Am­bu­lances make house calls to pre­vent fu­ture emer­gen­cies

The Commercial Appeal - - Business - Nora Doyle-Burr Le­banon Val­ley News

OR­FORD, N.H. – Two New Hamp­shire am­bu­lance com­pa­nies are mak­ing house calls th­ese days, with the phi­los­o­phy that a pre­ven­tive visit may help avoid an emer­gency call down the road.

The EMTs and paramedics are help­ing pri­mary care providers mon­i­tor pa­tients, es­pe­cially those with a chronic dis­ease, and also can spot haz­ards that may cause a prob­lem later.

In­ci­dents such as falls, for ex­am­ple, can re­sult in un­nec­es­sary harm to pa­tients and tax the emer­gency med­i­cal sys­tem, said Karissa LeClair, a stu­dent at Dart­mouth Col­lege’s Geisel School of Medicine.

LeClair, who also is an emer­gency med­i­cal tech­ni­cian, said re­spon­ders some­times might be tied up re­spond­ing to a fall in a home that lacked rail­ings in­stead of be­ing avail­able when an­other emer­gency call, such as one for a heart at­tack, comes through.

Early in­ter­ven­tion is “bet­ter in terms of ef­fi­ciency of the sys­tem,” LeClair said.

To in­ter­vene be­fore pa­tients need to call 911, LeClair and fel­low Geisel stu­dent Ni­cholas Valen­tini, also an EMT, have worked with Dart­mouth-Hitch­cock’s clinic in Lyme, New Hamp­shire, and Up­per Val­ley Am­bu­lance to cre­ate a pi­lot project in which paramedics use down­time be­tween emer­gency calls to visit pa­tients in Or­ford and Pier­mont, New Hamp­shire.

Dur­ing th­ese vis­its, para­medic Stephen San­born might ex­am­ine po­ten­tial safety haz­ards in the home, draw blood, give flu­ids, of­fer flu shots or check med­i­ca­tion. If ques­tions about a pa­tient’s care arise, the para­medic will com­mu­ni­cate with pri­mary care providers at the Lyme clinic through a shared elec­tronic med­i­cal record, said Clay Odell, ex­ec­u­tive di­rec­tor of Fair­lee-based Up­per Val­ley Am­bu­lance.

When San­born is un­avail­able to visit pa­tients in the pro­gram, Odell, who in ad­di­tion to be­ing a para­medic is a reg­is­tered nurse, fills in.

The goal is to keep ru­ral pa­tients, es­pe­cially those with chronic ill­nesses, “as healthy as we can for as long as we can and keep them in their home,” Odell said.

By check­ing on pa­tients reg­u­larly, from as of­ten as ev­ery cou­ple of days for a more acute is­sue to ev­ery three weeks for a reg­u­lar mon­i­tor­ing visit, Odell said the para­medic aims to “no­tice if there’s any de­cline.”

In ad­di­tion to the Geisel stu­dents’ pi­lot com­mu­nity paramedicine project, which be­gan op­er­a­tions about seven months ago, First Branch Am­bu­lance, which serves Chelsea, Tun­bridge and South Wash­ing­ton, Ver­mont, has in re­cent years been of­fer­ing pre­ven­tive house calls to pa­tients. First Branch re­cently for­mal­ized its re­la­tion­ship with the Chelsea Health Cen­ter, which is op­er­ated by the Ran­dolph-based Gif­ford Health Care, through a mem­o­ran­dum of un­der­stand­ing.

The two pro­grams op­er­ate un­der dif­fer­ent mod­els. First Branch de­ploys EMTs, who are able to pro­vide ba­sic life sup­port­ive care such as CPR, pro­vid­ing oxy­gen and ad­min­is­ter­ing glu­cose to di­a­bet­ics; and Up­per Val­ley Am­bu­lance de­ploys paramedics, who have more ad­vanced train­ing in ad­min­is­ter­ing med­i­ca­tions, start­ing in­tra­venous lines and pro­vid­ing ad­vanced air­way man­age­ment.

But both are ex­am­ples of trends in emer­gency med­i­cal ser­vices care around the coun­try.

“I think this is where EMS is go­ing,” said Nick Mer­curi, chief of strat­egy and plan­ning for the New Hamp­shire Depart­ment of Safety’s Divi­sion of Fire Stan­dards and Train­ing and EMS. “It’s an ex­cit­ing area for us … to help our com­mu­ni­ties in a way that we don’t tra­di­tion­ally do.”

Other ex­am­ples of paramedics do­ing pre­ven­tive work in New Hamp­shire in­clude the safe sta­tion pro­grams in Manch­ester and Nashua that in­vite those strug­gling with ad­dic­tion to come to fire sta­tions for a med­i­cal eval­u­a­tion and re­fer­ral to treat­ment. Along sim­i­lar lines, the Gran­ite State re­cently re­ceived a four-year, $3 mil­lion grant from the fed­eral Sub­stance Abuse and Men­tal Health Ser­vices Ad­min­is­tra­tion to sup­port ad­di­tional opi­oid pre­ven­tion work, Mer­curi said.

The funds have not yet been awarded to lo­cal emer­gency ser­vice providers, but Mer­curi said the idea will be that providers will go out to the homes of peo­ple re­ferred to the pro­gram and con­sid­ered at risk of over­dose. They will train res­i­dents in the home in ba­sic CPR and teach them how to ad­min­is­ter nalox­one, an over­dose re­ver­sal drug. In ad­di­tion, they will try to con­nect peo­ple strug­gling with ad­dic­tion with ap­pro­pri­ate treat­ment ser­vices.

Over­all, the goal is to “keep peo­ple out of the hos­pi­tal through a visit at home,” Mer­curi said. “… Or, with the opi­oids, try­ing to get them to where they need to go.”

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