Prevention Through Education
Belmont County CARES Program
Community Access, Resources, Education & Solutions
Currently serving any client in Belmont County
The program is operated by Cumberland Trail Fire District, in collaboration with Belmont County Commissioners, BHM Mental Health & Recovery Board, Senior Services of Belmont County, Belmont County Job & Family Services, and Belmont County Health Department.
The program aids navigating the healthcare system for those in need. Some areas the program can help with include:
-Preventing Frequent Use of Emergency Services (Ambulance, Emergency Department, etc.)
-Home Health Assistance
-Education
-Health Insurance
-Housing
-Access to Medication
-Medication Assessments
-Utilities
-Transportation
-Specialty Care
-Pregnancy Assistance
-Medical Care
-Dental Care
-Fall Assessments
-Smoke Detectors
Community paramedicine programs are one innovation that can particularly benefit rural populations because many people in rural communities have limited access to other types of healthcare. These programs are designed to supplement existing primary care, the public health infrastructure, and fill existing service gaps.
Community paramedicine services can help their communities by:
Reducing the burden on other providers. By treating patients in their homes or other locations outside the clinic, community paramedics reduce the number of patients in hospital beds, nursing homes, or emergency rooms.
Reducing unnecessary transports. In some situations, community paramedics can provide the appropriate level of care to individuals who call for help with non-emergent issues. For example, a community paramedic could assess and treat a patient who had a minor fall in their home and determine whether or not additional care and transportation to the hospital are needed.
Increasing access to primary care. Through home visits, community paramedics can provide traditional primary care services to patients. These can include routine vaccinations; wound care; or checkups for patients with high blood pressure, diabetes, or other chronic conditions. Programs may also help fill the needs of uninsured or underinsured patients who are otherwise unable to access services from home health agencies.
Improving quality of life. Through increased access to care, community paramedics provide individuals with services like home modifications that will improve patient quality of life and potentially allow them to stay independent in their own home for longer.
Supporting mobile integrated healthcare. Because community paramedics have already established relationships with healthcare providers outside of EMS, their role can bridge gaps between existing services and bring those services out into the community.
Types of Community Paramedicine Services
Community paramedics can receive training and provide a variety of different services depending on community needs and gaps in existing services.
Generally, a community paramedicine encounter will involve the community paramedic driving to a patient's home in a fleet vehicle, not an ambulance, dressed in their EMS uniform. Their activities while in the home may vary based on the patient's needs and health status. Programs typically have a set of protocols to navigate the health issues they are targeting in their patient population. After initial contact with the patient, community paramedics may continue to conduct in-home visits or may check in by phone or telehealth visit, depending on the program's protocols.
Post Discharge
Community paramedics visited patients with chronic conditions who were recently discharged from a hospital. These visits can provide an opportunity to introduce patients to techniques to manage their health conditions and reduce hospital readmission.
Frequent EMS Callers
A study by the Rural Policy Research Institute and Stratis Health reports that 5% of patients account for 25% of emergency department visits in the U.S. These patients, called “super-utilizers,” often have complex health issues that may be compounded by significant social, mental health, or physical resource needs that make it difficult to manage their conditions. As a result, they bounce between home, the emergency department, and the hospital, which is distressing, ineffective, and costly.
Often, super-utilizers resort to calling 911 because they need support for a range of medical and non-medical needs but do not have the ability or resources to seek out alternative solutions. This issue may be particularly challenging in rural areas, where there are fewer primary care providers and where services are more likely to be closed evenings and weekends. However, traditional EMS providers are not well-suited to provide care navigation and resource referrals, which can better suit this population and help stabilize their health.
Medication Management
People with complex chronic conditions often have many prescriptions, each with their own dosing schedules, warnings, and instructions. This complexity can make it challenging for patients to take their medication safely and correctly each day. In addition, because these prescriptions often come from multiple providers, patients may not have support managing their medication lists. There may be contraindications, errors in dosage, drug type, or patient usage, resulting in adverse drug events that can be harmful or even fatal.
One important role for community paramedics is to help patients manage medications. Community paramedics can help set up reminders, explain dosing instructions, identify medication management issues like improper storage, and uncover errors in their medication list. Medication reconciliation has three steps:
- Verification: Developing a comprehensive list of all current prescriptions
- Clarification: Confirming medications and dosage are appropriate
- Reconciliation: Making necessary adjustments to the list to ensure no errors, duplications, or omissions
Hospice
Community paramedics provided services to hospice patients in their homes to decrease their need to call emergency services and avoid difficult or unwanted hospital stays.
Mental Health
Community paramedics identified and evaluated patients who needed mental health services rather than emergency medical care and arranged transportation for them directly to a mental health crisis center rather than to the hospital emergency room.
Safety Assessments
Community paramedics conducting home visits are well-positioned to observe any issues in the patient's home that may pose safety risks. Particularly for elderly or frail patients, tripping hazards like throw rugs, broken stairs, ill-fitting slippers, or electrical cords may pose a risk for falls. Up to half of falls may be caused by these environmental risk factors. Home safety checks can help identify modifications that make it easier and safer for patients to age in place, including installing grab bars, adequate lighting, and non-slip surfaces.
By identifying these issues early, community paramedics can prevent accidents that may later result in a 911 call or emergency room visit.
Medical Equipment
Community paramedicine programs can also conduct safety checks of home durable medical equipment (DME) like nebulizers, wheelchairs, or continuous positive airway pressure (CPAP) machines. They can also help manage maintenance and distribution of DME for community lending closets that provide access to patients who are otherwise unable to obtain DME on their own.
Chronic Disease Management
People living in rural communities are more likely to have multiple chronic conditions, which has a significant impact on quality of life. With the right tools, including patient education, people can often manage their condition at home. This results in better long-term outcomes and saves both time and money for the patient and the health system.
Community paramedicine programs focus on a range of chronic conditions including diabetes, chronic obstructive pulmonary disease (COPD), congestive heart failure (CHF), and asthma, depending on the needs of their patient population. Their activities include checking and counseling patients on blood glucose levels, conducting regular weigh-ins with patients living with CHF, checking blood oxygen levels, and discussing the patient's current disease management strategies so they can be modified as needed.
As described by EMS World, a community paramedic engages the patient in an iterative process to ensure they understand how best to manage their disease. This includes education about symptoms, lifestyle modifications, warning signs for worsening health, and proper use of medication or equipment. The patient also works with the community paramedic to practice their self-monitoring and disease management techniques and teaches-back their medical plan to the paramedic.
-Rural Health Information Hub
f you, a friend, or family member could benefit from assistance with any services or similar, please contact the Belmont County CARES Program.
Chad Zambori
Coordinator, Belmont County CARES Program
Training Officer, Cumberland Trail Fire District
czambori@cumberlandtrailfire.com