Fla. community paramedics to begin seeing patients

By Claire Aronson
The Bradenton Herald

MANATEE COUNTY, Fla. — As a paramedic, Shane Pflieger has been interviewing patients for years as he transports them to the emergency room like a doctor does. But once the patient is transferred to the doctor, his questioning ends.

Now Pflieger, who is one of two Manatee County community paramedics, said he is "going to learn about the where they keep going part."

On a recent morning, Pflieger, along with other community paramedic, Angie Hadlock, were studying textbooks before they went over to Centerstone of Florida for a site visit. They are a couple weeks into the education component of the rollout of the county's new community paramedicine program, which became the newest division in the public safety department at the beginning of August.

"We are going to be working closely with them," Pflieger said of Centerstone.

Community paramedicine will "fill community health care gaps by preventing unnecessary hospitalizations, decreasing hospital re-admissions and increasing access to primary care," according to a program brochure.

"It's a very high profile initiative," said Bob Smith, the county's public safety director. "It's got a pretty extensive amount of partnering with outside agencies. ... The value for us is helping those people with more than current emergency problems. We've got a great amount of resources in this county that can help people in these situations. We just need someone that can take the time to sit down with a patient and point in right direction more than anything else."

By the end of the month, the community paramedics will begin serving one of its target patient populations — those with mental health and substance abuse issues. The community paramedics will help to provide these patients with the available resources in the community.

"We recognize you have a problem. Lets talk about community resources," said James Crutchfield, the county's community paramedicine division chief. "It is important that we commit to these people."

Melissa Larkin-Skinner, chief clinical officer with Centerstone, said she hopes the new program will reduce the number of individuals with mental health and substance abuse problems.

"As a community, we have to find an answer," she said. "I think this is a very innovative approach that we are certainly all hopeful will work. I am certainly excited to see it get started."

Other target populations include patients who experience frequent falls, individuals using the 911 system three or more times within 30 days, those who suffer from congestive heart failure/chronic respiratory conditions and diabetic patients.

"Every month or every other month, we will see another subtype of patient," Crutchfield said.

The state's Strategic Plan encourages the development of community paramedicine programs, according to Crutchfield.

"It is going to be a large topic for awhile," he said. "Our target population and community problems align almost directly with the state vision."

While Manatee County isn't one of the very first community paramedicine programs in the state, there have been others that have started and failed because the program tried to do much at once, which is why Manatee's rollout will be slower, Crutchfield said.

"The idea is to crawl before walk and then walk before run," he said.

With a 9 percent increase in population growth since 2010, there has been a 37 percent increase in 911 call volume since 2008, according to Manatee County Emergency Medical Services data.

"Our population is increasing so call volume is going to increase as well," Crutchfield said. "If you are taking care of patients that are most vulnerable in the community, the need of EMS for those patients decreases."

Community outreach will be a component of the program, such as visiting homeless camps and telling them, for example, that they shouldn't be calling 911 to go to the hospital for a shower, Crutchfield said.

"Those calls will decrease," he said. "If you start addressing preventative type of medicine for people falling, that number changes too. We have to be understanding that may not decrease as some may hope because of more people moving here, so maybe the type of calls change."

A lot of the issues in health care are related to the fact that people overuse emergency rooms because they either can't get into see a primary care physician or they wait until there is an emergency instead of ongoing maintenance of the issue, Larkin-Skinner said.

"They are going to take their medical knowledge into the community to help people," she said. "It is all about trying to change behavior. It is giving them someone that has expertise to be healthier. I also think it shows that somebody cares about them."

A grant is funding the three positions within the division for one year. But continued funding for the program is included in the county's 2016-17 budget, which the commission will consider Sept. 15.

"I think you have to prove need and value," Crutchfield said. "There are so many needs. As we prove our worth, I think it's easy to justify more."

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