BVFD re­ceives state com­mu­nity para­medic li­cense

First mu­nic­i­pal fire-based ser­vice in Arkansas to hold li­cense

The Weekly Vista - - News - Staff Re­ports

Bella Vista Fire De­part­ment is now a state-li­censed com­mu­nity para­medic ser­vice — the first fire-based ser­vice in the state to be named such.

The li­cense is through the Arkansas De­part­ment of Health Sec­tion of EMS and was granted af­ter Bella Vista met the re­quired train­ing cri­te­ria. BVFD has two paramedics al­ready trained in com­mu­nity paramedicine, with five more cur­rently work­ing to­ward cer­ti­fi­ca­tion, in­clud­ing fire chief Steve Sims.

The de­part­ment will be work­ing now in a 30-pa­tient pi­lot pro­gram in con­junc­tion with Hu­mana.

Paramedics are trained in acute care, Sims said, which ad­dresses only im­me­di­ate symp­toms. They re­spond to emer­gen­cies and as­sess the sit­u­a­tion, then de­ter­mine if that pa­tient should go to the hos­pi­tal.

“Com­mu­nity paramedicine is long-term care of chronic ill­nesses,” he said.

Ba­si­cally, com­mu­nity paramedicine gets the doc­tor into the home, he said.

Com­mu­nity para­medic pa­tients are es­tab­lished through re­fer­rals from healthcare providers and meet cer­tain cri­te­ria, in­clud­ing chronic ER-users, high-cost pa­tients that are con­stantly read­mit­ted to the hos­pi­tal and those who strug­gle with man­ag­ing their dis­eases at home. The trained com­mu­nity paramedics in Bella Vista can ac­cess these pa­tients’ health in­for­ma­tion and med­i­cal charts, in­clud­ing prior treat­ments and cur­rent med­i­ca­tions.

“A lot of pa­tients are read­mit­ted to the hos­pi­tal be­cause they don’t un­der­stand how to man­age their dis­ease on their own,” bat­tal­ion chief Ron­nie Crup­per said, cit­ing di­a­betes as an ex­am­ple.

A com­mu­nity para­medic can as­sist this type of pa­tient in ways other than he would get with a rou­tine doc­tor visit. The medic can visit the pa­tient in the home, cre­at­ing a level of com­fort that pro­motes a bet­ter un­der­stand­ing of what he or she is be­ing told. They can take time to dis­cuss med­i­ca­tions, an­swer ques­tions, help guide nu­tri­tion choices, as­sess the home for safety, such as mit­i­gat­ing fall risks and per­form fol­low-ups that can re­duce that pa­tient’s need to visit a hos­pi­tal.

A lot of doc­tors don’t have the time to talk to pa­tients on a per­sonal level, Crup­per said.

“I can go into their home, where they are com­fort­able, and talk to them like a per­son. I wear a uni­form that is rec­og­niz­able as some­one who is there to help, but they aren’t in­tim­i­dated by me be­cause I’m not a doc­tor,” he said.

The com­mu­nity paramedics, how­ever, of­fer the same treat­ments a doc­tor can, Sims said, “be­cause we work un­der pro­to­cols and guide­lines set by our de­part­ment’s med­i­cal di­rec­tor.”

Through this pro­gram and telemedicine, the com­mu­nity paramedics can rec­og­nize is­sues, and ei­ther mit­i­gate right away or con­sult a doc­tor while on the scene to ad­dress the con­cern. In­stead of treat­ing the symp­toms, they are now help­ing to iden­tify the un­der­ly­ing causes of why these par­tic­u­lar pa­tients are con­tin­u­ing to seek med­i­cal help, be it by call­ing 911 or mak­ing a trip to the ER.

The com­mu­nity para­medic pro­gram has been in place in Bella Vista since fall 2015. The state at that time did not yet have a li­cen­sure pro­gram but granted the de­part­ment, through the com­ple­tion of re­quired ed­u­ca­tion, the abil­ity to con­duct the pro­gram while the li­cense was be­ing de­vel­oped.

“Com­mu­nity paramedicine is in its in­fancy in Arkansas. Ev­ery­thing we are do­ing is ground­break­ing in the state,” Crup­per said.

He has been lead­ing the cer­ti­fi­ca­tion ini­tia­tive for the de­part­ment and sits on the sub-com­mit­tee of the Gov­er­nor’s ad­vi­sory com­mit­tee for com­mu­nity paramedicine. The group, con­sist­ing of rep­re­sen­ta­tives from the few hos­pi­tals and pri­vate am­bu­lance ser­vices in the state of­fer­ing the pro­gram, plus the state med­i­cal di­rec­tor Dr. Gre­gory Bled­soe, meets reg­u­larly to dis­cuss the pro­gram’s ad­vance­ment.

“We are all work­ing out of the same book, but we’re build­ing the book to­gether,” Crup­per said.

The ul­ti­mate goal, he said, is to get the pa­tient to be self-suf­fi­cient in man­ag­ing his or her dis­ease through ed­u­ca­tion.

Not only does the ser­vice pro­vide an ad­vanced level of care for pa­tients, it saves tax­payer dol­lars and gen­er­ates rev­enue for the de­part­ment, which can, in turn, be used to bet­ter the emer­gency ser­vices.

“We fa­cil­i­tate the care via telemedicine, and Medi­care, or Med­i­caid, pays as it would for a doc­tor’s visit,” Sims said.

Since the pa­tient never went to the doc­tor, the de­part­ment is re­im­bursed for the ser­vices per­formed.

It’s a cost sav­ing across the board, Crup­per said. If they can help keep pa­tients out of the ER and thus lower the cost to in­surance com­pa­nies, in­surance pre­mi­ums are lower for ev­ery­one, he said.

The Univer­sity of Cal­i­for­nia at Berke­ley did a 27-month study on the ef­fec­tive­ness of the pro­gram, Crup­per said. The pa­tients’ read­mit­tance level dropped 68 per­cent when they were en­rolled in the pro­gram, and the pro­gram saved the state and the hos­pi­tal mil­lions, he said.

Bax­ter County of­fers the pro­gram through its hos­pi­tal-based am­bu­lance ser­vice. In the first year of of­fer­ing com­mu­nity paramedicine, it saved more than $800,000.

“Paramedics on an am­bu­lance are seen as a stand­alone en­tity,” Crup­per said. “A com­mu­nity para­medic is part of the pa­tient’s en­tire healthcare team.”

"Com­mu­nity paramedicine is a long-term care of chronic ill­nesses." Steve Sims Bella Vista Fire Chief

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