Field paramedics are trained to respond quickly to help people who need emergency medical care, and then move on to the next emergency. Communication and assessment are important parts of the job, but there isn’t much time to build relationships or follow patients’ progress to help ensure that they stay well.
In 2014, HealthEast Care System decided to apply the compassion and problem-solving skills of paramedics to a different type of work – helping mental health patients readjust to their home environment, manage their medications and get follow-up care after they are discharged from St. Joseph’s Hospital’s inpatient mental health unit. Six HealthEast paramedics completed more than 200 hours of clinical training and became state-certified community paramedics.
During the program’s first year, HealthEast Community Paramedicine worked with more than 100 patients. Social workers arrange for the paramedics to meet each patient before discharge and review treatment notes and discharge plans.
Since the program’s inception, preventable mental health readmissions have dropped and more than 30 medication errors have been prevented. Grant funding has enabled each patient to receive 12 home visits, which typically are scheduled in advance and decrease in frequency as the patient progresses. Patients can call for additional assistance between appointments and receive extra visits if needed.
“We began with mental health because staff and patients told us they needed better transitions of care,” said Dr. Peter Tanghe, medical director of HealthEast Community Paramedicine. “Many of these patients don’t have much social interaction or family support. We are trained to handle their often complex medical needs.”
Jennifer Murphree, NREMT-CP, works one day a week as a community paramedic. She has been an emergency paramedic for more than five years. “I would love to do the community work full-time,” she said. “I enjoy being able to establish longer-term relationships with my patients.”
People experiencing their first serious bout of mental illness or who have not been ill for an extended period of time – such as new moms who experience postpartum depression – often respond well, Murphree said. It is sometimes difficult when patients “graduate,” she said, because the paramedics get to know them and their families so well.
"We help with anything they’re struggling with – from taking their medications properly to accessing food or transportation,” Murphree said. “We make a lot of calls to doctors and clinics to help coordinate medical care.”
Murphree believes community paramedicine work has made her a better 911 paramedic. “I understand HealthEast community paramedics support mental health care transitions the big picture of what’s happening and have a better understanding of mental health patients, and the stigma they often face,” she said.
“The program has been rejuvenating and transformative for us,” said Tanghe. “Emergency medical services have always been about responding and helping people at times of need. Community paramedicine recognizes the value of being proactive in this response.
”HealthEast Community Paramedicine is now moving on to its next arena of work, primary care. The paramedics recently began making home visits to patients of HealthEast Clinic – Roselawn in Maplewood.“We’ll be working with people who have chronic conditions, acute conditions such as hypertension that require intense attention, or even home visits for vaccinations if it’s tough for a mother and her children to make it into the clinic,” Tanghe said. “Community paramedicine can’t meet every need, but it is a vital, cost-effective and patient-centered part of an integrated system.”