The Bennington Rescue Squad (BRS) is establishing a team of specially educated and trained EMS clinicians to provide access to care and resource navigation within the home (or living environment) of rural residents within Bennington County. This type of team is often referred to as community paramedicine.
• BRS, like many EMS organizations and hospital emergency departments, continues to see a rise in non-emergency use of emergency systems. This situation may be exacerbated with anticipated changes in eligibility for health insurance.
• The traditional emergency system acts as a safety net for those with low health literacy or barriers in accessing healthcare, mental health, or other services.
• 37.9% of EMS calls are frequent or high use patients.
• 34.3% of EMS calls are related to conditions that could be managed with routine medical screening, home fall safety screening, health literacy education, and resource navigation.
The primary goals of this program are to provide intake and assessment in the patient’s home environment, resource navigation, medical assessment, and care in conjunction with healthcare and mental health practitioners in the community.
This program is augmenting EMS’s role as a safety net service. Our intent is to bridge gaps, not to replace or duplicate any existing vital services, such as home health nursing. We aim to help connect patients to appropriate existing services, reduce unnecessary and expensive emergency system care, and improve community health.
Exemplar
Why does Bennington County need a community paramedic program?
How is this different from home health services?
This program will help bridge gaps between existing services. As a common example, let’s say an older adult patient with reduced mobility is identified as an at-risk individual in the local emergency department. The patient has had multiple recent falls. The fall today resulted in a head laceration requiring evaluation at the ED. However, the EMS crew shared during their patient handoff report that the patient was resistant to consent to EMS transport, and it took over 30 minutes at the patient’s home convincing them to go to the hospital.
The patient is fiercely independent and wants little to do with healthcare services. During care in the ED, the patient shares they try to avoid healthcare settings out of fear they will be “put in a nursing home and forgot.” The patient’s wound is sutured, and they promptly leave against medical advice. Out of concern for additional injury, a referral is placed to the community paramedic team to see if the patient will consent to a home safety assessment.
The community paramedic team calls the patient and makes an over-the-phone introduction explaining the concerns of the ED team. The patient does consent to a visit after some discussion. The community paramedic performs an intake visit the next day to build patient rapport. The paramedic schedules a more comprehensive assessment visit in 2 days to avoid overwhelming the patient with too much information or activity at once.
During the third visit, home safety education is provided then collaborative home screening is performed with the patient. The patient then can self-identify hazards in their home or their own health and perhaps decide whether a change is needed. Depending on the patient’s needs, the team could connect the patient with another service:
• If the patient needs durable medical equipment, the team member can coordinate with the patient’s primary care provider to have equipment ordered and delivered.
• Perhaps, the patient is a veteran, the team member can make a referral to the regional VA office or local Home Depot to assist with necessary home safety modifications such as a mobility ramp into the home or bathroom modifications.
• If the patient has vision abnormalities identified after a brief non-invasive screening, the team member can help the patient set an appointment with an optometrist and ensure transportation with a family member or regional transport service.
• If the patient has a complex medical history and needs, they can establish a connection to home health nursing in the area.
