Community Paramedicine on San Juan Island

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 90’s 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 healthcare provider and the resources vulnerable populations need, avoiding costly ER 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 our citizens while reducing the cost of healthcare. Our paramedics and EMTs are trusted and respected for their medical expertise and are often consulted for healthcare advice by their friends and neighbors. This program helps fill gaps in local healthcare 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.

Our island program has developed in many ways including 911 calls, and referrals from Peace Island Medical Center ER (PIMC), 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/emergency medical technician (EMT). The bottom line is they must be patient and good listeners. Our community is lucky to have a long time Outreach and Prevention Coordinator and Senior EMT Lainey Volk spearheading the program San Juan Island. Lainey began seeing patients in their homes home 8+ years ago as part of a falls prevention program. Since about a year and a half ago her role expanded into what is now classified as community paramedicine.

Lainey explained that on a typical first visit, patients can expect open and friendly conversation. It is important for the community paramedic to understand the patient 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 Emergency Medical Services Chief. A patient is seen on a regular basis until “discharged.”

If you would like more information on your local community paramedicine program, please contact your primary care physician.