Ambulances make house calls to prevent future emergencies
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.”