A look at the San Juan Island EMS Community Paramedicine program

Submitted by San Juan Island EMS

In 2014, a group of advocates, firefighters, paramedics, state nurses, home health and hospital associations gathered together to pass a law in Washington state that allows pre-hospital providers to serve patients outside of emergency situations. The law had previously stated EMTs and paramedics could only provide care during an emergency. Since the early 90s community paramedic programs have tended to develop from the grassroots level to fill community healthcare gaps in an integrated fashion with public health agencies, home health providers, hospitals, and others. These days many 911 calls are not emergent situations. EMTs and paramedics are often the first to see these community members without the resources they need to get help. The only option they know of is to call 911. Community paramedicine bridges the gap between health care provider and the resources vulnerable populations need, avoiding costly emergency room visits and enabling them to get on the road to better health.

The main goal of the community paramedicine program is to improve the quality of life and health for citizens while reducing the cost of health care. The paramedics and EMTs are trusted and respected for their medical expertise and are often consulted for health care advice by their friends and neighbors. This program helps fill gaps in local health care by using existing providers in expanded roles, focusing on providing primary care, post-discharge follow-up care, integration with other local agencies and providing education and health promotion programs. Expanded roles include home assessments (safety); patient resource needs (food); chronic disease management (diabetes, congestive heart failure); assisting patients to manage their own healthcare; support for family caregivers; post-discharge follow-up to prevent readmissions; checking to make sure the patient is taking the correct medications and following up to see that patients get to their appointments.

The island program has developed in many ways including 911 calls, and referrals from Peace Island Medical Center ER, San Juan County Health Department, Hospice of San Juan, primary care doctors, Compass Health and family members.

Not just anyone is a good fit as a community paramedic. A key factor in the success of the program is the personality of the paramedic or EMT. The bottom line is they must be patient and good listeners. The community is lucky to have a long-time outreach and Prevention Coordinator and Senior EMT Lainey Volk spearheading the local program. Volk began seeing patients in their homes home more than eight years ago as part of a fall prevention program. Since about a year and a half ago, her role expanded into what is now classified as community paramedicine.

Volk explained that on a typical first visit, patients can expect open and friendly conversation. It is important for the community paramedic to understand the patients and what their needs and concerns may be. Home safety is usually a good first step. The community paramedic will look for things like loose rugs, stability rods in bathrooms, bed heights and food prep areas. Basic needs discovered have been anywhere from housekeeping, access to meals on wheels, rides, medication organization, access to social workers, hospice, respite care and a group of local volunteers called Island Neighbors. Reports are then generated and given to the patient’s primary care doctor and the EMS Chief. A patient is seen on a regular basis until “discharged.”

For more information on the local community paramedicine program, contact your primary care physician. Visit www.sanjuanems.org, to learn about EMS.