Firsthand Lessons from First Responders
Several community paramedic programs have encountered opposition from other health professionals, including nurse and home health care associations, which have opposed or questioned the expanded paramedic role on the grounds that these new duties encroach on their scope of practice. Many communities have found that engaging community members and providers throughout the process is an essential way to clarify roles, address concerns and develop strategies that make optimal use of all provider types.
While community paramedicine initiatives are primarily grassroots efforts—born out of the need to solve pressing community health problems—their evolution takes place within a rapidly changing national health care landscape. The impact of the Patient Protection and Affordable Care Act PPACA on these community-based initiatives is not yet fully understood, but many key provisions of the legislation will likely affect EMS agencies and initiatives and the environment in which they operate.
Several federal policy and funding approaches and trends appear to support the development of community paramedicine and similar healthcare approaches. Shift to Value-Based Purchasing. Although community paramedic services are not currently reimbursed under Medicaid, the shift in federal and state payment methodologies—away from fees paid for each service toward payment based on value and patient outcomes—could align with EMS personnel that work in a team to deliver low-cost, high-quality, coordinated care.
The Accountable Care Organization program, for example, provides incentives for health care providers to coordinate care for Medicare recipients. Under the program, providers accept a flat rate for the care provided to a patient, rather than fees for every service and procedure.
Under value-based reimbursement, providers have an incentive to coordinate care and provide the most efficient and effective care possible. Shift to Medical Homes and Coordinated Care. The federal legislation supports Patient Centered Medical Homes see right in multiple ways, including enhanced Medicaid and Medicare payments, as well as support for medical home demonstration projects.
PPACA also enables states to receive federal reimbursement for health home services for Medicaid populations with chronic illnesses. There are numerous types of medical home initiatives, including public e. According to a December report issued by The Commonwealth Fund and the National Academy for State Health Policy , public programs have taken the lead with medical homes, especially among individuals with chronic disease. Many community paramedics reinforce the medical home concept by linking patients with a primary care provider.
A strategic plan by the Joint Committee on Rural Emergency Care recommended that EMS reimbursement should be linked to medical home reimbursement and not contingent on transportation. Federal agencies are increasingly investing resources into programs that have strong evidence of effectiveness. Community paramedic programs are gathering data and measuring cost and quality outcomes that can be used by public and private payers to assess the return on investment for community-based strategies.
The strength of the evidence is expected to play a critical role in reimbursement policies for community paramedic services. Several resources and tools are available to assist communities as they assess their unmet needs and plan community paramedic initiatives. Funding for Payment and Delivery Innovations. In its Health Care Innovation Challenge cooperative agreement, the center expressly specified that community-based paramedic models would be considered for innovation grants.
Among the innovation grant recipients announced in are community health initiatives in Washington and Nevada that utilize community paramedics to provide in-home care, patient education and nonemergency phone line for patients with non-urgent medical situations. The manual is intended to help communities establish a common framework for measuring outcomes and capturing data, both of which are deemed essential for competing for federal and state grants.
In addition to communities that already have a community paramedicine program, the tool is expected to help new communities assess their unmet needs and build the necessary partnerships to support a community paramedic program.
Other federal grants opportunities may be available to assist communities with planning and needs assessment. For example, in , the federal Office of Rural Health Policy announced the Rural Health Network Development Planning Grant Program that provides one-year grants to help rural recipients develop a strategic plan or conduct a needs assessment. Tools for Workforce Development. The evolving role of EMS personnel has implications for workforce policy and development. Across the country, states and communities are paving the way for an expanded health care role for EMS personnel.
As described in this section, Minnesota and Maine have adopted community paramedic legislation. Existing legislation defines community paramedics and addresses payment, oversight and program evaluation. As the first state to adopt community paramedic legislation, Minnesota lawmakers took a two-pronged approach to recognizing and reimbursing a new class of paramedics, known as Emergency Medical Technician-Community Paramedics EMT-CP. In , lawmakers passed legislation Minn. Laws, Chap. The law enables community paramedics to provide specific health services, as well as prevention, emergency care, evaluation, disease management and referrals.
The following year, lawmakers authorized medical assistance reimbursement to cover community paramedic services to certain high-risk individuals, including frequent ED users or other patients that have been identified as at-risk for hospital readmission. The legislation Minn. Senator Julie Rosen, chief author of the legislation, believes the plan will provide additional care with existing health care resources.
Rosen pointed out that partnerships and stakeholder engagement were critical to the legislative process. Assembling nursing representatives and other local providers helped to raise and address stakeholder concerns. The initial legislation established a separate certification for community paramedics, with distinct service, training and educational requirements as defined by the EMS Regulatory Board. Although the legislation that mandates reimbursement applies only to public coverage, Rosen and others have an eye on reimbursement from private insurers.
Starting with public coverage will enable stakeholders to develop fee schedules and reimbursement procedures, as well as gather data about cost and health care outcomes. As of August , implementation was moving forward on several fronts. In July , the first class of 13 certified community paramedics graduated from the Hennepin Technical College.
The Department of Human Services has sought a Medicaid waiver that would allow reimbursement of community paramedics. According to Doyle, the training program will soon enable paramedics in remote and rural communities to obtain training locally, through a mix of interactive video and local clinical experiences. In March , legislators in Maine passed a law authorizing pilot projects for community paramedicine.
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It helps me maintain my well-being in stressful missions so that I can then get back to work.
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And Sid, the "Ice Age" character, because if everything goes wrong, I can say it is his fault! Earplugs to protect me from snoring colleagues, roaring generators and diesel engines. And dental floss, which acts as a strong wire for emergency repairs.
And Sid, the Ice Age character, because if everything goes wrong, I can say it is his fault! Here Jesper talks us through some of the highlights of the response. When I heard about the earthquake, I booked a ticket, packed a bag with what I could find at the office, and headed straight for the airport.
While we were on the runway, unfortunately the engine of the plane we were on blew up, so we had to head back. Eventually, I made it onto a flight and arrived in Istanbul. The West Africa Ebola virus epidemic was the most deadly outbreak of the disease in history. The virus infected 28, people, and killed 11, across Guinea, Liberia and Sierra Leone.
Fragile health systems in heavily affected areas were ravaged. It was quite risky, one of the most challenging missions for me.
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People had to carry on with their lives, so it seemed that the streets were full of people, but at the same time you knew that on the fringes, horrible things were happening. The Ebola virus required thousands of community members to take on difficult and dangerous jobs. On 8 October , South Asia was severely hit by a 7. The earthquake was one of the worst natural disasters in South Asia causing massive casualties and leaving over 3. The massive international response gave rise to the cluster coordination system, which has transformed humanitarian response to this day.
I was in Sudan when it happened. It was shocking. I had discussions with the team in Geneva about what I needed to take. It was really, really cold. But you have to have the affected people at heart. Bhag was so remote and we did not even have maps at the time.
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What I remember is how building relationships with the community really transformed how we would run things. The acceptance was incredible. I made friends with people very close to where we were pitching our tents. If responders want to use the toilet, they need to give us information. We had to manoeuvre our way through perilous roads that were damaged and over a creaky bridge that we crossed safely. They got into the airplane and we landed in Islamabad.
Next morning, we were the first internationals on the ground. Typhoon Haiyan, one of the strongest typhoons on record, struck the Philippines on 3 November It brought strong winds and heavy rains that resulted in flooding, landslides, and widespread damage to homes and infrastructure, affecting more than 14 million people across 44 provinces. Given its unprecedented scale, it was the first time the UN activated a UN system-wide response for a sudden onset natural disaster. As a result of this, there was an extraordinary outpouring of resources and international surge personnel targeting the region.
We all gathered in a church, which didn't have a roof anymore. The local population, all our team and other humanitarian organizations were there. And we were all in some ways, cheering together. And hoping for a good future, while it was raining on us. I thought it was going to be a one to three-day assessment mission, so I left my Go Bag in Manila. I didn't even have a sleeping bag or a toothbrush… I stayed in Tacloban airport for 14 days… I slept on the tarmac behind the airport.
On 26 December a major earthquake occurred off the west coast of Sumatra, triggering powerful tsunamis in the Indian Ocean. The tsunamis affected seven countries, killing at least , people and displacing 5 million more. UNDAC response teams arrived on the scene within hours and days to help the affected governments with victim identification, search and rescue, information management and coordination of the response.
One of the things that struck me was that businesses were running as usual in some areas, yet where the tsunami had hit it was complete devastation. They cleared the beaches of the corpses and did proper burials for those people who had been victims. But the assessment of what the actual damage was not clear yet. THE WORK Responding to emergencies is not like in the movies Lots of people have seen too many American movies, where the heroes come flying in on planes and are met with open arms. The hardest part of disaster management is making life-or-death decisions For me, response is hardest when I must take very important decisions, like whether to end a search-and-rescue phase, or where to prioritize search and rescue.
Thanks to social media, everyone can play a role in a crisis Social media has transformed the way people respond to crises. Crises in focus Each month in , UNDAC team members have been revisiting a memorable mission on its anniversary month. January Haiti Earthquake February Cyclone Winston March Peru Floods