Community Paramedicine in Washington state

Community paramedic visits people before they need 911 again

REPOSTED from, Thursday, September 18, 2014

By Eric Stevick, Herald Writer

EDMONDS – At 89, Rosemary Walters looks forward to Shane Cooper’s visits.

Their banter is rapid-fire and frequently funny.

Her mind is sharp.  It is her body that is wearing down.

Walters walks with the aid of two canes.  She has osteoarthritis of the spine and arthritis in her hands, an irregular heartbeat and diabetes.  Her morning routine includes swallowing 16 pills that are lined up on the arm of her easy chair.  More are taken throughout the day.

Senorita Nena, her slightly chubby chihuahua, trained to use scent to detect dangerous changes in Walters’ blood chemistry, stays close by.

The World War II British Army veteran likes it when the man in the dark blue uniform stops by her first-floor Edmonds condominium to check on her.

“He knows how to talk to the old folks,” she said.  “He doesn’t talk down to us.”

Cooper has an unusual job:  He is a community-based paramedic.  Unlike his peers at Snohomish County Fire District 1, he doesn’t respond to emergencies.  Instead, he roams south Snohomish County visiting people with serious medical problems before they need to call 911 again.

He has been at it for eight months now.  His boss thinks Cooper is the first community paramedic working for a fire department in the state.

What Cooper has is the luxury of taking time.  That’s not an option during a typical emergency call, when patients are panicked and seconds count.

“Now there is a conversation,” he said.

With Walters, he discusses a three-hour visit and assessment she had with a social worker.  He asks her daughter, Bryce Durst, if she is making progress with paperwork that will enable Durst to get paid for the around-the-clock care she’s providing.

Cooper checks the swelling in Walters’ legs and ankles.  They talk about the many medicines she is taking, her blood sugar levels and the time of day those levels are being recorded.

Mainly, he’s making sure she’s following her doctor’s orders.

Walters desperately wants to stay put in her cozy home, which has a bookshelf bulging with hard-bound classics.  Too many of her friends have died in nursing homes, she said.

“You want to keep your independence for as long as you can,” she said.

Walters also doesn’t want to be perceived as a chronic complainer.

That’s the beauty of the paramedic who makes house calls before there is a problem, her daughter said.

“It really has been a godsend,” Durst said.  “Mom tends to downplay a lot of the issues.”

Walters is one of an ever-changing number of people on Cooper’s case load.  Earlier this week, the list totaled 155.  Each is designated a row on a 38-column spreadsheet he maintains.

Initially, most of his stops were at homes with the district’s most frequent 911 callers.  That has changed.  Now the lion’s share are referrals from other paramedics and firefighters who have identified people in need of follow-up.

There’s a mix of patients.  Many have fallen.  Some have dementia or mental illness.  Others report weakness, breathing problems, or seizures.

Ideally, Cooper’s roster will be in constant flux.  A big part of his job is to connect patients to other professionals, including nurses and social workers.

“I think it’s going to take all three of us working together,” Fire District Capt. Shaughn Maxwell said.  “There is obviously a gap we are filling.  We want to route them to the right professionals.”

“Our challenge is how to keep up with the demand,” he added.  “How do we sustain this?”

Fire District 1 spent years researching successful community paramedic programs in Australia, Europe, and Canada.

The Verdant Health Commission, an offshoot of the Snohomish County Public Hospital District No. 2, found merit in the fire district’s vision.  It’s providing $144,426 annually over two years to get the program off the ground.

“It certainly seems to be reaching the goals of providing direct support to people with high needs,” said George Kosovich, Verdant’s director of programs and community investments.

It also is highlighting unmet medical needs in the community, which is important for Verdant so it can better understand where it fits in and how it can help, he said.

The job of monitoring the effectiveness of the community paramedic program falls to Robin Fenn, research manager with Snohomish County Human Services.

Initial results – though taken from a small sample of cases – are promising, she said.

She compared 13 patients who could be tracked for three months before and after the community paramedic began in January.  They accounted for 61 emergency medical calls beforehand and 23 after – a 62 percent reduction.  The patients’ emergency room visits also dropped by 54 percent.

“It is hard to track saved dollars,” Maxwell said.

Other fire departments in Snohomish County and beyond are now asking about the Fire District 1 experience.

“There is a lot of interest, a lot of passion, but not much money,” Fenn said.

A key factor in the success of the program is the personality of the paramedic, Maxwell said.

The bottom line is they must be patient and good listeners.

After visiting with Walters last Thursday afternoon, Cooper dropped in on Julia Williams in north Edmonds.

The fire district first began visiting the two-story home when Williams’ mom, who has dementia, took a fall.  She eventually was placed in a Shoreline rehab center.

It became apparent that Williams, 71, also needed help.

That afternoon, she asked Cooper to interpret one of her mother’s medical bills.

They talked about the need to sell the house and what could be done with its contents.

Making house payments has become increasingly stressful – “like keeping the Titanic floating,” Williams said.

Williams reported that she had an assessment scheduled with a psychologist the next day.

As he was preparing to leave, Cooper reviewed his notes.

“So I’m going to give you a buzz in the morning,” Cooper said.

“To keep me from going off the deep end,” she replied, with a smile.

Cooper did call to remind her of her appointment and later followed up to make sure she went.

He makes a lot of follow-up calls.

If patterns continue, his list of patients will grow.

There’s plenty of hidden need in a fire district of 225,000 people.

“It would be nice to replicate me by three,” he said.

Eric Stevick:  425-339-3446; stevick [at] heraldnet [dot] com

©2014 The Daily Herald Co., Everett, WA

Repost of original article located here