Community Paramedic

NomadicMedic

I know a guy who knows a guy.
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Are any members working as community paramedics?
 
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Tigger

Dodges Pucks
Community Leader
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Yis.
 
OP
OP
NomadicMedic

NomadicMedic

I know a guy who knows a guy.
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an you give me a basic rundown of what you’re doing, how you staff it and where the revenue is coming from?
 

Tigger

Dodges Pucks
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Sure. The program was originally envisioned to the "traditional" CP things like fall prevention, medication checks, readmission avoidance, and super-utilizer reductions. About five years ago all of the full time paramedics were put through a community college delivered mobile integrated health curriculum to prepare to start doing this. At the time we were running fewer than 2,000 calls so it was thought that the paramedics could provide this during our frequent downtimes. Well, as it turns out, getting paid for those things is hard. The hospital networks were not interested in partnering with us even though they do not offer home care services in our area.

In an effort to cut down the very high suicide rates in Colorado, the legislature mandated a statewide mental health crisis hotline and "mobile crisis response" to go along with this. The local Medicaid mental health service chose to take over that obligation in that region and we were able to then partner with them as subcontractors. Together we developed a checklist and diagnostic criteria for our paramedics to respond solo in an SUV along with law enforcement to navigate these patients to some place other than an ED. Presently we have the options of
  • making a referral
  • having an MSW come out during business hours and handle the patient
  • transporting them to a freestanding crisis stabilization unit
  • transporting to a psych hospital
  • transporting to an ED via SUV or as last resort by ambulance
Our contract pays us pretty well per patient, more than enough to cover our costs. Even if the patient is transported by ambulance, we still get paid for providing "crisis service." In fact, it allowed us to hire an EMT for the program. He drives the patients down to the city so the paramedic can go back in-service and also does a lot of the admin work. It also funds most of our CP Captain's salary, he works bankers hours and handles as many of the psych calls as he can. When he is not on duty, approved paramedics are responsible. Since we are not doing much in the way of traditional CP program, we have gotten all of the full time medics trained through an internal process to run the psych calls. It's really not that difficult, learning to interact with these patients is the hardest part as you can be with them for a long time while trying to find a destination. Otherwise it's just following some very long checklists and doing the iStat (which the contractor pays for).

Starting in December all of the paramedic's that haven't been through the CC's program will get the CP education program. We hope to branch out into some other roles though it is challenging in the rural environment as the call volume isn't there. In the last four years we've probably had 10 "patient specific protocols" developed by the CP Captain which were effective but perhaps less impactful than our mental health program which has cut ambulance use on these calls by more than half.
 

DrParasite

The fire extinguisher is not just for show
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