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34 MAY 2016 | EMSWORLD.com or inform the patient's primary care pro- vider of an underlying mental health issue. Sometimes the mental health issue may not present at a physician's office but might be more readily apparent at home. When the CP visits the home, they need to be prepared to identify, document and notify of mental health conditions observed there. The CP should be aware of medications a patient is taking. Often the diagnosis with a mental health issue may not be part of the patient's medical record. Upon further inspection the CP may find prescriptions from one physician that interact or interfere with the medication regimen of the primary care provider. The CP Curriculum To become a community paramedic, the provider must complete the core compe- tencies of the national community para- medic curriculum. One component of this education covers the mental and behavioral health of the patients they will encounter on a daily basis. Community paramedics are uniquely poised to assess, identify, treat and refer their patients to the appropriate level of care in the right setting. Different than the traditional 9-1-1 paramedic, CPs have the time, education and resources to meet different aspects of the patient's health needs. They might not be the expert in all areas, but they have the knowledge to get the patients the care and resources they need. Despite the prevalence of mental and behavioral health disorders, detection is difficult, and recognition and treatment rates are low. Even if patients obtain care, adherence to treatment guidelines is usu- ally less than 50%. With this in mind, the national community paramedic curriculum development team made this part of the education a priority. During the didactic portion of the course, students are taught how to con- duct a psycho-psychological assessment. They evaluate how the patient is function- ing, determine if they are in a psychiatric crisis, determine current psychological sta- tus, collect history about substance abuse, and assess the social margin of the patient. Their time is spent learning about how to conduct the mental status examination and screening for depression, suicide, demen- tia and substance abuse. Ultimately they bring everything together and determine the patient's unmet or undermet needs and get them connected with resources to improve their overall mental and physical health. Important areas of the mental status examination are noted in Figure 1. The clinical portion of the class re- emphasizes the learning by having the students attend a Psychological First Aid course and obtain clinical hours in behav- ioral health settings unique to the service area of the CP. Their time is spent in mental health settings, hospital social work depart- ments, and with other social service and public health organizations. These settings allow the students firsthand experience working alongside nurses, social workers, therapists and caseworkers. These pro- fessionals can provide the students with exposure to patients in a controlled envi- ronment, ideal for learning. The community paramedics not only gain the knowledge and understanding to care for patients in the out-of-hospital environment, but also create relationships through which they can collaborate in the future. Now these professionals will have the resources to refer patients to so they can continue their care and treatment once they have gone home or between visits. Conclusion Mental health issues will continue to increase and change, and community para- medics can be part of the solution. Start today by talking to stakeholders such as your crews, your emergency physicians and nurses, and mental health profession- als to find those gaps. You probably already know them in your community. Community paramedics get to be part of a team of care and will see successes with the interventions they can provide. A B O U T T H E A U T H O R Anne Montera, RN, BSN, is the cocreator and public health partner for the first national community paramedic pilot program in Eagle, CO. She has been a leader in the CP curriculum, leading a team of experts in developing the 3.0 version in 2012, coordinating the California CP statewide course and currently leading the team to develop the CP National Standard Curriculum. She received the Colorado Nightingale Luminary Award for Innovation work on the Colorado CP program in May 2011. T h e We l l n e s s C o o r d i n a t o r With the rising costs of health insurance and pressure to provide coverage for everyone, did you ever consider employing a wellness coordinator? A wellness coordinator organizes and directs programs, people and activities to achieve the best mental and physical health possible. What about using a community paramedic as the wellness coordinator for your organization? A community paramedic receives the education needed to guide individuals through a physical and mental well-being evaluation. They can assist personnel through nutrition and activity assessments, smoking cessation programs, an evaluation of the effects of stress and burnout, and overall discussion of the benefits of wellness. CPs can provide prevention services like cardiac screens, vaccinations, ergonomic evaluations and stress management classes. All of these can improve the health of employees, decrease lost work days and ultimately increase productivity. Look to healthcare partners in your area, such as hospitals and public health clinics. They might already have a program in place your CP can work alongside and expand to your employees. Some wellness programs even extend to employees' families, if they are covered by the insurance plan. Just think if you had the opportunity to prevent on-the-job injury, illness or burn- out—what a way to save healthcare costs! If EMS wants to work beside other healthcare professionals and be considered part of the healthcare team, we need to start acting like other healthcare agencies. Figure 1: Important Areas of the Mental Status Examination » Appearance and behavior » Speech and language » Mood » Thoughts and perceptions » Cognition, including memory, attention, information and vocabulary, calculation, abstract thinking and construction ability