HELENA — Angie Murphy, Jennie Webster, and Andrea Goyins are all Paramedics and Emergency Medical Technicians (EMTs) by training. For years, they "worked 9-1-1," meaning they've responded to medical emergencies in the community.
But in Spring 2020, the trio changed course, helping to launch the St. Peter's Health Community Paramedicine Program.
Community paramedicine is a relatively new and evolving healthcare model, according to the Rural Health Information Hub.
In a press release, St. Peter’s Health describes community paramedicine as a way for paramedics and EMTs “to operate in expanded roles by assisting with public health and preventative services to underserved populations in the community, or populations who have barriers to accessing healthcare.”
There are currently a handful of community paramedicine programs in Montana, with early pilot programs supported by the State of Montana Department of Public Health and Human Services (DPHHS).
In Helena, St. Peter's Health Community Paramedicine Program serves a wide variety of people. Since April 2020, they've conducted over 700 visits and over 300 individuals have been referred to the program.
"We serve folks who may not qualify for home healthcare but who have barriers to accessing healthcare for a variety of reasons," says Murphy.
The community paramedicine team provides care in various settings, from the home to the street. The care is just as diverse as the locations the care is delivered. The team offers many types of medical care and education, including but not limited to:
- In-home lab draws
- Monitoring international normalizing ratio (INR) for anticoagulation patients
- Basic wound care in line with established wound care plans
- Medication reconciliation and setups
- Home safety and welfare checks
- Vital signs monitoring
- Chronic illness monitoring and education
- Facilitation of virtual care visits
Community members are primarily referred to the program by local care managers, who identify patients that will benefit from services.
"We've seen patients from a month old to one hundred years old," says Goyins. "The care that we provide depends on the needs of the community. It is very rewarding."
COVID-19 has significantly impacted the team's work. St. Pete says COVID-19 cases increased in the community, the hospital saw more patients diagnosed with the virus who also had on-going healthcare needs that needed monitoring during the time they were ill and in isolation.
For example, some patients with COVID-19 need blood draws to monitor a chronic condition. In response to this new need, the community paramedicine team started visiting patients' homes to complete the blood draw. The patient does not have to go into the clinic, decreasing the potential to expose others to the highly contagious virus in the healthcare setting.
The team has provided care to patients across the St. Peter's Health service area throughout the pandemic.
"We served one family who had a very young infant with COVID-19. The family lived in a remote area and had no cell phone coverage at their house,” says Webster. “The mother was referred to the St. Peter’s Community Paramedicine Program because she just wanted a quick check on the infant to make sure the baby was doing okay. We went out to their home and did a quick assessment and general exam, checking the infant's blood oxygen saturation and providing education to the family on signs and symptoms to look out for as well as tips and tricks to alleviate symptoms like nasal congestion for their tiny baby."
While the team does not provide the emergency, life-saving care they once did, their daily work still improves people's well being and has helped save lives.
"There have been several times when I have visited the home of a patient with COVID-19 to help monitor their condition and realized that they needed immediate medical care," says Murphy. "In some cases, they've gone to the hospital and ended up being admitted because they were experiencing serious, potentially deadly complications.”
When the team encounters a patient in need of immediate or higher-level care, they either call 9-1-1 for ambulance transport or advise the individual/family to go to the emergency department.
The trio say although they fondly recall their days of providing emergency care (Goyins still does work part-time on the ambulance), none regret making the shift to community paramedicine.
"We're seeing people when they need help, and the care and the compassion the patients and the family members show solidifies why we do what we do...to be part of the team is spectacular."
The St. Peter’s Community Paramedicine Program is a referral based program, and is available to people who are referred to the program for eligible services from a medical provider. The local healthcare system says they are dedicated to identifying funding sources to sustain the growing program so it is available to eligible community members for years to come.
DPHHS also provided a statement in a press release:
"DPHHS is working with emergency medical services (EMS) providers across the state to implement Community Integrated Health (CIH), also known as community paramedicine. While the primary mission of EMS has been to respond to 911 calls, many calls are for non-emergency situations. This program allows emergency care providers to work in new, innovative ways that connect community members with the healthcare and social services they need, without routing through an unnecessary EMS transport and emergency department visit. These non-emergency transports challenge Montana’s EMS services, which are struggling with limited staffing and resources, especially with volunteer services in rural communities. Challenges that have only been compounded by the COVID-19 pandemic.”
DPHHS provided the following bullet points with more stats/details about community paramedicine:
- Currently, a handful of community paramedicine programs are providing services in Montana through support by DPHHS. Participants include Great Falls Emergency Services, Jesse Ambulance in Broadus, Marcus Daly in Hamilton, Red Lodge Fire Department, and Frances Mahon Deaconess Hospital in Glasgow, Jefferson Valley EMS and Rescue, and St. Peter’s Health Ambulance here in Helena.
- DPHHS received $300,000 in federal and private funding for a two-year pilot program, which includes a grant from the Montana Healthcare Foundation.
- Community paramedics are emergency care providers who, in addition to their initial training and certification, completed the Community Paramedic Technician training delivered through Hennepin Technical College, an accredited college based in Minneapolis. This training helps the emergency care providers identify community and individual health needs, assist patients and advanced practitioners with management of chronic diseases or post-hospitalization care, home safety checks, and more.
- The program came about through Senate Bill 38, sponsored by Sen. Margaret MacDonald, D-Billings, which passed during the 2019 legislative session. The Bureau of Medical Examiners, DPHHS and others are working to expand training opportunities, medical oversight, data collection and funding to help ensure the services are sustainable.
- 1% of Montanans account for 53% of all EMS services provided in the state; community paramedics have proactively engaged with 44 individuals who were classified as high-utilizers of 9-1-1 services and connected them with healthcare and social services, successfully reducing subsequent 9-1-1 calls.
- Community paramedics have provided care to over 2,600 individuals since April, 2020. Just over 1,000 were for home visits and approximately 1,600 were for COVID-19 related screening and testing.
- Approximately 120 patients participated in the CIH for assistance with managing their cardiovascular health; of these, patients with Stage 1 or greater Hypertension (systolic blood pressure ≥ 130 mmHg) at time of enrollment had an averaged 18 point decrease in systolic blood pressure. 95% of patients, whose blood pressure was previously uncontrolled, successfully improved or maintained their blood pressure while enrolled.
- 97% of patients meeting the participating in CIH for post-hospitalization care for chronic diseases and surgeries with a high likelihood for readmission according to the Centers for Medicare and Medicaid Services (CMS) criteria for the Hospital Readmissions Reduction Program (HRRP), were successfully managed after discharge without readmission to the hospital.