Indiana has the highest infant mortality rate in the American Midwest, with levels higher in rural areas such as Montgomery County, west of Indianapolis. Nationally the state’s infant mortality rate is the seventh-highest in the U.S.
Project Swaddle is a bid to lower these rates and improve overall public health. Operated under the leadership of Crawfordsville Fire Department (CFD) EMS Division Chief Paul Miller in partnership with Franciscan Health’s paramedicine program and the Indiana Department of Health, Project Swaddle provides at-risk mothers and their children with individualized, intensive medical attention and care.
Central to this enhanced care are regular home visits by long-time CFD community paramedic Darren Forman.
“Project Swaddle is an operation designed to incorporate Montgomery County’s paramedics, primarily Darren Forman, to extend prenatal and postnatal care to those in the community who have difficulty accessing it,” says Scott L. Sinnott, MD, chair of the ob-gyn department at St. Elizabeth Medical Center in Lafayette. “These patients are also generally those who are at highest risk for poor outcome.”
“We are hoping to achieve better outcomes in high-risk pregnancies with achieving term pregnancy, better and more complete prenatal care, finding needed resources for mothers and babies, including primary care physicians, guiding mothers in caring for their young, and much more,” adds Joshua Krumenacker, MD, PhD, a family physician with the Franciscan network in Crawfordsville and the local medical director for community paramedicine/mobile integrated healthcare.
Project Swaddle is part of a larger CFD effort to create a “cradle-to-grave approach to improve health equity and quality of life for everybody in Montgomery County,” says Miller.
How Project Swaddle Works
The Crawfordsville Fire Department has close working relationships with many state and local social services and health agencies. One of these is the Women’s Resource Center in Crawfordsville. It helps provide in-home medical support to Medicaid families living below the poverty line through the Indiana Nurse-Family Partnership program.
With the CFD’s community paramedic program, Miller and Forman saw an opportunity to provide in-home medical support to local pregnant women, new mothers, and newborns referred to Project Swaddle by the Women’s Resource Center.
“We are able to provide a high level of clinical and social care to these patients,” Miller says. “We try to do this within the first 12 weeks of pregnancy, because early access to prenatal care is a big factor in determining long-term outcomes physically, educationally, and socially.”
The Man on the Scene
Forman translates Project Swaddle’s goals into action. He is the CFD community paramedic who regularly visits the women and children identified by the program as needing in-home assistance, backing up the in-hospital care provided by Franciscan Health’s ob-gyns. (Miller works behind the scenes, managing Project Swaddle and accessing community resources from Franciscan, Wabash College, and Purdue University.)
“Darren is the point man and does the regular home visits, receives patient phone calls, directly contacts me, and does medical record charting,” says Sinnott. “He has gone through numerous courses and extensive training to place himself in the position he’s assumed.”
“I go to meet with the clients at their homes, outline what I can and can’t provide, and find out what they need,” says Forman. “Some of them are medically high-risk; others have had trouble with earlier pregnancies, and still others may be first-time mothers coping with the nausea and other side effects of pregnancy.”
The frequency of Project Swaddle visits varies depending on what the client requires. Sometimes Forman will visit a pregnant woman every week to administer injections that stave off premature labor/birth.
“Everything is very client-driven,” he says. “It’s all about what they need.” This level of at-home care makes a difference in Montgomery County, where some people are 40 minutes’ drive from a birthing center and can’t easily afford gas for a car ride.
To put it mildly, Forman is dedicated to his Project Swaddle patients. “Any time they call my phone, 24/7, I answer,” he says. “When a mom feels something they can’t explain, it’s stressful. If they’re a high-risk mom, it’s quadruply stressful. And if they start consulting ‘Dr. Google,’ it makes matters even worse. But if they can call me, then I can answer their questions and reduce their stress, either based on what I know or through the doctors who support Project Swaddle.”
Making a Difference
Because Project Swaddle was only launched in April 2018, it is too early to quantify the program’s impact on public health in Montgomery County. “However, I can see firsthand that these mothers and children are obtaining care both in the home (from the paramedics) and seem to be following through with visits with PCPs in the offices after birth and beyond,” says Krumenacker. “The children are getting immunized, mothers are getting educated, and resources are introduced to mothers if needed.”
Making this happen is in line with Project Swaddle’s primary goal, which is to “reduce neonatal morbidity and mortality in Montgomery County,” says Sinnott. “Doing so should drive down healthcare costs and improve our patients’ quality of life.”
For more about Project Swaddle, see www.franciscanhealth.org.
James Careless is a freelance writer and frequent contributor to EMS World.