As more EMS systems throughout the U.S. consider incorporating community paramedics, concerns about “turf wars” with home healthcare providers and others continue to be raised.
Proactive agencies will mitigate these concerns by working with these other healthcare providers rather than against or apart from them. What’s more, there are lessons EMS providers can learn from these folks about successfully caring for patients on a recurring basis.
Dwight A. Polk, MSW, LCSW-C, NREMT-P, is the paramedic program director at the University of Maryland, Baltimore County (UMBC). He also has a master’s degree in occupational social work and is a clinical social worker and crisis counselor for the Grassroots Crisis Center and two critical incident stress management (CISM) teams in the Baltimore region.
Polk says social workers are trained to acknowledge the acute but always look at the long-term causes of the patient’s situation. “One focus is that of seeing the patient from an ‘environmental perspective’—in other words, what is going on in the patient’s life or what is it about their situation that is causing or adding to the problem? For example, we may get called repeatedly to a patient’s home for an acute illness, especially during the first week of the month. The EMS provider’s question might be, ‘Did you take your medications today?’ or ‘Did you eat breakfast today?’ However, if we look further, we might find that the patient is disabled, does not drive or have access to public transportation, and has no family living nearby—thus they may not have access to pick up (or purchase) their medications, insulin syringes or groceries.”
According to Polk, while it’s common in EMS for providers to complain about “frequent flyers,” they should instead ask, “Why are they a frequent flyer?”
“In my many years as a paramedic,” Polk says, “I’ve found my repeat clients call due to one of the following reasons: (1) failing health; (2) failure to have access to healthcare or medications; (3) failure to use their primary care physician and opting for the emergency department as their first call when ill; (4) mental illness resulting in somatic symptoms; or (5) loneliness.”
But the opportunity to witness a client repeatedly can provide community paramedics with the advantage of continuity. When caring for a patient multiple times, providers get to know that patient and witness changes that occur over time, such as:
• Are we seeing weight changes?
• Are they eating properly?
• Are they being neglected or abused by family members?
• Are there underlying mental health issues such as anxiety or depression?
• Are they experiencing unresolved grief from the death of a loved one?
• Are they in need of companionship?
• Can they still care for themselves, or do they need placement in an assisted living or nursing care facility?
Another advantage of community paramedicine is that providers can see the patient in their home environment, often in the nonemergent setting, Polk explains. “Over the years, the fire service has done an outstanding job of designing prevention programs and providing education, such as smoke alarms and ‘Stop, drop and roll.’ EMS now needs to do the same. By entering patients’ homes, we can be doing safety checks for hazards such as throw rugs or poor lighting, and education programs about how to safely handle and take medications.
“Also, it gives us a good opportunity to assess the patient for needed services,” he continues. “Are they in need of dental care, food stamps, heating supplements or other human service programs? A good community paramedicine program will need to work closely with local agencies such as the Department on Aging and Department of Social Services. By doing so, the EMS provider will be able to provide information to the client and make referrals to both the client and the service agency.”
Polk says community paramedicine and home visits also afford providers access to a wealth of information on the patient’s daily routine, and allow providers to evaluate the patient’s ADLs (activities of daily living), such as:
• Can they cook for themselves?
• How much are they eating?
• Do they have access to healthy food?
• What is the temperature in their home? Too hot or too cold? Has their electricity been turned off?
• Do they have a working telephone or cell phone to call for help?
• What are their living conditions? Clean? Dirty? Hoarding?
• Do they have working smoke and carbon monoxide detectors in their home? When were the batteries changed last?
• Do they have access to their medications, and are they taking them?
• Are they wearing the same outfit every time you go to visit? Is it clean or dirty?
• How many animals do they have in their home, and are they being cared for?
• Are they wearing an emergency alert pendant around their neck?
Most important, Polk advises, is for EMS providers to remember no matter how busy our day or how bad things seem for us, usually they truly are worse for patients. “Remember that perception is reality in the minds of our patients,” Polk says. “What may be a minor thing to us can be a major event for an ill or injured patient. They’re not just patients; they’re also humans—with needs just like us.”
Some additional tips for building good personal relationships with recurring patients:
• Go the extra mile to help someone. When time permits, make sure their home is secured or that a neighbor has a key and will check on their pets, or turn back the thermostat to conserve energy and money.
• Stop by just to check on them when you are in the neighborhood. Maybe even bring along a few flowers or fresh fruit as a gift. It makes them feel important but also allows you to see them in a nonemergent situation, especially if they are elderly or live alone.
• Help them find support in the community. Programs such as Meals on Wheels, pet therapists, spiritual advisors and grief support groups can dramatically change the way your patient sees the world.