1. Ramiro Jervis, MD, SFHM NSLIJ Advanced Illness Management ©AAHCM

2.  None ©AAHCM

5.  Off hour & urgent in person assessments limited  Telephone assessments limited ©AAHCM

7.  Only 1 RCT: 27% ED use  Programs varied in implementation  Scattered reports of programs in the United States ◦ ~40% utilization ©AAHCM

8. 8

9. Kashif Baqai BS, CCEMT-P David Kugler, MD Elizabeth Quellhorst BFA, NREMT-P, CCEMT- P, PNCCT, CMTE, EMD-Q Jon. D. Washko, BS-EMSA, NREMT-P, AEMD Thomas Kwiatkowski MD, FACEP Kristofer Smith, MD ©AAHCM

10. House Calls Providers credentialed as On Line Medical Control (OLMC) ©AAHCM

11. House Calls Providers credentialed as On Line Medical Control (OLMC) ©AAHCM

13.  Advanced Care Paramedics  Supplemental Instruction ◦ Geriatric assessment ◦ Advance Care Planning ◦ Clinical Rotation ©AAHCM

14. Community Paramedic Response ©AAHCM

15.  Shortness of breath~47%  Change in mental status ~23%  Other ~30% ©AAHCM

16.  Since October 2013 ◦ 1158 calls routed through EMS Call Center ◦ 120 Community Paramedic responses ◦ 23 transports to ED (19%) ©AAHCM

17. Chart review of 42 Community Paramedicine Responses

18. ©AAHCM