Caring for COVID-19 Patients With Mobile Integrated Health

As a department that has been using mobile integrated health and community paramedicine (MIH-CP) long before the COVID-19 pandemic started, Palm Beach County Fire Rescue (PBCFR) in West Palm Beach, Fla. was already prepared to provide supplemental care to COVID-positive patients outside of the typical emergent EMS response or care in the hospital setting. For patients with the novel coronavirus who are not transported to the hospital, the department's telehealth model provides follow-up assessments and medical, social, and emotional care as needed—a model particularly beneficial to more vulnerable patients with comorbidities, substance use disorders, or pyschiatric disabilities. EMS World asked Lauren Young, LCSW, medical social work coordinator of PBCFR, about their MIH-CP program and the positive impact it has had on their community during the pandemic.

EMS World: How are you using telehealth and MIH-CP for PUI?

Lauren Young: PBCFR was utilizing telehealth prior to the COVID-19 pandemic so it was an easy transition to move MIH to a more robust telehealth model of care to ensure the safety of vulnerable patients as well as our personnel. We are using the telephone to complete biopsychosocial assessment and have created a two-tier system where the patient connects to both our medical social worker as well as our community paramedic via phone. We also have the capacity to use video calling as part of the patient care experience. Additionally, MIH is expanding its use of telehealth to the frontline by initiating a 14-day automated phone screening related to COVID-19 on patients we encounter who are home with symptoms and not being transported. The automated call system reaches out daily to inquire about symptom progression, and our MIH team would follow-up if the patient reports any symptoms that may require medical attention.

What advice would you give to agencies who might want to expand or attempt the use of telehealth right now?

LY: For departments wanting to implement telehealth now, I recommend the telephone as a starting point. There is tremendous evidence of the efficacy of working with patients via phone, phones are readily available and will bypass the need for budget consideration as well as any government-related permissions your agency may require, and you can use phones in any setting. For departments with the capacity to integrate more sophisticated technology, consider reaching out to your ePCR provider to see if they offer telehealth options that integrate into your program, or reach out to a telehealth vendor, all of whom are moving quickly with implementations during the pandemic.

What role does MIH-CP have in the pandemic that is different than traditional EMS?

LY: MIH has really been a standout for our department in terms of the flexibility we can offer to support patients and our crews. Our capacity to follow symptomatic patients is one critical important aspect of our role, but our community paramedics and medical social workers are also specially trained to deal with patients with comorbidities who are also experiencing life challenges, and in the COVID-19 environment, this skillset is invaluable. MIH social workers created an emotional support tool for both our patients and crews who are experiencing high levels of stress and anxiety right now. Our familiarity and comfort with telehealth and the capacity to quickly expand our use of telehealth has been a critical asset to the front line. We were able to immediately offer a screening tool for use on the 9-1-1 call that ties in seamlessly to our ePCR, HealthCall, and then allows our MIH team to implement this 14-day monitoring of patients.

What do you think MIH-CP programs should be doing differently during the pandemic?

LY: During the pandemic I do believe MIH programs need to stay focused on post-EMS care. How can we support all those patients who will be at home with COVID-19 through assessment, care planning, crisis intervention, resource attainment, and advocacy, and how can we do it safely for patients and personnel? The care of patients at home will get less attention in the news, but it is its own crisis unfolding. Not only for the 14 days the person will be homebound, but for a long duration due to the emotional, financial, and social impacts of COVID-19. Additionally, for patients with substance use disorders and psychiatric disabilities the potential for exacerbation of symptoms, I believe, will skyrocket. MIH is incredibly innovative and flexible by nature, we don’t operate within the same box of protocols that the front line units adhere to; this work flow is going to serve patients well as we create new ways to innovate caring for significant numbers of vulnerable people at home, for now, via telehealth.