Community Integrated Paramedicine (CIP) Fact vs. Fiction.

Where we are in Michigan

CONTACT INFORMATION

Kristine Kuhl, Paramedic, I/C, BA, MACommunity Integrated Paramedicine CoordinatorDivision of EMS and TraumaBureau of EMS, Trauma and PreparednessMichigan Department of Health and Human Services

Office: 517-241-4304Mobile: 517-582-5155

Michigan Emergency Medical Services System website

OBJECTIVES

Describe the structure of Community Integrated

Paramedicine (CIP) in Michigan

Explain why other program models across the country

will not necessarily work in Michigan.

List two benefits an EMS agency and their personnel may

experience from a CIP program

Be able to make a statement for and a statement against

Community Integrated Paramedicine in Michigan

FACT FICTION?

In Michigan, a paramedic license allows you to work in a

variety of places such as hospitals or urgent cares.

FACT FICTION?

EMS is part of public health

Public

HealthBETP

EMS & Trauma

Kathy Wahl

Linda Scott

Trauma

EMS

Sabrina

Kerr

Preparedness

Director Gordon

Dr. Joneigh Khaldun

FACT FICTION?

Only an EMS agency can be approved as Community

Paramedicine program.

FACT FICTION?

There is a huge cost to start a Community Paramedicine program

REINVENTING THE WHEEL?

Q: Why can’t we just copy successful programs from other states? Why reinvent the wheel?

This Photo by Unknown Author is licensed under CC BY

A: Difference in regulatory structure

REGULATIONS AND RESOURCES

Michigan Stat EMS Office – 20 people

AGENCIES – 800 (ALL LEVELS)

220 + Advanced Life Support (ALS)

225-230 Volunteer

PERSONNEL – 29,000 (ALL LEVELS)

9,000 Paramedics

300 AEMT

13,000 EMT

6,500 MFT

VEHICLES - 4,500-5,000

87 Counties

63 Medical Control Authorities

63 Physicians to 800 agencies and 29,000 personnel

Other states (not all)

• One EMS Agency Medical Director per agency

• Agency Medical Director plays a different (bigger) role

than in Michigan

MICHIGAN: PLAN & IMPLEMENT

Education

Protocols

Replication

Data

Regulation

Sustainability

THIS MIGHT NOT FIT

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ON FURTHER ANALYSIS…

Language

Education

Standardize and must match a scope of practice

define a scope of practice

Protocols

Standardize (must fit with education & scope)

Replication

Will need standardization of above things first

Data

EMS documentation is for acute care – can’t define elements until we have defined their scope

Regulation

All above in place first

Sustainability

Dependent on regulation

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#1 LANGUAGE

COMMUNITY INTEGRATED PARAMEDICINE

Mobile Integrated Health

CHW

Community Paramedicine

EMS

Nurse

Social Worker Physical Therapy

Health Plan

Physician

Dietitian

May not even include EMS

Somewhat of a closed system Heavy on bidirectional referrals

PCP CHWLHDCardiac

Rehab

#2 SCOPE AND ROLE

#2.5 STANDARDIZED EDUCATION

Scope and Role Workgroup: hospital physicians, MCA physicians, EMS providers, CPs,

hospitals

Current MI programs, national programs, wish list

Curriculum Workgroup: Educators, ICs, CPs, hospital

Created objectives for the scope

Place objectives in some semblance of order

Standardized minimum curriculum

#3 PROGRAM REPLICATION

CURRENT PROCESS - Special Study Application PA 368

Application Guide

FUTURE PROCESS

Regulated & assimilated into the EMS system

#4 PROTOCOL SUITE

Correspond with scope and curriculum

Standardized

3 Categories within the suite of protocols: CIP Protocols Table of Contents & Adoption Status

Program protocols (system) – ADOPT ALL

Procedure protocols – Flexible – Plug and play

Approved procedure protocols

Treatment/Population – Flexible – Plug and play

CIP Patient General Assessment and Care

Populations

Complaints

#5 DATA

EMS documentation is not geared toward MIH/CP care

Data collected should be related to the deliverable (scope & role/protocols)

Definitions need to be universal (or at least state-wide)

17 vendors for EMS documentation in the state of Michigan (ESO, Stryker, Zoll, ImageTrend, etc.)

All into ImageTrend (repository)

Mapping and acceptance matter

#6 REGULATORY

Special Study - 3 years – adopt, extend, or reject

Endorse, certify, license

All three pose barriers but licensure appears to be the easiest and the most sustainable route

Allows integration into the EMS system

#7 SUSTAINABILITY

The final piece

Currently – contracts between a program and a payer

Payers know it works and it will save them money

ET3

Statewide partners from MDHHS are interested

LET’S TALK ABOUT

YOUR FEELINGS

Good idea?

Bad idea?

Good use of

resources?

Does it really help

us (EMS)?

This Photo by Unknown Author is licensed under CC BY-NC

POLL QUESTION #1

What is your current stance on Community Paramedicine?

1) Adamantly against it. CP does not belong in EMS at all.

2) I’m on the fence

3) Good idea

NOT NEW

Internationally (Australia, Canada, England, Germany, Ireland, Israel,

Norway, Switzerland)

Some form of community paramedicine or mobile integrated healthcare

established in over half of the states in the U.S.

Early 2000’s

No state reports ‘zero activity’ – everyone is at least exploring it

Most established programs report success (reducing ED utilization,

reducing readmissions, bridging gaps in access to care)

This ship has already set sail regardless of our willingness/unwillingness

to embrace it

This Photo by Unknown Author is licensed under CC BY-NC-ND

WHAT COMMUNITY PARAMEDICINE IS NOT

An answer for everything

A resource available everywhere

Duplication or competition of established services

A good idea for everyone

Being a good EMS provider does not make someone a good CP provider

WHAT COMMUNITY PARAMEDICINE IS

Gap filler

Utilization of an untapped resource (EMS)

More time consuming than an EMS call

Maybe a way to help ourselves

EMS SYSTEM RESOURCES – PART OF OUR ‘WHY’

AGENCIES – 800 (ALL LEVELS)

220 + Advanced Life Support (ALS)

225-230 Volunteer

PERSONNEL – 29,000 (ALL LEVELS)

9,000 Paramedics

300 AEMT

13,000 EMT

6,500 MFT

VEHICLES - 4,500-5,000

87 Counties

63 Medical Control Authorities

63 Physicians to 800 agencies and 29,000 personnel

*2015 Nursing was approximately 1,230 per 100,000 people

Survey of Nurses

*EMS Paramedics are <1 per 100,000 people (approximately 1 per 111,000 people)

Michigan• Population of 10 million

• 83 countiesRural county - 57Metropolitan county containing identified rural census tract(s)Metropolitan county

• Wayne: 1.8 million people/673 square mile = 3,000 people per square mile• IF - 1 ambulances per 5 square miles (15,000 people).

Busy, hospital is likely near, turn around time is short.

• Keweenaw 2,000 people/540 square miles = 4 people per square mile• IF - 1 ambulance per 5 square miles (20 people). No

calls, long transport time – not sustainable. 1 ambulance per 540 square miles – long response, transport and turn around times – also not sustainable.

CHALLENGES

Resources

2 people wear 6 hats

Can’t staff our regular trucks

Access

No public transportation (rural)

The ED is all care

Inclement weather

Time

It take hours to turn a call around

Sitting point for hours is horrible

This Photo by Unknown Author is licensed under CC BY-SA-NC

EMS SEES A DIFFERENT SIDE…

This Photo by

Unknown Author is

licensed under CC

BY-SA

This Photo by Unknown Author is licensed under CC BY-SA

MAYBE WE CAN HELP OURSELVES WHILE WE HELP THEM

❑ Think of one patient that was your frequent.

❑ Why were you always there?

❑ Root cause?

❑ Think of one call you ran that was an unnecessary transport.

❑ Could it have been treated on scene?

❑ Treated the next day?

❑ Think of a call that you transported to the ED just to have to turn around to transport back within hours.

❑ What did the ED do?

❑ASK WHY

Procedures

CIP Fall Risk Reduction Assessment CIP SDOH Assessment CIP Medication Audit CIP Feeding Tube CIP Urinary CatheterCIP Nasal PackingCIP Specimen Collection CIP Point of Care Testing for Blood Analysis CIP Suture RemovalCIP PICC Access CIP Vaccinations

Treatment

CIP Diabetic CareCIP Asthma CareCIP Chronic Obstructive Pulmonary Disease CareCIP Congestive Heart Failure CareCIP Chronic Hypertension CareCIP Post MI or Cardiac Intervention CareCIP Post Orthopedic Surgery CareCIP Post Stroke CareCIP Prenatal CareCIP Mom/Baby Postpartum CareCIP Wound CareCIP Substance Use Disorder Care CIP Urinary ComplaintsCIP Gastrointestinal ComplaintsCIP Nontraumatic Nosebleed Complaints

Possibilities

WHAT IS THE REAL COST OF DOING BUSINESS?

Staff, wage, truck, time

Return on Investment (ROI)

I challenge you to think differently about this. (Time on task for non billable services)

Compassion fatigue/burn out

We are human and we are not all built the same

Sitting point/system status management

Utilization vs. me being alseep

IS IT WORTH IT?

CONS

Staffing

Time

Education

Resources

Oversight

Compensation/Sustainability

PROS

Staffing preservation

Time preservation

Resource awareness

Community Engagement

Patient Outcomes

Networks

MICHIGAN

PROGRAMS

Green – CP Program Running

Purple – CP Program will start

soon (January 2021)

Red – CP Program in conceptual

phase – students started class in

August.

INFRASTRUCTURE

Documentation and data

HIE

Sustainable Education

Regulatory

Sustainability

CONTACT INFORMATION

Kristine Kuhl, Paramedic, I/C, BA, MACommunity Integrated Paramedicine CoordinatorDivision of EMS and TraumaBureau of EMS, Trauma and PreparednessMichigan Department of Health and Human Services

Office: 517-241-4304Mobile: 517-582-5155

Michigan Emergency Medical Services System website

EMS CONTINUING EDUCATION QUIZ AND EVALUATION

To receive continuing education credits you

must complete the quiz and evaluation within 2

weeks of the webinar here:

https://msu.co1.qualtrics.com/jfe/form/SV_escur

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Please allow 2-3 weeks for CE distribution to

your email.

You can also find this link in your email.