The long quest to bring community paramedicine to California finally yielded boots on the ground this summer as the state’s approved CP pilot projects began their patient interventions.
Seven of the 12 projects were to be operational by mid August. The other five were awaiting final approval from institutional review boards and, in one case, a last bit of site-specific training, but were expected to be live by the time you read this.
“It’s been a long road, but everybody’s been extremely dedicated, and we’re excited we’re close to getting there,” says Lou Meyer, who’s managing the projects for the state Emergency Medical Services Authority (EMSA). “It’s a process that, as a project manager, you have to stay on top of and keep everyone enthused, but we haven’t had a problem doing that—everybody’s really on board.”
Bringing CP to the nation’s most populous state required navigating a winding road of political opposition and legislative uncertainty. But since formal approval of the projects by the state’s Office of Statewide Health Planning and Development (OSHPD) last November, things have moved quickly. Since then project leaders have launched and conducted core community paramedic training statewide, tweaked medical protocols as necessary, passing everything through local IRBs, and gathered communities’ baseline data to compare against.
The programs aren’t just a dozen variations of the same idea, though some overlap. The idea is 12 separate labs testing a range of concepts. Some are common to community paramedicine, like post-discharge follow-up visits, frequent-caller interventions and transport to alternative destinations. Others are more novel, like hospice support and treatment of tuberculosis. EMSA gave the communities a range of possible interventions they could select from based on their local needs assessments.
A legal loophole of sorts was needed to bring concepts to reality. By law paramedic practice in California is restricted to emergency care at the scene of an emergency, during transport and transfer, in the ED until care is turned over, and during training.
That may have ruled out CP-type activities, but a workaround was found in OSHPD’s Health Workforce Pilot Program. That’s based on another section of law that acknowledges “there is a need to improve the effectiveness of healthcare delivery systems. One way of accomplishing that objective is to utilize healthcare personnel in new roles and to reallocate health tasks to better meet the health needs of the citizenry.” For that, certain publicly evaluated health workforce pilot projects may be permitted.
What the Projects Do
Here’s how the projects break down:
• Alternative destinations—Four involve guiding patients with certain conditions to treatment locations other than emergency departments. Projects in the L.A. area, Orange County and Carlsbad are doing this; in Stanislaus County they’re taking behavioral health patients to mental health facilities.
• Frequent 9-1-1 users—Alameda County and San Diego are intervening against those who inappropriately overutilize the emergency number and hospital EDs by helping them access primary care and needed social services.
• Postdischarge support—Five programs will provide short-term home follow-up care to at-risk patients who’ve recently left hospitals in an effort to keep them from returning.
TB afflicts many of the laborers who sustain California’s huge agricultural industry. A project in Ventura County helps bring them the directly observed therapy (DOT) treatment guidelines require. DOT requires a healthcare worker actually watch the patient ingest every dose of their medications. “What we hope we’re doing there,” says Meyer, “is filling a gap by working with the health department to make sure their TB patients are well controlled.”
Education for the programs began in January using the standardized CP curriculum developed by the Community Healthcare and Emergency Collaborative. California was the first state to adopt the curriculum at the statewide level. The UCLA Center for Prehospital Care developed content that was live-streamed across the state, then clinical and lab time followed. Other states are now looking at the same model.
As the programs progress, the Phillip R. Lee Institute for Health Policy Studies and Center for Health Professions will conduct a comprehensive evaluation, and a final report will be issued in 2017 by the UC San Francisco evaluation team, EMSA and the OSHPD-HWPP. If the programs are successful, they’ll be followed by efforts to change the law to allow CP in the state to become permanent.