Southwestern District Health Unit
Report date
August 2018
What has been most instrumental to your progress?
We have established a referral process with providers. Along with referrals and case management of clients, we also have a process for referring individuals to other programs, if needed. The original intent was for the CP to be sent to the homes to help fill gaps, and take care of individuals. After the paramedic moved, we continued the process utilizing various nurses. We will continue this process going forward, helping clients, referring clients, and case management of clients, even after the grant is done. We were able to train 2 community paramedics to full capacity, and still work with one. With this grant, services for the elderly---not covered under any program were able to be offered. this allowed more people to get services.
We reassessed the program with the extension and were able to focus on more community based needs. We held many community based screenings for high blood pressure, mental health etc utilizing the CP coordinator (RN) and EMT/Paramedic personnel. This also utilized our referral system with other providers. This allowed more people to be identified that could potentially have cardiac, depression, High Blood Pressure etc issues. There were 187 people screened and 20 individuals had elevated BP, and were referred to providers. This grant allowed for follow-up with the clients as well, and actually was able to save several lives with the finding from these clinics.
Another area that was a large gap in our region, was providing instructors and trainings for CPR. With this grant, we were able to not only train EMTs to become instructors in both American Heart Saver and American Heart BLS, but also provide several trainings for daycare providers, school staff, community partners. Without this grant this need would not have been met. We had a nursing shortage, and an increased need in the schools for help with diabetic students, the EMTs and paramedics also were able to fill this gap as well.
Key lessons learned
We were unable to Increase revenue streams not exclusively tied to transport of patients to or from medical facilities to sustain the existing EMS system. Under the current system design, EMS providers have substantial periods of time in which they are not delivering services as they wait for the next emergency call and revenue is only generated when patients are transported. We attempted to acquire a funding stream for utilizing Community Paramedics to fill this gap. This was worked on in detail during last legislative sessions, but this was eventually held up at the state and not brought forward to legislative due to state budget cuts. I do not think this can be brought forward this time.
I think another challenge was to train and keep community paramedics due to the distance for them to get their training. We did have 2 complete the program, and have one continuing to work with us ( From Billings County), but the other moved to Minnesoata to be a Community Paramedic. We also did find it useful to use EMT and genral paramedics to fill the gaps.
Reflections on the community innovation process
We identified the gaps in our region. Collaboration with community partners was invaluable. Without partners coming to the table, and working together to come up with soluitons to gaps, this program would not of been started. Even though the focus changed a bit, the process, and the program worked well, and continues to work.
Progress toward an innovation
We have truly achieved the goals we had hoped to achieve, maybe not to the exact level, but in a way that will be sustainable. CP/Paramedics/ EMT in place to assist in areas where there are gaps.
What it will take to reach an innovation?
The only thing that was not achieved was utilizing only Community Paramedics, and that was because it was difficult to train them, due to training location. Having a mixture and the model of EMS working with Public Health Nurses has been truly an amazing adventure.
What's next?
We will continue to provide services on this model going forward. Because we will not have the grant, the number of screening may be less, but we plan to continue the community health/paramedic model going forward.
If you could do it all over again...
Being mindful that starting a new program will take time. Having this grant gives the process a start and momentum to start new innovative ideas. The other thing is to be flexible...if the way your vision started may change on factors beyond your control. HAving patience and not giving up is very important as well. This grant allows you to be able to adapt and change to what works best for the community.
One last thought
Staff for this grant have been amazing to work with. This grant was such a blessing to receive and carry out.