Evolution of Emergency Medical Services

CALIFORNIA

White Paper 1966

Agenda for the FUTURE

Institute of Medicine Report 2006

Community Paramedic Community Paramedicine Mobile Integrated Health

2013 EMS and Community Health Partnership

Lou Meyer Project Manager, State of California Community Paramedic Program Howard Backer, MD, MPH, FACEP Director of the California Emergency Medical Services Authority

CORE Programs

FOUNDATION CALIFORNIA

State of California Community Paramedic Educational Taskforce CALIFORNIA

Modules 1. Role of the Community Paramedic In the Health Care System 2. Public Health and Primary Care Role of the Community Paramedic 3. Social Determinants of Health 4. Developing Cultural Competence

Modules (cont.) 5. The Community Paramedic s Role Within the Community 6. Community Paramedic s Personal Safety & Wellness Review 7. Clinical assessment, application and skill s for the Community Paramedic 8. Pilot site specific education

Schedule Six week program Meet every Tuesday and Thursday Mornings Broadcasted LIVE Subject Matter Experts 8 Locations

Afternoons Small Group Problem Based Case Based Standardized Patients

Online Course Page

CORE Hours 96 Classroom At least 56 hours independent Study TOTAL 152 hours of CORE Does not include Pilot Site Specific Training

Competencies 100 % Attendance Participation points above satisfactory Complete all assignments Development of Web of Resources Community Manual 3 quizzes, Fill in and essay Written Final Exam, fill in Standardized Patients Medical Scenario Psycho-Social Scenario Medical Director Oral Exam

Community Paramedic Candidates Butte = 10 Alameda = 6 Solano = 6 Stanislaus = 7 Ventura = 14 Requirement: 4 years Field Experience as Paramedic. Sponsored by LEMSA Medical Director. San Bernardino = 18 (2 from Orange) Los Angeles = 7 San Diego = 10 (2 from Orange)

Community Paramedic Candidates Total 79 Candidates 1:260 Ratio Community Paramedic Candidate : State of California Paramedics

Program Started January 13, 2015 Program Ended February 19, 2015

San Diego San Bernardino Solano Butte Ventura Stanislaus Los Angeles Alameda

Butte County Stanislaus County Solano County

Ventura County Los Angeles County San Diego County San Bernardino County

POST DISCHARGE The 'Post Discharge' pilot projects are designed to improve the patient healthcare experience while reducing hospital readmissions and unnecessary medical costs. Community Paramedics provide recently discharged patients with timely follow-up, helping to prevent simple medical problems from becoming serious or lifethreatening emergencies. Patients with the designated diagnoses are contacted by a Community Paramedic within 48 hours of discharge. In a number of the pilot sites, the Community Paramedics visit the patients while they are in the hospital to establish a rapport prior to discharge. The Community Paramedics ensure that the patients fully understand their discharge instructions, any new prescriptions, and when their next physician follow-up visit is scheduled. The Community Paramedics will also use their assessment skills to identify changes in health status that need to be relayed to the physician before the next appointment, determine whether an additional in-person visit by a Community Paramedic is necessary to solve any problems, and ensure that the patient is living in a safe environment in order to help prevent readmission. In October 2012, Medicare began reducing payments to hospitals with excess readmissions related to heart attacks, heart failure, pneumonia, hip/knee replacement, and chronic obstructive pulmonary disease (COPD). The Community Paramedicine projects are partnerships between local paramedic service providers and hospitals, collaborating to reduce the number of avoidable readmissions. The program also coordinates activities with visiting nurses and home healthcare provider agencies. Locations: Alameda City, Butte County, City of Glendale, San Bernardino County, Solano County

ALTERNATE DESTINATION The 'Alternate Destination' pilot projects are designed to align the patient care needs of 911 callers with the most appropriate care setting, and help patients get necessary services more quickly. Community Paramedics triage and transport non-acute patients to alternate destinations, such as urgent care facilities, thereby freeing up emergency care resources for patients with emergency care needs and giving patients a choice. Community Paramedics assess patients (using medical director approved protocols) to determine a 911 patient's acuity status and potential for transportation to an alternative location that will better serve their healthcare needs. The Community Paramedics use their detailed knowledge of alternate care facilities to direct and transport patients to medical facilities where the patients receive the most appropriate level of care. Current California law requires paramedics to transport all 911 patients, including those with non-emergency conditions, to the emergency department of an acute care hospital. This contributes to ED overcrowding, creates longer waits for patients, and reduces the availability of emergency medical services resources to respond to 911 calls, creating a gap in the healthcare community. Locations: City of Carlsbad, City of Glendale, Fountain Valley, Huntington Beach, Newport Beach, Santa Monica

FREQUENT 911 The 'Frequent 911 Caller' pilot projects are designed to improve access to primary care and social services for frequent 911 callers, reduce unnecessary burdens on the emergency services system, and lower costs. Community Paramedics identify the highest volume 911 callers in the community and work to connect them with care and services that best meet their needs. Community Paramedics assess, treat, and/or refer frequent 911 callers at the scene of an emergency call and provide followup assistance to connect them to alternate services in the community. Community Paramedics strive to reconnect frequent 911 callers to existing primary care providers or establish new connections to primary care providers. Community Paramedics also connect frequent 911 callers to social service and other non-health resources in the community that may be able to address their needs. A relatively small group of adults disproportionately use emergency medical services and emergency departments. The resulting episodic, uncoordinated health services are at a higher cost, consume valuable public safety and acute care resources, and importantly, often do not address the underlying issues the person is experiencing - including homelessness, loneliness, hunger and addiction. Addressing these basic issues can break the cycle of excessive repetitive emergency resource utilization. Locations: City of Alameda, City of San Diego

address the underlying issues the person is experiencing - including homelessness, loneliness, hunger and addiction. Addressing these basic issues can break the cycle of excessive repetitive emergency resource utilization. Locations: City of Alameda, City of San Diego

HOSPICE The 'Hospice Care' pilot project is designed to fill the gap in services between the time a hospice patient (or their surrogate) contacts the 911 system, and when their hospice caregiver is available to respond. Community Paramedics provide patients with comfort care - using the patient's own comfort care kit and supplemental medications - until care can be transitioned to the hospice nurse. This allows patients to remain in their home (or other location of choice) rather than being transported to the hospital. Community Paramedics also provide grief support and crisis support services for the patient, their family, and their friends until the hospice nurse arrives. 911 calls for hospice patients continue to receive a full emergency medical services response, as defined by the local medical priority dispatch protocols. In addition, the closest Community Paramedic is dispatched and the patient's hospice provider is notified. The Community Paramedic performs an assessment of the patient and communicates with the family or caregiver. The Community Paramedic also communicates via telephone with the hospice nurse to create a "right now" care plan focused on getting the patient through the next few moments until the hospice nurse arrives. The plan may include transport to the hospital, or administration of medications for pain, nausea, or difficulty breathing. Hospice supports patients facing life-limiting illness when a cure is not possible, and comfort is desired. Hospice is designed to provide a safe comfortable journey for the patient while also comforting their loved ones. While most patients admitted to hospice care die according to their wishes, it's common in the final stages of life for a friend or family member to call 911, possibly changing the patient's chosen course of care and treatment. Locations: Ventura County

TUBERCULOSIS The 'Paramedic Directly Observed Treatment' pilot project is a partnership between Community Paramedics and a local public health department. It's designed to ensure that more tuberculosis patients receive complete courses of treatment by using Community Paramedics to administer tuberculosis medications, and assess patients for disease progression or medication reaction. Patient intake, diagnosis, and treatment plans are handled by the county tuberculosis specialty clinic staff. Initial treatment is provided by the county tuberculosis nurse, which includes dispensing medications to patients and providing symptomatic treatment of tuberculosis medication side effects. When the patient's treatment regimen has been stabilized, the Community Paramedics take over Directly observed therapy, in consultation with the county tuberculosis officer. Tuberculosis is a contagious disease most commonly spread when a person with active tuberculosis coughs, sneezes, talks or releases infectious particles into the air. All physicians in California are required to report diagnosed cases of tuberculosis. County governments maintain active surveillance and treatment programs to halt the spread of the disease. Directly observed therapy is the standard of care for patients with tuberculosis disease. Directly observed therapy requires a healthcare professional to directly observe the patient swallowing each dose of their medication and monitor for disease progression or medication side effects. It is very important that people who have tuberculosis disease are treated, finish the medicine, and take the drugs exactly as prescribed. If they stop taking the drugs too soon, they can become sick again. If they do not take the drugs correctly, the tuberculosis bacteria that are still alive may become resistant to those medications, which makes tuberculosis even more difficult and expensive to treat. tuberculosis disease can be treated by taking several drugs for six to nine months. Locations: Ventura County

BEHAVIORNAL HEALTH This 'Alternate Destination Behavioral Health' pilot project is designed to improve care for people with mental health conditions by connecting them with treatment resources more quickly than if they were taken to a hospital emergency department. Community Paramedics assess patients with mental health conditions in the field and then transfer responsibility for their care to an ambulance crew for transport to care. There are multiple pathways through which Community Paramedic services can be requested: 1.By a paramedic who responds to a 911 call for a patient with a mental health condition. 2.By a law enforcement officer who has identified a person suspected of having an acute psychiatric illness. 3.By crisis center staff, after a mental health evaluation is conducted on a walk-in patient. Community Paramedics assess patients with behavioral health conditions to determine the best location for the patient to receive the most appropriate level of care and timely services. After conducting a patient medical screening, Community Paramedics use protocols to decide whether the patient is more effectively served by transporting them to an emergency department or directly to a behavioral care facility, potentially avoiding an unnecessary emergency department visit. Stanislaus County's Community Paramedic pilot was developed after a community needs assessment identified "improving care for patients with mental health conditions" as a priority, due to the increasing number of individuals requiring crisis evaluation. This project focuses on Medi-Cal and uninsured patients because those are the patients for whom the county has responsibility. The model is also structured so that it can be applied to commercially insured and Medicare patients should other non-governmental stakeholders choose to participate in this innovative approach in the future. Locations: Stanislaus County

Pilots stopped in September 2015

Report to be generated from UCSF by January 2017

U tube https://www.youtube.com/watch?v=niqqf530d3u&feature=youtu.be

LAFD Project https://www.youtube.com/watch?v=bgkwds0c1g4

FUTURE

Takeover

Are we open to CHANGE?

Change Can Be GOOD

Prepare for a fight