Calif. County Spearheads Hospice Training for Paramedics

Nov. 27--Under a pilot program spearheaded in Ventura County, more than a dozen local paramedics have been trained in hospice care to ensure they can properly help terminally ill patients and reduce the number of ambulance trips.

The project is one of 13 conducted across the state. The projects, which started in 2015, serve patients ranging from frequent 911 callers to those with behavioral health issues. Ventura County is heading up two of the projects, including the one for hospice patients and another for tuberculosis patients.

The local programs combined cost just under $100,000 to implement and are funded by American Medical Response, Gold Coast and Life Line, the ambulance companies that hire the paramedics, said Mike Taigman, project manager of Ventura County's Hospice Community Paramedicine Pilot Project.

When paramedics are called to care for hospice patients, many times the patients are taken to a hospital, which interrupts the hospice program and possibly changes their chosen course of treatment, Taigman said.

"We all think we know how it's going to feel when it gets to the end. People, even though they've been told what happens, sometimes they forget. Sometimes they can't handle it and they call 911," Taigman said.

The California Emergency Medical Services Authority and California Health Care Foundation partnered in the effort to implement the community paramedicine programs, which aim to provide more effective and efficient services at a lower cost. Paramedics selected for the program receive specialized training

"These paramedics are stepping out of the normal scope of practice for normal paramedics," said Steve Carroll, emergency medical services administrator for the Ventura County Emergency Medical Services Agency.

The agency oversees the contracting of the three ambulance companies, and the paramedics on those ambulances work under the agency's medical oversight, Carroll said.

Some grant money was also contributed by the California Health Care Foundation toward data collection.

Statistics indicate that between January 2015 and August 2016, community paramedics were able to reduce the number of hospice patients taken to a hospital from 80 percent before the pilot project to 37 percent.

The project began August 2015, so the first six months provided baseline data, Taigman said.

Filling the gap

Taigman was the general manager for Ventura County AMR/Gold Coast when the idea for the project came up. He was meeting with hospice care providers and discussing ways to improve the relationship between 911 paramedics and caregivers.

The talks eventually went on to involve Carroll, the ambulance companies and local hospice providers, including Assisted Home Health and Hospice, Buena Vista Hospice, Livingston Memorial Visiting Nurse Association & Hospice, and TLC Home Hospice.

"It's all about working together to do what's best for the patient no matter the circumstance," Taigman said.

Jamie Villa, a paramedic supervisor with Gold Coast Ambulance Services out of Oxnard, said his job also is about helping someone die with dignity.

Carroll said a letter of intent for the projects was sent to the state Legislature in September 2013 because approval was needed to allow paramedics to work outside their normal duties. The programs were awarded in spring 2014 and training started soon after then, Carroll said.

"We were party to the curriculum to an extent, but that's mostly done on the state level," Caroll said.

Local hospice providers were also involved in that process, Taigman said.

The measures taken by paramedics in the 911 world is different than those taken in the hospice world, Taigman said. Fourteen paramedic supervisors were chosen to receive the 50 hours of training.

"These are paramedics with a lot of experience behind them and education," he said, adding that he wanted senior paramedics to start the project.

Villa said much of the training he received was related to social skills. He also learned about the cultural and religious differences for families of hospice patients. He said his ability to speak Spanish, especially in the Oxnard area, has been a plus.

The time spent with a patient and their family is also different for paramedics involved in the project, which can make the job more difficult, Villa said. There may also be multiple interactions with a patient, he said.

"You try not to internalize it and remember that they're better off with you there," Villa said.

Four supervisors are on duty 24/7 to respond to an average of about 20 hospice patient calls a month, Taigman said. When responders get to the scene and discover the incident is regarding a hospice patient, the paramedic supervisor is called, he said. They are not on ambulances and at times may be able to respond sooner than a hospice nurse would, Taigman said.

The hospice care nurse will also be called, he said.

The project is a collaborative effort, and the paramedics often are there to "fill the gap" before the hospice team arrives.

Finding solutions

Although a significant number of patients do get taken to a hospital, not all of the patients require medical care. One patient in Oxnard, for example, just needed a lift.

"We had one patient who kept falling on the way to the bathroom at night and his wife wasn't strong enough to pick him up," Taigman said.

The community paramedic found out the patient was falling because his bed was too high, so rescuers took the bed out of the frame and put it on the floor. A few weeks later after the patient died, they returned to put the bed back, Taigman said.

Other times, the paramedic is there to provide comfort in ways like holding someone's hand, Taigman said.

"Part of it is help from the paramedics to explain to the family, 'Your loved one is in the last stages of dying,' " Taigman said. "It's about compassion and grief support."

Villa said the authority and trust that come with being a first responder help break the ice in those situations because it's a hard conversation to have, especially when death is imminent.

"The family tends to latch onto you and gravitate to you because that's what they're looking for," Villa said.

Carroll said the paramedics involved in the project have embraced the responsibility and education to have a significant impact on patient care.

"They're the reason why it's been successful," Carroll said.

State officials have extended the project through November 2017, Carroll said.

Copyright 2016 - Ventura County Star, Calif.