A community paramedic is a seasoned prehospital medical practitioner who has received supplementary training to have an expanded scope of care, such as making house calls to help patients with chronic conditions or assessing patients after hospital discharge. In addition to the standard educational program — consisting of 1,600 to 2,200 hours of academic training — to become a paramedic, community paramedics are trained to do expanded patient assessments and examinations.
Community paramedics may also be trained to perform procedures like wound suturing, and they are also following up with overdose patients to discuss addiction treatment options and harm reduction steps if the patient continues to use opioids.
Working under a physician’s license, these medical providers are eligible, under specific authorizing protocols, to adjust medicines depending on the patient’s needs, review basic lab test results, basic X-ray studies and determine care based upon the patient’s plan of management. In short, community paramedics have significant clinical skills which help fill gaps in access to health care within certain underserved communities.
Under the direction of Michael Wilcox, MD, an innovative program in Minnesota is leveraging these professionals to improve the care provided to individuals held in the county jail while at the same time also reducing total costs for health care for those individuals.
“I provide a clinic in our Scott County Jail, where I work with two of our nurses to provide patient care and we have a clinic that occurs twice a month,” Wilcox said.
“We have also — as part of our health care team, a psychiatrist — a mental health specialist and various types of nursing folks work with us. But then along with that, we’re adding the community paramedics now to do work in this facility. What they’re doing is they’re spending additional time in the facility to do patient care. They’re extenders — they aren’t independent providers of care. They need to work under a medical director’s license in order to do this work,” Wilcox said.
Serving jail populations
The Scott County Jail is made up of six pods, four containing male inmates and two pods for females. The average population is 130-150 inmates at any given time, with ages ranging anywhere between 18-75 years old.
According to Wilcox, a large number of these inmates are characterized as “homeless” upon their admission, many of whom come from the streets of Minneapolis and St. Paul by a free bus service provided by a local casino.
Under Wilcox’s license — and, importantly, his direction — the community paramedics at Scott County Jail are enabling the facility managers to extend the hours during which on-site medical care is available to the population. For example, there are two nurses that work in this clinic. Their hours start at 0600 and end at 1600. But patient needs in that setting occur 24/7. Under the community paramedicine program, facility managers are able to offer significantly extended hours during which service is available.
“Our CPs start working at 10 in the morning and they end up working until 10 in the evening and they can provide patient care on days that the nurses are not available, including weekends,” Wilcox said.
Community paramedics take calls at the facility and Wilcox backs them up on calls — if they have questions they can reach the doctor via phone.
“The thought is that having more additional hours of this kind of provider in-house should provide better quality of care, number one, and then along with that, should cut down on the expenses of having these individuals go into an urgent care setting or an emergency care setting for issues that can be dealt with right there in the facility. So that’s the premise this is built on and that’s what we’re moving to do in this program here in Scott County,” Wilcox said.
There are four community paramedics currently participating in the program at Scott County Jail. Wilcox said that they will probably expand on that number if there’s a need to provide additional hours.
The four community paramedics presently working in the jail are addressing a host of medical matters that one might expect in the correctional setting. Many of the inmates have chemical dependency issues, as well as diseases that are tied in with their chemical dependency — blood-borne pathogens such as Hepatitis B, Hepatitis C and HIV/AIDS.
Many of the inmates have significant dental health issues. Others have skin related problems, such as wounds and abscesses, related to the chemicals they’ve been abusing or shooting up.
Inmates’ medical needs don’t cease while they are weeks or months away from trial or release.
“Some of them, actually, when they’re sentenced, if they have a sentence that’s less than a year, they’ll end up spending that entire time in our jail there in Scott County to complete their sentencing,” said Wilcox
The Scott County Jail also has boarders — inmates who come in from other counties or when the state prison system has overflow issues.
Multiple benefits of jail-based community paramedics
When Wilcox presented an overview of the community paramedicine program being tested at the Scott County Jail to an assembly of EMS providers, he highlighted three principal benefits.
1. The community paramedic placed within a correctional facility can contribute greatly to the level of services provided by the health care team.
2. By adding the community paramedic, the correctional facility could achieve a higher level of in-house care by increasing efficiencies and reducing overhead costs.
3. By adding the community paramedic, additional time could become available for the health care team to develop a discharge plan of care (a continuum of care).
Wilcox imagines this program to be something that can — and probably will — be replicated elsewhere.
“Look at the number of patient care providers that we’ve got now. There are not enough nurses ... not enough docs. There are not enough nurse practitioners and PAs to provide care for patients in various settings. I think folding into our care team a community paramedic is going to be a unique opportunity to expand what EMS can do for us in the area of community health. If you look at the jail setting — the penal institution setting — in particular, I think there would be a place for them to do this work within this setting as well,” Wilcox said.
Wilcox and his team are examining the efficacy of their program. The team is currently gathering data —six months before and six months after the beginning of the program — so they can evaluate the quality of care and financial savings. Specifically, they are going to assess whether the quality of care has increased for the inmates and whether they have been able to save money for the county by preventing the need for transferring inmates to urgent care clinics or emergency departments.
Once Wilcox and his team have assembled and analyzed that data, we will revisit this topic in this space. Meanwhile, take a look at these articles about correctional health care and community paramedicine.
Stay tuned.
