Block Paramedicine Distributes and Diversifies EMS

VANCOUVER, British Columbia - Feb. 27, 2015 - PRLog -- A city paramedic’s prime purpose is early intervention in medical crises. Call volume, thick traffic, address confusion, security – they all take their toll, and because of this, vehicular EMS (fire, ambulance) cannot reliably deliver its most valuable service.

If that response time can be 3-5 minutes, when ambulance or fire ordinarily takes 13+ minutes (http://www.apbc.ca/index.php/download_file/view/1210/1615/), then definitive treatments will be enabled. High rise buildings have an endemic risk for that reason – no easy rescues here – unless we respond within this short time frame. So let’s try this again, except onsite and on foot.

Block Paramedicine

Block paramedicine means there is always an onsite community health worker responding immediately, 24/7.

These EMRs are at your call for medical emergencies only, but they have lots to do each shift – including registering every person on the block that is working or living there, and configuring their cellphones to call them with one icon press, if needed.

That alert can be in the form of an MMS text, and display any confidential information you offered, to assist the EMR or the 911 dispatcher during a life emergency.

Then, if your chest tightens up someday, you need not become one of the 85% of sudden cardiac arrests, e.g. who are not “witnessed” – and may be cleanly resuscitated.

Show me the money

If it sounds expensive to have a medical worker on premises all the time – what is the estimated cost? Let’s look at having one EMR on duty protecting 1000+ people.

The monthly salaries for a team of 5 EMRs, delivering 720 hours (30×24) of coverage each month, might be $17,000 in the US and Canada at living union wages. Office tower complexes open only during business hours might require just 3 EMRs.

Community paramedicine creates an end point in the ambulance hub and spoke system, using onsite paramedics to securely anchor EMS.  The 911 dispatcher can readily distinguish acute emergencies from less urgent requests, transport runs, or unwarranted calls.

Large savings flow from this mod alone, whether from fire trucks not rolled, fire stations no longer required, ED’s not swamped, hospitals not crowded with chronic re-admits, etc. High density districts with tower buildings offer opportunities of scale to control escalating costs, and to get alongside a patient in 3-5 minutes.

In many cities the fire department is the first or sole responder for medical emergencies, and onsite paramedics can effectively replace that need. Firefighting resources are then reserved for their other duties, and for all outlying areas. Busy districts that before had unattainable response standards, now become islands of unprecedented safety, to everyone’s relief and benefit.

The intangible savings in lives not lost, in bodies and families not broken, will always be incalculable.

Diversifying onsite services

While making rounds up on the 22nd floor, the EMR might get a call from 911: “Mrs Jones in 2515…can’t turn on her dialysis.” So the EMR looks in, and shows her where the new switch was installed.

These community health options enable monitored discharges from hospitals, fewer re-admits, and can generate “reimbursables” i.e. revenues for remote services – financial entries over there on the plus side of the ledger.

As insurance payers migrate toward P4P (Pay for Performance) and “outcomes” results, paramedicine will be a prime recipient, as first care and early intervention are the gold standard anywhere. It makes sense to share some of those rewards with the front line practitioners.

These revenue sources will lower net EMR costs, and provide incentives for paramedics to improve their incomes. Improved property and lease values will allow municipalities to underwrite paramedicine, by balancing property assessments with implementation incentives – all stakeholders will benefit and contribute as they do with other city services.

In keeping with the deep value of a trained human attendant, a program providing early intervention to everyone, with health equity is truly priceless. To enable this, legacy EMS policies that muster fire crews every time, or mandate obligatory transport to a hospital should be updated, once this more comprehensive model is introduced.

Paramedicine might (eventually) be structured as a teaching society for young paramedics – a frontline practicum taught by working veterans, creating an independent business model as a late career option for these life savers, if the stairs and sirens become too trying. Their direct and diversified care of this city demographic will resolve issues locally, within optimal time and cost limits, and protect their communities to a bright new standard.

If this coverage is shown to be economically achievable, then health authorities have some duty to deploy a solution that effectively protects against life risk factors.

Contiguous Block Paramedicine

Interweaving city blocks that are not as densely populated into one fabric should be practical, and studied for best practices, as it promises to extend contiguous protection across these downtown and densely populated districts.

If a paramedic’s home block has only 500 occupants, but is adjacent to a block with 300 people on one side and 250 on the other side, this sequence of three less populated blocks can be assigned to one team in the center block. If required, the end blocks can be appended as well, for a total of 5 blocks, to make up sufficient occupants for economic scale. The adjacent blocks all remain within a 4-5 minute total response time from the center. (See the life safety protocol (http://elevaed.com/archives/4553))

Ambulances can be rolled if there is uncertainty about some calls, but dispatchers will be able to assess the situation conservatively, knowing that a block paramedic has accepted the alert, is conversing with video, and will reliably be alongside within 5 minutes.

In this way the health authority can economically protect a city core, including some less densely populated districts. There will still be 1000+ people subtending each paramedic 24/7 team, so the upfront cost stays under $17 per person each month.

With a mix of pilot programs in varying urban contexts and municipalities, we can learn to map in city paramedicine and migrate city cores and districts away from our singular dependence on this 911-ambulance-hospital axis, toward distributed and diversified treatment, with its revolutionary promise of early intervention outcomes.

Authorities are within their mandate to require this level of care, if a full range of community paramedicine and informed EMS support can indeed be delivered this reasonably. The public will embrace the healthcare landscape paramedicine offers, and welcome this advance into their living and work spaces with pride and appreciation.