1. Community Paramedicine in Minnesota, 2014 EMS Medical Directors Annual Conference Arrow Wood Lodge | Alexandria, MN 9/5 – 9/7 2014 Dr. Michael Wilcox FACEP, FAAFP

2. Introduction  The dilemma: access to health care is becoming more difficult (rural and Metro)  Complicated by increasing numbers of elderly, immigrants, the uninsured, and mentally challenged  Between 2010 and 2050, U.S. population will increase by 42% (310 to 439 million)  More diverse racially aggregate minority population will be come the majority by 2042.  By 2030, 20% will be >65 year of age.

3. Introduction  Further impacted by the Federal Accountable Health Care Act passed in 2013  Compounded by a lack of primary care providers (MD, NP, PA)

4. Minnesota’s Response  In an effort to address these issues, Minnesota in 2007, funded a pilot program to educate skilled paramedics to increase their role in providing primary care unto the needy members of their communities  A “Flex Grant” was provided by the Minnesota Department of Health, Office of Rural Health, to train 10 paramedics to this role.

5. Minnesota’s Response  I was the Medical Director of the program, and provided a summary of this initiative to this conference in 2009.  In 2010, Minnesota passed legislation to assist in paying these providers to do their work.  In 2012, the Minnesota Department of Employment/Economic Development, provided a $250,000 Jobs Skills Partnership grant to EMS organizations who wished to train a portion of their paramedics in pursing this career path

6. Minnesota’s Response  NMMC, Allina, Hennepin County and Health East participated in this initiative.

7. The Training Program  MnSCU, through Hennepin Technical College and later Inver Hills Community College, provided the academic curriculum.  The curriculum was developed by the North Central EMS Institute (Susan Long MA, BA, AS, NREMT-P, President)  It was heavily supported by Gary Wingrove NREMT-P, Mayo EMS and fine- tuned by many national and international instructors.

8. The Training Program  The program consists of 114 Didactic Hours and 196 clinical hours which lead to the attainment of 14 credits toward a degree.  Since its inception Hennepin Technical College has trained over 100 Minnesota Paramedics to this certification (over 300 national/international candidates).  Inver Hills Community College presently has 10 students in its program  Kai Hjermstad NREMT-P – HTC coordinator  Brad Wright NREMT-P – IHCC coordinator

10. HENNEPIN TECHNICAL COLLEGE - TRAINED BY LOCATION Florida Minnesota Maine Canada Nova Scotia Washington North Dakota Nevada Idaho Missouri Kansas New Jersey North Carolina Kentucky Saudi Arabia

11. The CP Programs  Scott County Health Care Collaborative  This program came into existence in 2009  The first Minnesota program to use CPs  Its made up of a partnership including the Mdewakanton Sioux Community, Scott County Public Health, and the Faith Communities of Scott County  Provides medical care freely to the uninsured, under insured of Scott County  Medical Director: Michael R. Wilcox MD  Coordinator: Merrilee Brown, RN; Scott County Public Health Nurse Director

12. SHAKOPEE MDEWAKANTON SIOUX COMMUNITY Mobile Clinic

13. SCOTT COUNTY MED-FIRE CLINICS Med-Fire medical van travels to five areas throughout Scott County every two weeks 14-20 patients per session Access issues – cannot afford insurance Identify a medical home

14. The CP Programs  North Memorial Medical Center  Program came into existence in 2012  At the present time they have 10 paramedics certified to the level of CP  It is a nationally recognized program to provide care to the needy of the northwest metro area  They have recently increased their FTEs to 3 CPs, seeing patients in their home 12 hours a day 7 days a week  Patient numbers: 12 – 16 per day  These CPs see “High Medical Risk Recall Patients”  10 or more medications  3 or more chronic diseases  Medications with a tight therapeutic window (Coumadin, Digitalis, etc)  Mental health related comorbidities  Medical Director: Marc Conterato, MD  Coordinators: Emilie Hedland, RN; Rick Wagner, NREMT-P

17. The CP Programs  Allina EMS Transportation  Program came into existence in 2013  Have 5 paramedics who have been certified to the level of CP  These CPs are working with chronic disease patients to reduce readmission into two of Allina’s Hospitals  These CPs are working also with mentally ill patients to cut down on the need of transfer from busy emergency room settings  Medical Directors: Charlie Lick, MD; Paul Satterlee, MD  Coordinator: Corey Kissling BA, RN, NREMT-P

19. The CP Programs  Hennepin County EMS Transportation  Program came into existence in 2013  It has 1.5 FTE CPs who are serving patients in downtown Minneapolis  These CPs are working with patients referred from the Emergency Room, Coordinated Care Center Clinic, Cardiology Clinic (CHF patients), and the Senior Care Clinic  15 – 20 patient encounters per FTE have been the norm  CPs have found significant benefit in being able to spend an extra 20 mins at the seen with their patients during 911 response to assist them in finding an ideal disposition for F/U  Medical Director: Brian Mahoney, MD  Coordinator: Dave Johnson, NREMT-P

22. The CP Programs  Health East EMS Transportation  This program came into existence in 2013  Has 4 working CPs dealing with issues of behavioral health (medication compliance),  follow up appointments, and home assessments  In the future these CPs will deal with assessments for chronic medical diseases, including diabetes, COPD, and cardiac issues.  Medical Directors: Peter Tanghe, MD; Keith Wesley, MD  Coordinator: Chris Schulz MHA, NREMT-P

24. The CP Programs  Tri-County Health Care EMS  This program came into existence in 2013  Has 5 CPs providing 24/7 accessibility to health care  They work in partnership with Wadena Public Health to address gaps in health care determined by Wadena County Community Health Survey and TCHC’s health needs assessment  The partnership ensures local stakeholders are involved in providing a solution to the county’s health needs.  The initiative is tied to the hospital’s readmission program and the medical assistance readmission program.

25. The CP Programs  The CPs do the following tasks during their home visits:  lab draws for long term care patients and home bound patients  Trach-tube stoma care  Bladder scans  Medication administration to mentally ill patients  Medication reconciliation  Medication Education  12 Lead EKGs for long term care patients  IV starts for long term care patients  Wound care  Home Safety assessments  Post surgical visits (orthopedic care)  Assist with transport of mentally ill and chemically dependent patients to higher levels of care.  Medical Director: John Pate, MN  Coordinator: Allen Smith BS, NREMT-P

27. Summary  Over the next 50 years there will be an increased needs to access health care in Minnesota, the nation and the world  In an effort to address these needs the role of EMS within our communities will change  A greater focus on primary care provided by our EMS colleagues under the direction of a licensed MD/DO, NP, PA will be a major component of this initiative

28. Questions Michael R. Wilcox, MD 612-803-2912 mwilcox3090@yahoo.com