1. Community Paramedic National Organization of State Offices of Rural Health Regional Meeting Lansing August 13, 2015 Marvin Helmker, Manager EMS Section Michigan Department of Health and Human Services helmkerm1@michigan.gov 517 241-3024

2. Community Paramedic Why do people go to the hospital ED? it’s free! hungry lonely hurt toe three days ago ran out of medication and need a refill recording at Dr. office told them to ED physician is their primary care physician legitimate illness/injury which is true emergency

3. Community Paramedic Goals: Reduce frequent flyers/super utilizers cost reduction; better resource utilization Provide health and risk assessments for vulnerable patients outside of the hospital setting Connect right patient with right resources Very good video:www.youtube.comwww.youtube.com NAEMT transforming EMS

4. Community Paramedic Paramedics do: 1000-1500 hours of training medical and trauma assessments 12-lead EKGs wound care vital signs (BP, P, R, skin, pupils, LS, LOC) med administration (IV, SQ, IM, SL, PO) oxygen administration measure oxygen saturation blood glucose checks advanced airways (King, LMA, Combitube, ET intubation) work under authority of a medical control physician

5. Community Paramedic Paramedics do not: prescribe medications suture conclusively diagnose provide hospice care read x-rays perform surgery provide social work services like being called “ambulance drivers”

6. Community Paramedic MDHHS EMS Section ideas: move forward with community paramedicine concept special study process gather data develop education component rural/urban component private/not-for-profit/fire-based EMS agencies explore/develop best practices

7. Community Paramedic Challenges: fee for services (currently EMS only reimbursed for transports) buy-in from agencies support from MCAs

8. Community Paramedic Rural challenges: will CP work in a rural area? rural/remote location limited access to healthcare options underserved areas for healthcare providers distance/travel time to access healthcare services volunteer/paid-on-call EMS agencies fewer paramedics in rural areas?

9. Community Paramedic Sampling of 12 agencies approved to conduct CP special study: Life EMSGrand Rapids Huron Valley AmbulanceAnn Arbor Community EMSSouthfield American Medical ResponseGrand Rapids Clinton Area AmbulanceSt. Johns Portland Area AmbulancePortland Medstar AmbulanceClinton Twp.

10. Community Paramedic Success stories… 75 y.o. female pt.; diabetes hx.; lying in bed unresponsive; EMS arrives, determines low blood sugar; I.V. dextrose administered with rapid return to normal status; no further complaints; left in care of CP and family; follow-up phone call next day; pt. is fine.

11. Community Paramedic Success stories… 94 y.o. female pt.; DIB; swollen legs with pitting edema; wheezes present in lungs; breathing treatment administered; DIB improvement noted; second breathing treatment administered with increased improvement; pt. wishes to remain at home; CP contacted pt’s primary care physician; follow-up appt. made; transportation assistance provided to pt’s appt.

12. Community Paramedic Success stories… 68 y.o. male pt.; fell while standing to use walker; small abrasions to L leg; no other injuries found; assisted pt. to recliner; corrected several trip hazards throughout home; determined no need for transport to hosp.; social worker followed up with pt. the next day; pt. doing well.

13. Community Paramedic Sunset over Lake Lansing