When Washington County Emergency Medical Services (EMS) Director Kevin Deramus ran the numbers at the end of 2011, it was clear something had to change. More than 1,200 of the 5,000 emergency calls his paramedics received came from a mere 380 patients, many of whom would have been better served by their primary care physician or a walk-in clinic.
One elderly patient called the EMS 11 times for transport to his medical appointments in Houston, at a whopping $38,000 price tag for taxpayers. The situation illustrated a broken system—broken for the patient, paramedics and taxpayers.
Seeing an opportunity to better target health care and increase efficiency, Deramus and Washington County Medical Director Robert Stark visited their most frequent patient at home to forge a personal connection, then followed up with monthly visits. Deramus offered the gentleman advice and found him a ride to his doctor’s appointments.
“Just an hour of my time every once in a while was all he really wanted,” Deramus said. “That was the best medicine.”
The patient hasn’t called for a transport in the 13 months since Deramus’ first visit.
Aiming to build on that success, Washington County has enrolled nine veteran emergency paramedics in an advanced community paramedic class certified through Blinn College’s Office of Workforce Education.
The course merges preventative and emergency medicine. Students learn which medical situations require urgent care and which scenarios need education and information—but not an ambulance.
Blinn’s program is in rare company, with only a handful of similar offerings around the country—and no such programs at other community colleges in Texas.
“If you look at the data, as a community we make pretty good calls regarding whether to go to the emergency room or the clinic between 8 a.m. and 5 p.m.,” Deramus said. “After about 6 o’clock, we make horrible decisions, and everybody decides they’re going to the emergency room. That’s the part we have to manage better, and a lot of that is just educating people.”
Program graduates can help schedule doctor’s appointments, make certain the patients receive the medications they require and alert them to programs that can provide financial assistance. These veteran paramedics provide personal service to patients that a traditional 911 paramedic doesn't always have the time or training to offer.
“The community paramedic fills the gaps between true emergencies and those who are not acutely ill,” Deramus said. “Traditional paramedics are good at treating acutely ill patients – if you’re dying of a heart attack or having a stroke, those kinds of scenarios. What we’re not geared for is treating chronic health problems that patients aren’t necessarily dying from. That’s what this program is all about.”
Once an advanced community paramedic is introduced to a patient, he or she will check in regularly to ensure that the individual is taking the precautions that lead to a healthier lifestyle and fewer ER visits. If the program is successful, Deramus expects to see the EMS responding to fewer emergency calls.
“Eliminating just one non-urgent trip for each of our 400 patients who call most often will save about $800,000 in the first year,” Deramus said.
Without the advanced community paramedic program, Deramus said Washington County would have already been forced to add another ambulance and crew to handle the demand at a cost of approximately $440,000.
The program includes 186 hours of instruction divided between an internship, the classroom and the clinical simulation labs at Blinn’s Allied Health facilities in the Texas A&M Health Science Center.
The first class of advanced community paramedics will graduate in June. The students with the four highest scores in the class will be assigned shifts as advanced community paramedics, while another two to three will be added after January. At least one advanced community paramedic will be on shift at all times, Deramus said.
The class fulfills 120 of the 144 hours of continuing education paramedics are required to complete every four years. Deramus has heard from EMS departments throughout the state who are closely monitoring Washington County’s success while considering similar programs in their own regions.
Blinn’s Office of Workforce Education offers non-credit classes designed to fulfill the specific training needs for individuals, businesses and industry. Through these courses, individuals can master skills without taking entrance exams or enrolling in college credit classes. These courses vary in length and are offered throughout the year.