EMS World

FEB 2019

EMS World Magazine is the most authoritative source in the world for clinical and educational material designed to improve the delivery of prehospital emergency medical care.

Issue link: https://emsworld.epubxp.com/i/1071873

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Page 24 of 53

EMSWORLD.com | FEBRUARY 2019 23 EMSWORLD.com | FEBRUARY 2019 23 A t 0815 the Baltimore community paramedic and her nurse partner knock on the door of their first patient of the day: a 97-year-old female with significant health needs. Upon entering they note the patient has set up a sleeping cot in the living room, a lit cigarette nearby in a full ashtray. The CP and RN will complete three more patient visits this day, finishing with an appointment with a 64-year-old female who has taken to sleeping with scissors under her pillow because she's afraid of her son when he's not taking his medications. Baltimore citizens have significant social and medical needs. These result from lack of access to healthcare, high HIV rates, excessive tobacco use, use of illicit drugs, homelessness, lack of nutrition, and lack of transportation, among other factors. 1 The result is exceptionally high healthcare and EMS utilization. Baltimore's EMS system is among the busiest in the nation. The Baltimore City Fire Department (BCFD) receives more than 154,000 EMS calls for service a year and transports more than 100,000 people to emergency departments. In addition, Maryland's ED wait times currently exceed national rates, with EMS transport units often waiting hours to offload patients. 2 With this demand, the Baltimore EMS system is often taxed beyond its capabilities. The BCFD needed a way to focus on appropriately managing nonemergent patents through alter- native mechanisms. Launching a Program With these daunting numbers in mind, program leaders conducted extensive research on national and state MIH-CP program models to determine their feasibility in Baltimore. BCFD Deputy Chief Mark Fletcher and David Marcozzi, MD, MHS-CL, FACEP, from the Univer- sity of Maryland Medical Center (UMMC) agreed to colead a pilot MIH program in West Baltimore. They submitted a proposal to the Maryland Health Services Cost Review Commission. With the leadership and support of BCFD Chief Niles R. Ford, UMMC Chief Operating Officer Keith Persinger, and Brian Browne, MD, chair of UMMC's Department of Emergency Medicine, the commission funded the proposal for two years. The initiative is divided into two components. Program #1: Transitional Health Support (THS)—THS provides community-based in-home services to high-acuity patients dis- charged to their homes in an effort to improve health at a lower cost for medically and socially challenged patients. The THS team, consisting of a CP and an RN from the BCFD and an advanced- license practitioner (ALP) from UMMC, works with enrolled patients for 30 days after hospital discharge. It provides the fol- lowing services and support: • Social/functional assessments; • Environmental assessments; • Fall risk assessments; • Prescription reconciliation; • Medical assessments; • Coordination of resources to meet patients' needs. Through the support of an interdisciplinary operations center, a pharmacist, social workers, nurses, physicians, community health workers, and EMTs, the program launched May 15, 2018 and comprehensively addresses barriers to achieving improved

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