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Community Paramedics

As healthcare changes, a paramedics’ role is expanding. Paramedics no longer only respond to emergency situations in the 911 system. They also visit recently-discharged hospital patients or referred patients in their homes or businesses. This kind of paramedicine, called Community Paramedicine, is helping fill gaps in our healthcare system. Community Paramedics are now improving patient outcomes and experiences, and lowering healthcare costs in non-emergent settings. This expanded role comes with additional education, medical oversight, and consistent program evaluation. Partnerships and collaboration with local stakeholders, leveraging established resources, and a patient-centered focus helps ensure success and positive patient outcomes. Community Paramedic programs can focus on a variety of areas of healthcare. Some of these can include:

• Extension of Primary Care
• Patient Care Coordination and Activation
• Avoidance of Hospital and Emergency Department Admission and Readmission
• Chronic Disease Education, Management, and Prevention
• Mental Health Evaluation
• Expanded Public Health Services
• Wellness Programs
• Emergency Department Diversion and Decrease Use of the 911 System

Community Paramedics all across the nation, and in many other countries, are finding that Community Paramedic programs reduce unnecessary 911 calls and saves both patients and providers in their healthcare costs. With the expanded role of paramedics, Ada County provides additional services and programs to those who need individualized medical care in our community.

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Patient Example

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Betty is a 68-year-old female who was recently discharged from the local hospital after experiencing shortness of breath and was diagnosed with congestive heart failure (CHF). The hospital released her with new diet requirements, a stack of discharge instructions, a slew of new medication prescriptions and a list of upcoming appointments with various providers Betty will need to schedule in upcoming weeks.

When Betty’s doctor was getting ready to sign the discharge paperwork at the hospital, he went over everything with her in great detail and asked if she had any questions. At the time she did not. Yet, days later, Betty started sorting through all the paperwork and now she does have questions, but she’s not sure who to call or how to best schedule her appointments. She hasn’t seen her primary care provider for several years and found out he’s now retired. Betty also has instructions to make an appointment with a cardiologist, but was only give a phone number with no name. Betty is also trying to figure out her new diet requirements, but she’s unsure if any of the food she has at home is OK to eat. The discharge paperwork also indicates Betty should be taking her blood pressure every day and weighing herself, but she has no way to check her blood pressure at home and she doesn’t own a scale. It all seems so confusing.

Betty has also been having issues with her new medications. The bottle says she needs to take two pills, morning and night. But Betty isn’t sure if she’s supposed to take two in the morning and two at night, or just two pills total.  Another medication has a different name on the bottle than what is on her hospital paperwork. She thinks it might be a generic, but doesn’t know for sure. Again, Betty isn’t sure whom to call to ask. Would the pharmacist know? Should she call the hospital? 911?

This is where a Community Paramedic can help. Community Paramedics are uniquely positioned within the healthcare system to help patients navigate the process because they work closely with everyone from dispatch, to doctors and nurses in the emergency department, to system partners like fire departments, health and welfare, and everyone in between. And since paramedics have medical education, they can help answer patients’ questions or put them directly in touch with a more appropriate person to find the correct answer.

A Community Paramedic could also assist Betty in managing her new chronic heart issue, teach her healthier habits to keep her from having another heart problem, review her medications with her, connect her with resources in the community and act as an extension of her healthcare team.

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Program Initiatives

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Ada County Paramedics formed an independent advisory council with membership consisting of individuals from a variety of areas of expertise; including healthcare, nursing, home healthcare, public health, nonprofit organizations, institutes of higher education, hospital systems, payers, and government offices.  The goal of the Council is to continually evaluate and advise the Ada County Community Paramedic Program, and to be a champion for Community Paramedics within each Council Member’s area of expertise.  The Community Paramedic Liaison and Advisory Council is made of 16 Council Members who meet on a quarterly basis.

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This program is a collaborative population health partnership between Ada County Community Paramedics and the Saint Alphonsus Hospital System & the Saint Alphonsus Health Alliance.  Patients eligible for this program have recently been discharged from the emergency department, identified by a nurse or physician, and meet criteria for being at risk for readmission to the emergency department.  Patients enrolled receive in-home visits and telephonic support for the entire time they participate in the program.  Community paramedics perform home assessments, medication inventories, a review of discharge instructions, disease management education, physical assessments, select medical therapeutics, and resource coordination.  The goals of the program are to decrease emergency department and hospital use, connect patients with primary care providers and resources, and help patients develop the skills & knowledge to navigate the healthcare system.

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This team is a collaboration between Ada County Community Paramedics and the Idaho Department of Health and Welfare’s Mobile Crisis Unit (M.C.U). funded through a grant from St. Luke’s Health System. The PET team responds with all law enforcement agencies in Ada County, and assists Ada County Paramedics on a variety of 911 calls involving citizens experiencing mental health crises.  By involving family, existing mental health providers, crisis lines, and at times the involuntary hold process, PET provides a collaborative and multi-disciplinary response to Ada County.

Ada County PD teams
Boise PD
Meridian PD
Ada County Sheriff
Garden City PD

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The Ada County Community Paramedic Program continues to partner with Idaho State University to instruct their Community Paramedic Certificate Program.  The program is 9 college credits specific to Community Paramedicine. The program focuses on the expanded role of community paramedics; including community needs and health assessments, system and program evaluation, program messaging, sub-acute physical assessments, and more detailed information on chronic disease conditions. The program consists of both didactic and clinical hours. To learn more about the Idaho State Community Paramedic Certificate Program, please visit their website.

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This program is a partnership between the Community Paramedics and the Ada County Benefits Department.  During influenza season, the Community Paramedics administer the influenza vaccination to Ada County employees at various vaccination clinic sites.  The Community Paramedics put on clinics at various Ada County work locations throughout the entire county.  Some of these locations include the Ada County Court House, Public Safety Building, various Department of Motor Vehicle locations, the Ada County Elections Office, Juvenile Dentention, and Waste Management.  Community Paramedics offer free blood pressure screenings at each location.  Community Paramedics also encourage each employee to let their primary care provider know they received the vaccination, and provide all relevant information.  The goals of this program are to improve the health of Ada County’s 1700 employees, provide the employees with a good experience, and potentially sick time

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If you are a system partner and would like to refer a patient to the Ada County Community Paramedics, please call 208-287-2998.

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