Community Paramedicine

8 01 2015

Below you will find a great article written by Mihir Zaveri, on December 14, 2014, in the Houston Chronicle.  As you will note in the article, the establishment of “community paramedicine” programs are an effort by some of our local counties to provide enhanced health care to citizens.    Congratulations to the Montgomery County Health District for putting together the described program as a new way for meeting the needs of their citizens. Fort Bend County is also moving into this area, and Fort Bend County citizens will be hearing more about the program as it grows.

Fort Bend County’s Community Paramedic Program is designed to give hope, support, and guidance to the citizens of Fort Bend County by providing in-home assessments, education, and health care system navigation.  For more information about the effort in Fort Bend County, feel free to email Mary.Fuglaar@fortbendcountytx.gov; or call 281-633-7086

 

Brett Coomer/Staff/Houston Chronicle

Brett Coomer/Staff/Houston Chronicle

 

Paramedics’ house calls highlight of new health care approach

William Jones sat on a brown sofa in his small, cluttered living room, as a paramedic rolled up his jean leg and pulled down his sock, revealing a limb swollen with fluid.

The 77-year-old’s faulty kidneys concerned paramedic Nivea Wheat.

“We might need to get you in to your doctor,” Wheat told Jones.

Several feet away, Morgan Clark, another paramedic, sat at a wooden kitchen table, methodically sorting some 10 different types of medication for Jones’ heart problems, kidney disease, diabetes and other health problems into a color-coded pill box.

It’s an unusual role for paramedics who are used to seeing a patient for 15 minutes in the back of an ambulance. For about two months now, Wheat and Clark have visited Jones’ house every week, checking his blood sugar, taking his blood pressure readings, setting up appointments with his doctor and helping Jones find a home health nurse.

These relationships are becoming increasingly common as health care organizations push to reduce reliance on the costly emergency response system.

Wheat and Clark are part of a new six-member group in the Montgomery County Hospital District, an adaptable team of paramedics that helps patients who repeatedly find themselves in the emergency room navigate a dauntingly complex health care system and identify more proactive approaches to their health.

They’re calling the program “community paramedicine.”

“Obviously for much of the population, 911 is a great service. For the heart attacks, the strokes, the trauma, it’s a great system, and we do that very well here at MCHD,” said Andrew Karrer, who is running the district’s community paramedicine program. “But for a lot of individuals, that’s not necessarily what they need. They need other options.”

‘Back and forth’

While still new and untested in many areas of the country, emergency response providers are increasingly creating similar programs. Harris County Emergency Corps, an emergency response provider for north Harris County, started a community paramedicine program in the summer, which it calls “mobile integrated health care.”

A few months ago, Fort Bend County announced a similar program.

Matt Zavadsky, a spokesman for MedStar in Fort Worth, one of the earliest adopters of the community paramedicine program that consults with others throughout the country, said according to his organization’s research, there are about 230 different community paramedicine programs in the country. When Fort Worth started its program in 2009, there were only three, he said.

“People are seeing that these programs can have a really big impact,” said Richard Bradley, chief of the EMS and disaster medicine division at University of Texas Health Science Center at Houston.

Partly driving the proliferation is a desire to improve patient outcomes. Patients in these programs receive more intimate instruction and care, rather than being treated by multiple doctors in an ER.

But Zavadsky said a bigger impetus is likely the passage of the Affordable Care Act, also known as Obamacare, which penalizes hospitals for readmissions and creates a financial incentive for proactive programs like community paramedicine.

A goal for the MCHD is to reduce 911 calls from frequent users, Karrer said.

While he said that in its first year, almost two-thirds of the patients who worked with community paramedics reduced their 911 usage, there’s not enough data to say whether the program is working.

“We just want to see we’re moving in the right direction for these individuals,” he said.

That goal has meant paramedics playing a variety of new and unique roles – from health care adviser to social worker to therapist – for a segment of the population that has been “falling through those cracks” in the health care system, he said.

Some patients they visit have only an elementary school education and can’t understand the pages of verbose medical instructions they receive after being discharged from the hospital. Some are uninsured and don’t have primary-care physicians. Some have severe anxiety or other behavioral health problems.

They all see 911 as their only option to access the care they need, Karrer and his team said.

Jones would repeatedly end up in the emergency room after fainting due to low blood sugar because he didn’t take his insulin shots or medication properly. “I’ve been back and forth in the hospital forever,” Jones said.

Managing 42 patients

To pinpoint whom to contact, Karrer looks at who has called 911 between 10 and 35 times in the past six months. Then paramedics contact those individuals and ask if they’d like help, an offer they’ve found has been overwhelmingly appreciated.

“The single most common thing people tell me is, ‘I’ve never had someone explain this in common terms before,’ ” said Cathy Kraus, the case manager for the program.

So far, paramedics in Montgomery County are managing 42 patients, up from 26 last year when the program started. After hiring four paramedics this October, the goal is to reach 120 patients and 145 the year after that, Karrer said.

That number pales in comparison to the need in the county. Based on the 911 data he looks at, Karrer estimates there are likely thousands of people overusing the system.

At Jones’ house, when Clark swings open the door of the fridge, it’s filled with gallon jugs of milk, regular and chocolate, orange juice and a bottle of Dr Pepper, which, upon some light interrogation, Jones coyly admits drinking from time to time.

But the beverages risk dangerously elevating Jones’ blood sugar, so Wheat volunteers to bring him some Crystal Light or another, healthier drink. With other patients, paramedics in these programs might do groceries, help them with their electric or water bills, or simply show up and provide a regular social presence in patients’ lives.

“We’re kind of doing a reboot on our thinking of what is this role of the ambulance, what is the role of the heath care providers that are on it,” said Chivas Guillotte, vice president of clinical services for the Harris County Emergency Corps.

At least for Wheat and Clark, the ultimate goal isn’t to be waiting on Jones indefinitely. Their job is to connect him with the right resources and, eventually, get him off the high-frequency 911 user list.

But for Jones, the paramedics are a mainstay in his life. There are tight embraces and kisses on the cheek when Wheat and Clark enter and leave his house.

“I hope I can stay in contact with y’all,” Jones said.

“I don’t have nothing else.”

 





Are Drones a Good Thing or a Bad Thing?

12 12 2012

The following article was first published in Governing magazine, and then later in Emergency Management magazine.  Written by Eli Richman, and published by Emergency Management on November 30, 2012, the article provides an overview of the use of drones by emergency responders in the United States.  It is becoming apparent that unmanned aerial vehicles (UAVs), or drones, can assist law enforcement agencies in a variety of activities.  As pointed out in the article, perhaps it could be helpful in finding a lost hiker in a national forest.  Closer to home, perhaps a drone could have been used a few years ago when local responders attempted to find a missing kayaker lost on a stream in Fort Bend County?

Drone owned by Montgomery County TexasFire first responders could use such a tool also; perhaps for getting a birds-eye view of a hazardous materials incident or major fire.  Think about how valuable the use of such equipment might be as hundreds of responders attempt to fight a raging wildfire in close proximity to a subdivision.  Emergency managers could use an unmanned aerial vehicle for conducting damage assessments after a hurricane.  It would seem to be an efficient way of getting needed information without putting responder lives at risk.  As a matter of fact, it has recently become known that NASA is readying a couple of experimental UAVs to track future storms.  Why?  To assist communities in preparing for the storms.  

For more information on NASA’s use of drones:   http://www.wired.com/dangerroom/2012/10/hurricane-hunters/

But, the use of drones is not without controversy.  Many individuals have privacy concerns, thinking that use of such equipment is confirmation that “Big Brother” lives and is trying to gain personal information from innocent citizens.  In addition, some politicians have indicated that the purchase of drones with homeland security monies is a suspect expenditure.  Hopefully, any legislation related to government’s use of drone technology will incorporate logical regulations that will still allow first responders to use UAVs for saving lives, arresting criminals, and assisting responders to extinguish fires.

No jurisdiction within Fort Bend County owns a drone.  As you will note in Mr. Richman’s article, Montgomery County does have a drone in their equipment inventory.  What does Fort Bend County do when we need to get a birds-eye view?  Probably, the first request would be to the Houston Police Department; we would request for assistance from one of Houston’s police helicopters.  Another possibility, would be utilizing the Civil Air Patrol (CAP); today, Texas has 3500 volunteer members who are active in Civil Air Patrol.  CAP is an outstanding resource for conducting inland search and rescue missions.  And, of course, contacting Montgomery County, and requesting mutual aid assistance would be another option.  Over the last several years, counties in the Houston area collaborate closely in matters of emergency response.

So, to give you an overview of this topic, please read the attached article.  It provides a balanced viewpoint on the issue of using drones.  If you have any thoughts on the subject, please feel free to make a comment on the blog site.

 

Drones:  The Future of Law Enforcement?

Eli Richman

Law enforcement officials say that’s not their intention, and they couldn’t use drones that way even if they wanted to. “We did not obtain this for the purpose of surveillance,” says McDaniel. “Our ShadowHawk’s maximum aloft time is only two hours and 20 minutes, and you would never fly it for that length of time to begin with.” FAA regulations prohibit drones from flying higher than 400 feet, and they require that drones remain in line of sight of the user. In other words, says McDaniel, if a drone’s around, you’ll know it. “It’s not like its 30,000 feet up in the air and you can’t see it and you can’t hear it. It’s going to be visible to the naked eye, and you’re certainly going to hear it.”

Current drone technology may not lend itself to stealth surveillance, but that’s why privacy legislation should be passed now, before it becomes a problem, say advocates. “While drones are new and novel and everybody’s worried about the privacy issue,” says Stanley, “we need to put in place some farseeing rules and protections that will cover every possible evolution of this technology.”

So far, no state has passed legislation regulating drones, although New Jersey took a preliminary step in June by introducing a bill that outlined warrant procedures for law enforcement’s use of drones. In August, the International Association of Chiefs of Police adopted guidelines for the use of unmanned aircraft. The guidelines call for transparency in how the vehicles are used, and say that any images captured by aerial drones and retained by police should be open to the public. In cases where drones might collect evidence of criminal wrongdoing, or if they will intrude on reasonable expectations of privacy, guidelines suggest police should obtain a prior search warrant. Those instructions aren’t binding, but they’re a good start, privacy advocates say.

At the federal level, the ACLU has recommended that government use of drones be banned except in very specific cases. One piece of legislation has been introduced in Congress by Republican Sen. Rand Paul of Kentucky, which would ban domestic governmental drone use except in patrolling the border or in high-risk security situations. The bill currently lacks bipartisan support. While the ACLU says the bill isn’t perfect, its legislative counsel Chris Calabrese says the bill is “starting in the right place, and we’re going to work with him as he moves forward.”

In addition to questions about privacy, another concern is drones’ security. First, there’s the immediate worry that comes from allowing individually operated aircraft in domestic airspace, particularly in a post-9/11 world. That concern was borne out last year, when a man in Massachusetts was thwarted after attempting to equip several drones with C4 explosives and fly them into the Capitol and Pentagon. Second, civilian drones can be hacked, or “spoofed,” by a counterfeit GPS signal. (Unlike military GPS signals, civilian signals are not encrypted.) The spoofed drone thinks it’s in a different place, allowing the hacker to take rudimentary control of it. In a demonstration in June, the University of Texas’ Humphreys led a team of researchers who successfully hacked into one drone’s navigation system.

Regulating this type of vehicle typically would fall under the purview of Homeland Security, but that department has so far declined to regulate the UAV industry. That’s a major problem, says Texas Rep. Michael McCaul, who chairs the House Subcommittee on Oversight, Investigations and Management. “I find this to be a bit of a ‘nobody’s minding the store’ type scenario,” McCaul says. “No federal agency’s willing to step up to the plate, and when you have the [Government Accountability Office] saying the DHS needs to do it, I tend to agree with them.” Without regulation at the federal level, security oversight could fall to individual states.

For his part, Humphreys says he’s not overly worried about drone security. Spoofing a UAV requires a high level of expertise and very expensive software. But as with the privacy issues, it’s an issue that almost certainly will be exacerbated as technology advances. “What my nightmare scenario would be,” he says, “is looking forward three or four years, where we have now adopted the UAVs into the national airspace without addressing this problem. Now the problem is scaling up, so that we have more heavy UAVs, more capable UAVs and yet this particular vulnerability isn’t addressed.”

There’s no question that unmanned aerial vehicles could forever change crime fighting, disaster response and a host of other functions. Given the push from the federal government, it seems inevitable that drones will increasingly be a part of police assets around the country. But it’s important to address concerns over privacy and security now, says Humphreys. “Let’s let it go ahead,” he says. “But let’s be vigilant.”