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Community Paramedicine

Ramiro Jervis, MD, SFHM

NSLIJ Advanced Illness Management

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None

Financial Disclosures

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Clinical Scenario

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Why Community Paramedicine?

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Off hour & urgent in person assessments limited

Telephone assessments limited

Limits of Primary Care Models

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Why Community Paramedicine?

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Only 1 RCT: 27% ED use

Programs varied in implementation

Scattered reports of programs in the United States◦~40% utilization

Evidence of Success is Limited

8

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Kashif Baqai BS, CCEMT-PDavid Kugler, MD

Elizabeth Quellhorst BFA, NREMT-P, CCEMT-P, PNCCT, CMTE, EMD-Q

Jon. D. Washko, BS-EMSA, NREMT-P, AEMDThomas Kwiatkowski MD, FACEP

Kristofer Smith, MD

Collaborative Effort

House Calls Providers credentialed as On Line Medical Control (OLMC)

NS LIJ Community ParamedicineExperience

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House Calls Providers credentialed as On Line Medical Control (OLMC)

NS LIJ Community ParamedicineExperience

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Patient Education

Advanced Care Paramedics

Supplemental Instruction◦Geriatric assessment◦Advance Care Planning◦Clinical Rotation

NS LIJ Community ParamedicineExperience

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Community Paramedic Response

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Shortness of breath~47%

Change in mental status ~23%

Other ~30%

Community Paramedic Calls

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Since October 2013◦1158 calls routed through EMS Call Center

◦120 Community Paramedic responses

◦23 transports to ED (19%)

Low Transport Rate

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Admissions avoided

Chart review of 42 Community Paramedicine

Responses

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Room For Improvement

Q1 2013 Q2 2013 Q3 2013 Q4 2013 Q1 20140

50

100

150

200

250

14% 13%17%

13%19%

911 vs Call Center Initiated Transport

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Thank You