Ala. City Launches Paramedicine Program

The Tuscaloosa News, Ala.

Jan. 12—In a first for the state of Alabama, the city of Tuscaloosa and the University of Alabama have teamed up to bring a new medical program to city residents.

Dubbed ACTION—Appropriate Care and Treatment in Our Neighborhoods—this new approach to health care is now available to all Tuscaloosa 911 calls that will apply.

Announced last year, this ambitious new medical program is aimed at reducing health care costs while improving patient care.

The city, the University Medical Center and UA's College of Community Health Sciences have partnered to launch the paramedicine program, which will bring health care treatment to certain patients in their homes.

Dr. Elwin Crawford, medical director of the city's Emergency Medical Services operations, likened the new program to the house calls once made by local doctors.

"Anytime you call 911, we're going to respond. But that response may not mean that we need to take that patient to the emergency department," said Crawford, who was hired in 2011 to oversee and manage the policies and direction of the emergency medical services of the Tuscaloosa Fire and Rescue Service and the city's only private ambulance provider, NorthStar Emergency Medical Services.

"This has almost come full circle in that we're actually taking the medical care to the patient and not necessarily transporting that patient to the emergency department," Crawford said.

Tuscaloosa Fire and Rescue Chief Alan J. Martin said the program is aimed at "low acuity" patients, like those who call 911 over a nose bleed, stomach ache or flu-like symptoms, for example.

He estimated that about one-third of all of the city's 911 calls fall into that category.

Nurse practitioners and, when necessary, social workers will ride with designated first responders on these calls and offer treatment at the patient's residence. This will eliminate the need for an ambulance ride and emergency department visit, which can lead to mounting healthcare costs and extended wait times.

"One of the key parts of this program is in sending these midlevel practitioners and paramedics. It keeps that rescue unit with two paramedics and engine companies available to make the fire calls, or the wreck calls or the heart attack calls—very serious life-changing events," Martin said.

The ACTION paramedic units also will respond to certain mental health and psychiatric calls.

With Bryce Hospital in Alberta classified as the state's largest mental health facility and, according to Mayor Walt Maddox, the Tuscaloosa County Jail serving as the state's second largest psychiatric services provider—about one-third of inmates there are on some form of psychotropic drug, the mayor said—an estimated 30 percent of the city's non-emergency 911 calls involve some form of mental health condition.

"Our first responders deal with this issue every single day," Maddox said.

Funded with a $500,000 allocation through Medicaid by the Alabama Legislature, the program will use employees through the Department of Family and Internal Rural Medicine, a division of UA's College of Community Health Sciences, to provide the care.

The paramedicine program is being modeled on a similar program in Arizona. A key difference, though, is that the Arizona example does not have a university as a partner.

Part of the University of Alabama's function will be to collect data and information on how the program is performing. From these findings, the city and UA hope to justify the program's expansion statewide.

But based on the preliminary findings from the Arizona model, the medical cost savings could be $6 for every $1 that's invested.

"We believe it's really creating an innovative and common sense solution to address some of our health care needs," said Dr. Richard Friend, chair of UA's Department of Family and Internal Rural Medicine. "That allows us to better utilize the resources of the city and better utilize the resources of the health care system."