Michigan Community Paramedics Bring Antibiotics to the Field

Since August 2015 specially trained community paramedics with Michigan’s Livingston County EMS and Huron Valley Ambulance have been responding alongside traditional emergency crews to patients who may not require ambulance transport to the hospital.

Community paramedics conduct a comprehensive assessment in addition to the ambulance-based providers and, if they determine the patient lacks priority symptoms necessitating a trip to the emergency department, will release the crew back into service. The three-year program is intended to reduce costs and demand on the emergency services system.

A unique element of the program that’s being evaluated closely has been the addition of medications beyond those normally carried by paramedics, including antibiotics. This approach allows the patient to start treatment for an infection at the time they are seen by the community paramedic.

Before departing, a follow-up is scheduled with either the patient’s PCP or the emergency physician via telemedicine. For patients who lack a family doctor, the community paramedic will assist in identifying one. The goal is to ensure continuity of care, as the community paramedic will only provide the first dose, requiring the patient to see one of those providers to receive the full prescription and any other care necessary.

The Washtenaw/Livingston Medical Control Authority, designated by the state of Michigan to provide medical oversight for EMS in both counties, approved a formulary addendum under the new community paramedic protocols that went into effect in October. It includes 14 new medications, seven of which are antibiotics.

The protocols include both a general community paramedic assessment and intervention guideline that provides for a mixture of autonomous treatments under published protocols, as well as online direction via traditional means and telemedicine with imaging. All the protocols require a continuity-of-care plan that the patient is comfortable with prior to EMS departing after on-scene care has been rendered.

Critical Care Roots

While it is early in the pilot, Livingston County EMS Community Paramedic Supervisor Tony Peters says crews have encountered little difficulty implementing the new CP resource, and follow-up calls to patients treated by them have been overwhelmingly favorable.

Livingston County EMS, which also serves Washtenaw County, operates an all-ALS system and turned to its well-established critical care transport program to get things up and running. The dual-role community/critical care transport paramedics provide coverage around the clock and respond to requests for service in their own vehicle. They are either augmented by a dual-paramedic crew for high-acuity patient transports or can remain on scene with a nonemergent patient without tying up emergency resources.

Community paramedics undergo several months of advanced training, including additional education on chronic debilitative diseases, homebound patients with special challenges such as indwelling catheters and home biomedical equipment, and expanded assessment skills.

In conjunction with a robust telemedicine system, the CPs can often address complaints that would otherwise require transport to the ED by starting treatment. This ensures the patient is connected to a primary care physician for appropriate, and often more efficient, follow-up.

Antibiotics Experiences

Peters describes Livingston County’s experiences to date with first-dose antibiotic administration as fairly straightforward. The option of using the ED physician for a telemedicine consultation in order to write the full antibiotic prescription seems to alleviate concerns that a patient may not have or be able to follow up with a primary care physician after the CP visit.

As community paramedicine and mobile integrated health continue to mature, trials such as this are an opportunity to explore how paramedics can improve patient outcomes within their scope of education and training. The combination of expanded on-scene assessment with telemedicine consults and early administration of appropriate nonemergency medications, followed by a clear plan for follow-up with primary care, has the potential to reduce healthcare costs. EMS and emergency department resources may see a reduction in demand for nonurgent care as well.

Washtenaw/Livingston Medical Control Authority’s pilot program balances paramedic scope of practice along with novel delivery of care in a model that may change the way patients and insurers view EMS.

Jonah Thompson, NRP, CP-C, is a community paramedic with the CONNECT program in the Pittsburgh area.