Push emerging to recognize gap-filling community paramedicine

Kansas emergency medical workers respond at a moment’s notice, no matter if they just sat down for dinner or laid down to sleep. Many are volunteers with full-time jobs and families.

First responders in the Sunflower State are trained to deal with a multitude of calamities, from traffic crashes to plummeting blood sugar levels in diabetic patients and everything in between.

But they often provide non-emergency care that doesn’t receive much recognition or funding.

Emergency health care professionals across the state are working to bring awareness to non-emergency practices long implemented by local ambulance crews and paramedics, for the purpose of categorizing those services to potentially receive state and federal funding. The practice is called community paramedicine , and for Deb Kaufman, former Sheridan County EMS director, it’s just another phrase to convey what her staff of 20 volunteers have been doing for years.

“It takes a lot of dedication,” she says. “We don’t fill all the needs (of our community), we still have patients who need additional care who aren’t getting it.”

Sheridan County’s volunteer EMTs cover almost 900 square miles, serving an area with more than 2,440 people in and around the small towns of Hoxie and Selden. During the winter months, Kaufman and other emergency medical professionals in her region identified multiple gaps in health care coverage that could be addressed with more funding and more trained staff.

“We have a large county,” Kaufman says, “and it really helps when people know the roads, how to get somewhere, and how to interact with people on their worst day. It really helps when the EMT is somebody they know and trust.”

That’s one of the advantages, she says, of having a community paramedicine program in a rural area like Sheridan County. Crews that serve sparsely populated places can more easily check on residents and follow-up with their care needs once they’ve bonded with them. Some patients will refuse care unless it’s from a medic they know and trust.

Trust is an important element of the community paramedicine approach. Most of the ambulance calls in Sheridan County are for issues related to an aging population, especially fall hazards. To help mitigate the risk of falling, Sheridan County paramedics will conduct an in-home assessment for elderly people and rearrange their furniture or install handrails to create a safer environment.

“That’s probably our most common ambulance call is lift assists,” Kaufman says. “That’s one thing community paramedicine is trying to address. We’re trying to reach those people before they go to long-term care, so they can stay in their homes and thrive instead of struggling.”

Paramedics in Emergency Medical Services Region 1, which includes all of northwest and some of north-central Kansas, have identified coverage gaps that include  diabetes management, mental health support, substance abuse and nalaxone distribution. First responders in Sheridan County also host community education programs on various subjects, such as ATV and firearm safety, seat belt use and stroke prevention.

Sheridan County EMTs, like other medical first responders in Kansas, go unpaid for nonemergency ambulance trips. David Jordan, president and CEO of United Methodist Health Ministry Fund, says EMS departments only receive reimbursement via state property taxes  taxes when a patient is transported to a hospital. Non-emergency visits are not being reimbursed because the Kansas Legislature continues to block Medicaid expansion. Additionally, the stresses of the COVID-19 pandemic on health care workers and lower rates of volunteerism in Kansas have led to fewer active emergency medical professionals.

“I think there’s really an opportunity for a larger conversation about workforce, broadening entry points for community members who don’t have (medical) degrees,” Jordan says. “This conversation is very doable, and the research is there to support this model.”

Kansas Health Institute senior analyst Wyatt Beckman is keen on advancing the statewide conversation about community paramedicine. He says more states are looking for ways to leverage the skills of existing paramedics and EMTs to cover those health care gaps, and he hopes Kansas can lead the way in expanding those professional roles.

“Community paramedicine looks different depending on where you are,” Beckman says, but the common goals are to prevent hospital “frequent flyers,” those who are admitted with regularity, as well as expanding access to care and helping patients manage chronic diseases. Beckman and health institute analysts are hosting a video briefing involving community paramedicine approaches later in May.

David Adams leads the Riley County emergency medical services  department, which covers the city of Manhattan and Kansas State University. He also oversees a community care team made up of regional first responders, and that team performs services that would be classified as community paramedicine.

“Putting a name to it helps people understand what it is,” Adams says. “The more people understand, the more willing they are to support it. With that support comes funding and credibility.”

Additionally, Adams is the vice president of the Kansas EMS Association . He says one of the first steps toward reimbursing first responders for nonemergency trips would be to secure private and public grants. Before that can happen, however, state officials require data on the number of non-emergency ambulance visits. Adams says there’s one major caveat.

“Everybody says we have to have the data first, but we need money to set up the program to show the data.”

An example of how a community paramedicine program can successfully cover health care gaps is in Wyandotte County. Kansas City, Kansas Assistant Fire Chief Mark Heath oversees the county’s EMS department, which includes a community paramedicine program called WyCo Care Connection , one of only three such programs in Kansas.

Heath likes to joke that he has the “Toyota Corolla of paramedicine programs,” because it’s not fancy, but it works.

“It’s just my community medic and a nurse practitioner,” Heath says, “so I can’t say we’ve found the magic yet.”

Jessica Kraus, the community medic, and Erika Ortiz, the nurse practitioner, are the WyCo Care Connection. More than 40 years of emergency medical training are represented between the two.

“The biggest chunk of what we do is connecting people with resources,” Ortiz says. “Most of the time it’s not necessarily even a medical problem.”

Kraus has a few firsthand examples of the kind of services that would benefit from government funding.

“One patient couldn’t use her CPAP machine because she didn’t have a nightstand. The floor was too far away, so we got her a nightstand to rest her CPAP on,” she says. “Another patient had their box springs removed so their mattress was lowered to the same height as their wheelchair.”

Ortiz says continuing non-emergency visits would benefit all patients, not just those with insurance. According to Heath, unreimbursed medical services in neighboring Johnson County tally about $3 million annually. He says expanding Medicaid and increasing federal reimbursement amounts would be a “huge win” for Kansas EMS departments, many of which suffer from what Heath calls an “identity crisis.”

“We’re still talked about as just ambulance drivers,” he says. “We try to prove ourselves as qualified trained professionals who will show up at your house and help you.”

That’s the kind of description that has a champion out in Sheridan County. Kaufman retired at the end of March, but she’s still working to establish the official nomenclature for the scope of the EMTs’ approach to their duties. And she’s not referring to it as “community paramedicine.”

“We’re just doing these things as part of our regular operations.”

The post Push emerging to recognize gap-filling community paramedicine appeared first on KLC Journal - A Civic Issues Magazine from the Kansas Leadership Center