Community Paramedic SPEAKER NOTES About 75 million Americans live in rural or remote areas of the U.S. 80% of the U.S. geography is rural and remote. 4 times as many rural and remote residents traveled 30 miles or more for health care, compared to urban residents1 Only about 10% of America’s doctors practice in rural and remote areas There exist limitless opportunities in every industry. Where there is an open mind, there will always be a frontier. Charles F. Kettering

The Rural and Remote Dilemma ¼ of Americans live in rural and remote areas Only 10% of America’s doctors practice there 4 times as many rural and remote residents traveled >30 miles for health care, compared to urban residents SPEAKER NOTES About 75 million Americans live in rural or remote areas of the U.S. 80% of the U.S. geography is rural and remote. Health worker shortages, recruitment and retention of primary care providers are major concerns among state offices of rural and remote health and public health professionals. Access to quality health services was the most often nominated rural and remote health priority by state and local rural and remote health leaders across the nation. [1] travel study by South Carolina Rural Health Research Center

The Rural and Remote Dilemma POPULATION OF RURAL AMERICANS 25% PRACTICING DOCTORS 10%

Rural and Remote Demographics More elderly More immigrants More poverty Poorer health

HEALTHY PEOPLE 2010 Goals: Have a source of ongoing care Have a usual primary care provider (PCP) Increase the number of under-represented ethnic and racial groups with degrees in health professions Reduce avoidable hospitalizations www.healthypeople.gov The Dept. of Health & Human Services launched its Healthy People 2010 Initiative with these objectives. How do we achieve these objectives against the challenges facing rural and remote communities?

Filling an Unmet Need with Untapped Resources

Filling an Unmet Need with Untapped Resources

Volunteer and Paid Paramedics EMTs/Paramedics already know how to deliver care locally Know how to assess resources and make decisions They could fill gaps in care with enhanced skills through targeted training

Seizing the Opportunity Built on the Rural and Frontier EMS Agenda of the Future Community Healthcare and Emergency Cooperative (CHEC) developed the curriculum The curriculum supports the work of the International Roundtable on Community Paramedicine supports (IRCP) Spearheading a movement SPEAKER NOTES Rural Health Assoc. Initiative… To explore the CP idea, a team of experts came together and formed the International Roundtable on Community Paramedicine Members sharing experiences with funding, data, curriculum Discussions/collaboration spread quickly around globe via Internet Group is driving force for a new health delivery paradigm—the Community Paramedic Program

The Community Healthcare and Emergency Collaborative

The Community Paramedic Program Expand role, not scope Assess and identify gaps between community needs and services Improve quality of life/health SPEAKER NOTES Expands role of paramedics, not scope of work—a subtle but important difference Example, paramedics already mix some drugs and give shots— the CP would simply expand formulary to include IV antibiotics and immunizations. Services provided only where and when there are no others to provide them CP navigates and establishes systems to better serve citizens CP becomes advocate, facilitator, liaison and resource coordinator GOAL: Empower community stakeholders, residents, business, health care workers and service providers,) and policymakers, toward optimal wellness for all

The Community Paramedic Program Level 1 – Non-paramedic filling some roles of the Community Paramedic Level 2 -- Certificate or Associate degree Level 3 – Bachelor’s degree Level 4 – Master’s degree

Expanded Services Primary care Emergency care Public health Disease management Prevention Wellness Mental health Dental care SPEAKER NOTES Developed in each community in collaboration with all stakeholders Read list of services on slide Community Paramedic model will not interrupt any emergency care or EMS services It will enhance skills of emergency care providers Opportunity to care for our fellow citizens in most appropriate way, based 100% on needs of each community

Building on Experience SPEAKER NOTES We don’t have to start from scratch IRCP studied numerous home-grown projects, each with something unique to offer in approach and success Aiming to create a Community Paramedic model based on what has worked in other locations Not entirely new Similar successes around the world

Building on Experience ALASKA NOVA SCOTIA QUEENSLAND, AUSTRALIA SPEAKER NOTES We don’t have to start from scratch IRCP studied numerous home-grown projects, each with something unique to offer in approach and success Aiming to create a Community Paramedic model based on what has worked in other locations

Nova Scotia Community Paramedic Model Serves Long and Brier Island Population: 1,240 >50% age 65+ 2 hours + to nearest hospital No local health care provider SPEAKER NOTES Long and Brier Islands have aging year-round population with ever-increasing health care requirements No local health care provider > two hours, and two ferry rides, to closest hospital Low volume of emergency calls on the Islands—approximately one call every 2.7 days

Nova Scotia Community Paramedic Model Program Development 1. Hired project manager 2. Assigned medical oversight physician 3. Expanded paramedics’ skill set 4. Explained program to community SPEAKER NOTES Emergency Health Services hired project manager—a medical nurse with background in EMS quality audit management Provincial Medical Director developed and approved all medical policies and protocols Used curriculum to train paramedics/expand skills Reached out to the community to explain how the program works, what services were available

Nova Scotia Community Paramedic Model Reaching the Community Health clinics Home health assessments Adopt-a-patient SPEAKER NOTES Paramedics hosted health clinics and visited residents in their homes to help detect fall hazards, other dangers Through innovative adopt-a-patient component, paramedics were assigned to visit shut-ins regularly

Nova Scotia Community Paramedic Model Impressive Results SPEAKER NOTES Expanded role of paramedics demonstrated a 40% reduction in ER visits and 28% reduction in clinic visits over five years for island residents REDUCTION IN EMERGENCY ROOM VISITS REDUCTION IN CLINIC VISITS OVER 5 YEARS

Queensland, Australia Rural and Remote Paramedic Program Australia’s second largest state Rapidly increasing/aging population Needed sustainable health care model SPEAKER NOTES Queensland faced a crisis in how to serve rapidly increasing and aging population Role of extended-care paramedics developed in collaboration with all health services and the community

Queensland, Australia Rural and Remote Paramedic Program Expanded duties Wound dressing with local anesthetics Suturing/minor surgical procedures Chronic pain management X-rays Mental health assessment/treatment SPEAKER NOTES In 2006, Queensland Ambulance Service conducted survey to learn of services expanded-role paramedics provided in rural and remote locations beyond normal practice Even included vaccinations and monitoring of blood pressure/cardiovascular health

Queensland, Australia Rural and Remote Paramedic Program Expanded activities CPR/indigenous first aid Road accident prevention Community presentations SPEAKER NOTES Survey also revealed numerous health promotion activities, from first aid to accident prevention Included special presentations to nursing mothers, farm and industry groups and others

Alaska Community Health Aide/Practitioner (CHA/P)‏ > 550 CHA/Ps 180 villages > 300,000 patient encounters SPEAKER NOTES Today over 550 C-H-A-Ps in 180 villages In the 1950s and 1960, Alaska had Community Health Aide/Practitioners in scattered villages

Alaska Community Health Aide/Practitioner (CHA/P)‏ 24-hour emergency care Acute, non-emergent and urgent care Prenatal, emergency childbirth and newborn care Preventive care Chronic care SPEAKER NOTES Provide full array of health services Use comprehensive manual of best practices to guide every patient encounter

The List Goes On Red River Project, New Mexico Independent Practice Medic, military Guanajuato, Mexico SPEAKER NOTES Plenty of other examples to draw from and successes to consider in developing a universally effective model Guanajuato, Mexico – modeled from Alaska

Community Paramedic Training Program • Where is the pilot based? • Which communities will be served? • Who is involved? Colleges? County? Town? Hospitals? • When will it start? SPEAKER NOTES Describe program, components, timeline

Community Paramedic Program SPEAKER NOTES Community Paramedic Program brings together all best practices and lessons learned in creating effective new model BRINGING THE BEST TOGETHER

Keys to Community Paramedic Program Resourceful Flexible SPEAKER NOTES Community Paramedic Program brings together all best practices and lessons learned in creating effective new model Gap-filling Rural and Remote Centric

Identify specific needs in community health care Standardized curriculum, modified for communities SPEAKER NOTES One size does not fit all—program is tailored to the needs and resources in each community, not based on outside models Community Paramedics will receive standardized training consistent internationally yet modified for each community, state, nation Community Parmedics play important role assessing and identifying gaps and needs in communities

(but not exclusive)‏ Target sparsely populated areas Address special population issues Rising immigrant demographic Aging in place Decreasing availability of medical professionals SPEAKER NOTES Rural and remote locations have been trapped in a corporate, urbanized model As more immigrants move to rural and remote/remote locations, CPP will be well equipped to address unique cultural issues Language Customs Health care traditions/viewpoint Ideally suited for elderly populations that are without health care assessment, support, treatment options Important to note: Model could have applications in urban areas where health care providers are more visible, but not accessible

Identifies what is available And what is missing SPEAKER NOTES This model identifies, assesses and uses a community’s available physical, financial and human resources to help care for all citizens

Creates “health home” for citizens Eyes, ears, and voice of community SPEAKER NOTES Creates “health home” for citizens where none exist CPs become advocates, facilitators, liaisons, community brokers and resource coordinators Make referrals as necessary Fill in missing service areas based on assessment

Community Paramedic Guidelines Essential oversight by community care providers Practice where designated underserved Approved and welcomed Funding specific to each locale SPEAKER NOTES In every community, CP will have close oversight and consultation with existing care providers Provider input especially important for developing the needs assessment and community plan Community Paramedics permitted to "practice" in areas designated as underserved and removed from essential professional health services Community Paramedic only permitted to practice where they have been officially "welcomed and approved" by local government officials and existing health professionals  Program operational in states only after appropriate notification of Secretary of Health and appropriate practice boards Funding will be an issue that needs to be resolved, but likely will be very specific to each community/state/province, etc.

Major Benefits of Community Paramedic Program Keeps rural and remote health issues on the radar of policymakers and community leaders Measures and addresses health issues specific to rural and remote populations SPEAKER NOTES Policy makers and community leaders will have a significant role in the decisions around the CP so issues will be top-of-mind Model will help capture and measure health issues in remote areas—which is currently difficult

Making the Program a Reality Community/citizen support Driven by local needs and resources Current EMS/paramedics SPEAKER NOTES Communities and citizens have the power to get the program started Current volunteer EMS force could pursue launch of CP Program First stages of usage may come as subscription model with city or county support Avenues for employment might be through critical access hospitals, rural and remote health clinics Credentialing CPs may come under clinics, hospital or home health

Making the Program a Reality University/community college participation Establish international registry of student graduates SPEAKER NOTES University/community college participation is crucial to offer training and to initiate programs locally Not just those with paramedic programs, but all with connections to rural and remote communities CP creates attractive new career option for potential EMS students, current EMTs and paramedics Upon graduation, students get certificate, can register with NCEMSI for access to job openings

Curriculum Ready to Go Standardized multi-module delivery model Applicable across America and internationally Certificate, associate, bachelor’s, master’s programs SPEAKER NOTES CHEC Advisory Council – oversight-registry Standardized multi-module delivery model that can be customized for every community, province, state and nation Can be customized to suit colleges/communities across America/internationally New opportunities for a variety of students at a variety of levels

Curriculum—Phase I Foundational Skills @100 hours Role, advocacy, outreach and public health Community assessments Developing community strategies for care and prevention SPEAKER NOTES Understand the CP role Map community health care system Bridge gap between communities and the health/social service systems Educate communities on how to use these systems Identify resources and needs Develop locally appropriate solutions Promote wellness by providing culturally appropriate health information to clients and providers Foster health promotion and disease prevention Refer and link to preventive services through health screenings and health care information Develop partnerships in community to address the health care needs

Curriculum—Phase II Clinical Skills @15-146 hours SPEAKER NOTES Phase two builds foundational clinical skills Dependent on past training of individual Supervised training by medical director, nurse practitioner, physician asst., and or public health provider

Filling the Gaps Together SPEAKER NOTES The time for the Community Paramedic Program is now It is a sensible and promising option that will improve quality of life and health for millions of Americans in underserved rural and remote areas Whether you are a public health department, town council, community college, student or EMS org., CHEC/NCEMSI will help and guide you in your efforts to put the CP program in place.

Filling the Gaps Together SPEAKER NOTES The time for the Community Paramedic Program is now It is a sensible and promising option that will improve quality of life and health for millions of Americans in underserved rural and remote areas Whether you are a public health department, town council, community college, student or EMS org., CHEC/NCEMSI will help and guide you in your efforts to put the CP program in place.

Community Paramedic Program Not many sounds in life, and I include all urban and rural sounds, exceed in interest a knock at the door. Charles Lamb

THANK YOU… QUESTIONS…