. With paramedics being able to transport to approved urgent care centers, patients are seen much quicker.
...the most critical time for patients with CHF is 48 to 72 hours.
Dr. Steven J. Rottman states that the most critical time for patients with CHF is 48 to 72 hours. The home visits for the paramedics is in this critical timeframe. If a CHF patient can make it through the critical first week, they may be able to avoid hospital re-admission. Thus, using paramedics may be the missing chain of care need in quality care for CHF patients. Going back to the hospital is disruptive in the care of the patient and it is not always a positive outcome. In addition, Medicare is not reimbursing hospitals where re-admission is with the 30-day window of the CHF patient’s discharge.
Cathy Childester, director for the Los Angeles County Emergency Medical Services, states that often paramedics have to wait at the over-burdened emergency departments anywhere from 20 minutes to an hour to unload their patients, thus making them unavailable for responses to other patients in their community.
Fire chiefs from the agencies involved in these two pilot projects agree that everyone benefits from getting the patient to the right place the first time. All the emergency services agencies in these two pilot projects agree that this partnership with the healthcare and social service agencies is gratifying and they will continue to examine and implement other approved healthcare delivery modalities.
Bio: Gary Seidel, EFOP, CFO, MPA; is a retired Fire Chief from Hillsboro Fire Department in Oregon and a retired Assistant Chief from Los Angeles Fire Department in California.