Fla. Community Paramedic Program Curtails Ambulance Calls and ER Visits

The recurring operating expenses to continue the program for another year are $338,000--and possibly another $104,000 if the County Commission honors Emergency Medical Services' request to expand service from one paramedic assigned to it seven days a week to have two paramedics handling home appointments five days a week.

EMS now identifies users of the local health care system with conditions such as diabetes, substance abuse, frequent falls and heart conditions who frequently rely on 9-1-1, which can result in an ambulance trip costing an average of $632, and emergency room visits, which can cost an average of $900. The referrals come from physicians, hospitals, 9-1-1 dispatchers, fire district emergency medical technicians and even fellow paramedics.

So far, Community Paramedic Chief James Crutchfield told county commissioners on Tuesday that the service has made about 1,400 house calls.

Although the program is not yet paying for itself, commissioners say it is bringing positive results by redirecting more patients toward better, and less costly, long-term care.

So far this month, the program has diverted at least 20 patients from emergency rooms, Crutchfield said.

Victoria Reinhartz, a pharmacist instructor at Lake Erie College of Osteopathic Medicine, assists the program by reviewing patients' prescriptions and determining whether they are taking their medicines as directed, have conflicting prescriptions or are experiencing side effects.

She described the treatment of a patient who, within six months, called for an ambulance 14 times. The 58-year-old African-American woman with diabetes, obesity and fluid on her lungs and heart used an inhaler 12 times a day. Because of side effects, she stopped taking all of her medications. Since being enrolled in the community paramedicine program, she is off the prescription that caused side effects and is back on her other prescriptions. She quit smoking and lost 27 pounds. In her case, at least seven ambulance trips were avoided.

Currently, the program is assisting 59 patients. The intent is to get their problems resolved and enable them to independently care for themselves in less than two months.

"Ideally, once they graduate the program, we'd like them to not come back," Crutchfield said.

The Florida Agency for Health Care Administration provided $512,007 for the county to cover "start-up" costs, which included one-time equipment expenses.

Deputy County Administrator Karen Windon said the county will continue to seek other grant opportunities for the program.

Crutchfield said he is getting inquires from across the nation from other emergency medical services interested in starting similar services. Another came from the United Kingdom, from someone who will be vacationing in Manatee soon and who intends to accompany and observe a paramedic on house calls.

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