Innovative Community Paramedic Program in McDowell County
McDowell County in Western North Carolina has embraced a forward-thinking Community Paramedic Program, led by Captain Sam Robinson, to enhance emergency medical services for its 45,000 citizens. The program focuses on building strong patient relationships, offering non-time-sensitive care, and forming crucial partnerships to address various healthcare needs in the community. Through proactive measures such as wellness checks, fall prevention, and mental health support, McDowell County EMS is revolutionizing traditional emergency response models.
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McDowell County McDowell County Community Paramedic Program Community Paramedic Program ENGAGE, EMPOWER, CONNECT ENGAGE, EMPOWER, CONNECT Captain Sam Robinson, AAS, CCEMT-P, LEO Community Paramedic Coordinator McDowell County 1
McDowell County EMS Community Care Paramedic Program Funded by Healthy Places NC An Initiative of the Kate B Reynolds Charitable Trust McDowell County is a rural county in Western North Carolina with a population of 45,000 citizens. McDowell County EMS responds to all calls for emergency medical care which totaled 9,496 in year 2018. 2
Outdated Delivery Design Traditional EMS Model 911 Call Emergency Response Assess / Stabilize Treat Transport 3
Culture Change with CP Program Patient Relationships Change in Treatments Not Time Sensitive Change of Care Setting Partnerships 4
It All Began Here McDowell EMS Launches New Community Outreach Program November 23, 2009 McDowell County EMS is once again expanding its level of service to McDowell County Citizens by launching a new community outreach program. Each day paramedics in McDowell encounter patients who require assistance beyond emergency medical care. Many times paramedics are called to a residence for a variety of reasons including falls without injuries, hunger, lack of in-home care, loneliness, and other special needs. Many of these patients are elderly and often live alone. Administrators developed the program and began testing it in early July to establish its effectiveness. 5
Established Program 2009 Beta Tested Community Paramedic Program on Select Number of High Utilizers 2012 CMS Innovation Grant (Denied) 2013 Funded by Kate B. Charitable Trust 2015 _ Foundation for the Carolinas Grant 2016 Funded for two additional years by Kate B. Reynolds Trust NC OEMS Pilot Grant --- Foundation for Healthy Carolinas Continued awards in 2017, 2018 & 2019 6
McDowell Program Design Address High Utilizers of EMS and ER Services Focus on getting patients a primary care home Improve access and education on community services Reduce 30 Day Re-Admission Rates Receive referrals from area hospitals to conduct wellness checks on patients within 48 hours of discharge after diagnosis of CHF, Sepsis, COPD, AMI, CVA, and Pneumonia Community Wellness Conduct Know-Your-Number Screenings Partnered with Volunteer Fire Depts. / Faith Based Community Fall Prevention Mental Health Diversions Alternate Destination 7
Current Operations (4 FTE) Community Care Paramedics (1 FTE) Peer Support Program (Grant Partnership) Supported by Administrative Staff / Medical Directors 8
Community Paramedic Team Unscheduled Visits / Scheduled Visits Vital Signs / Physical Assessment Social Support Eval. / PCP Appt. / Medication Recon. / Home Assessment / Health Education Referral to Community Resources Strong collaboration with McDowell Health Coalition, MATCH & other Healthy Places Programs. Community Events / Health Fairs Employer Health Initiatives Welfare Checks (referrals from physician offices) 9
911 Calls for Service Medical Alarm Activation Falls without Injury Mental Health Calls Overdoses Cardiac Arrests (Family Liaison) Unknown Problem/Slumped Over the Wheel 10
Successes of the CP Program Significant reduction of high utilizers. 825 patients were served in the first three years. 81% of CP patients are considered financially needy, living in poverty or have serious needs 83 % of high utilizers enrolled within the program had decrease in EMS and ER calls for service within first 90 days. Community Support & Buy In Community paramedics are recognized within the community and among healthcare providers. Within 12 months the CP Program was the 3rd most recognized program in McDowell by Senior Citizens. Quality of Life Improvements Wheelchair Ramps Veteran Services Home Improvements/modifications Fear of having no medications Mental Health Assistance / Suicide Prevention Fall Prevention Health literacy 11
McDowell Balance and Fall Prevention Program Partnered with MBFPP in 2014 Falls without injury would be referred to MBFPP by CP If injured McDowell ED could refer the PT MBFPP reaches out to Patient s PCP and requests a PT referral due to recent fall. PT evaluation performed and treatment initiated. Patient has the ability to select preferred provider or if no preference a provider is assigned. This built partnerships 12
Addressing 911 High Utilizer Can typically be linked to a health disparity or social determinate of health Often the patient does not have an established PCP Lack of health literacy for both patient and/or family. Often the Patient has an episode that resolves and they do not follow up with PCP. (ie. Falls without injury) Lack ability to advocate for their self or navigate a complex system. FALL THROUGH THE CRACKS 13
Community Paramedicine and Fall Prevention Respond to calls for service for fall without injury. Access for the primary cause and frequency of the fall. (weakness, balance, clutter, transferring, meds) Access the use of or need for DME or Assistive devices Perform Home Safety Assessment Contact patients PCP and notify of the fall Speak with PCP about the corrective actions that Community paramedic s recommend (PT, walker, bedside commode) 14
Community Paramedicine and Fall Prevention (Cont.) Contact need specific resources (Faith based community, Gateway foundation, Isothermal Agency on Aging) Make changes that are feasible and immediately needed (clearing clutter, ensuring access to 911, education) If established with a PT or home health group, contact a case manager and discuss findings. 15
Home Safety Assessment Methodical review of all aspects of the home. Safe approach from outside of the home. Trip hazards within the home. Adequate lighting. Use/compliance/knowledge of assistive devices. Need for home repairs/modifications. Review of medications and side effects. 16
Link With Resources Once the patient is linked with PCP and/or PT, additional resources are then linked for the patient. Transit Wheelchair ramps (Faith based community) Home Improvements/modifications (Faith based/agency on aging) Adaptive devices Appropriate/working order DME 20
Link With Resources Social Services CP Direct interventions (Assist with clearing clutter, making a plan to prevent falls or remedy them quickly) Family involvement McDowell County Senior Center 21
Questions Contact Information: Captain Sam Robinson Community Paramedic Coordinator 828-652-3241 (o) 828-442-3452 (c) srobinson@mcdowellems.com 22
