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Study: paramedics can help treat frail, older adults in their homes

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New York --  A new study says paramedics may be the best option for treating frail and elderly patients in their homes.

Researchers recently conducted a study in New York state where paramedics took on an extended primary care role in treating frail, elderly patients.

Thirty physicians, nurse practitioners, registered nurses, medical coordinators and social workers  provided support to the paramedics who treated 2,000 homebound patients.

A traditional 911 EMS system is regulated by the U.S. Department of Transportation and paramedics have no other treatment option than to transport to an emergency department when they respond to a call.

With this study, paramedics provided mobile health services. They had additional training in geriatrics and home-based primary and palliative care and were equipped with an extensive supply of essential medications and diagnostic tools.

Patient called the program's central number to report a change in their condition, a registered nurse answered the call and provided nurse triage. When needed, a clinician was contacted and the decision to dispatch community paramedics was made.

Over a four-year period ending in January 2017:

  • 1,159 individuals received 2,378 CP responses.
  • The average age of the patient was 86-years-old and most were dependent on assistance for daily living.
  • The paramedic was on scene for about 73 minutes.
  • Approximately 66% of dispatches were for patients experiencing breathing difficulty, sickness, unconscious/fainting and chest pain.
  • In nearly 28% of the dispatches, one or more medications/treatments were given by the paramedic.

Transport to a hospital can be a stressful experience for a medically fragile person. These service enabled many people to be treated in the comfort of their own home.

Currently there is no reimbursement in that system for an EMS response that does not involve an emergency department transport. 

But earlier this year the Centers for Medicare and Medicaid Services (CMS) announced a new voluntary alternative payment model called Emergency Triage, Treat and Transport or ET3. Under this model, CMS will pay participating Emergency Medical Services (EMS) providers to either:

  • Transport an individual to a hospital.
  • Transport to a primary doctor's office or clinic.
  • Or, provide treatment by a qualified health practitioner at home or connected using telehealth.

If you'd like to read more about the study, follow this link: https://spcare.bmj.com/content/early/2019/04/04/bmjspcare-2018-001746.full

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