After suffering four strokes, Thomas Hernandez says he owes more than just improved health to the Community Paramedic (CP) Program.
“Without them, I might be dead,” said Hernandez, 66, a Cuban native and former farmhand. He lived on the streets for about a year until he found emergency accommodation through Interfaith Emergency Services 18 months ago.
AdventHealth Ocala partnered with Ocala Fire Rescue in April 2020 to launch the first local CP program, with OFR Captain Jesse Blair as the initial coordinator.
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CP programs use home visits to respond to frequent 911 calls, repeat emergency department visitors who might be treated non-emergency, and patients who might be homeless, without transportation, without a primary care provider or without insurance, or otherwise need help managing the health system.
The goal is to help patients and ease the load on the 911 system, EMS, transportation and medical personnel. These services should be preserved for use in emergency and critical care situations.
Hernandez was referred to the Ocala Fire Rescue CP program by the AdventHealth 360 team after his last stroke about 60 days ago. He had lost the use of his left side but got better.
During a recent meeting on the campus of the Downtown Interfaith Shelter with Ocala Fire Rescue paramedic Captain Chris Hickman, Hernandez flexed his arm and shook Hickman’s hand so the paramedic could measure his progress.
Hickman checked Hernandez’s vital signs with a portable monitor that reads blood pressure, electrocardiogram and oxygen levels. Hickman also checked Hernandez’s medications.
Community paramedics focus on education, communication and proactive outreach
“Education and communication” are the cornerstones of the CP program, Hickman said. He said that currently patients in the OFR/CP program are between 18 and 70 years old.
Hickman said patients may be homeless, without transportation, food or adequate communication with their healthcare provider.
“A lot (of patients) don’t have insurance or don’t know how to get it. They need advice and education on what’s out there,” he said.
OFR’s public information officer, Ashley Lopez, said tracking is an important part of CP’s program.
“The CP program educates patients about agencies that can help them in the situation they find themselves in. In the case of patients without insurance, they are referred to agencies that can help them despite their insurance status,” said she wrote in an email.
Lopez said the OFR/CP program is, in part, for people who use the ER as their primary physician.
“The CP program can relieve (emergency departments) of cases that require minimal treatment and are not ‘hot’ calls,” Lopez said.
The CP paramedic also confirms the patient is being transported and “follows up before and after appointments to ensure the care plan is being followed,” Lopez said.
Captain Hickman serves the community
Hickman has been in emergency medical services since 1994 and with OFR since 2001. He visits people referred by AdventHealth and also partners with agencies like Marion Senior Services to identify people with medical needs.
Briana Kelley, social services counselor at Marion Senior Services, said she and Hickman worked together to help 75 people.
The OFR/CP program has a full-time paramedic (Hickman), a marked SUV, and a $97,400 stipend from AdventHealth for 2022.
Ocala Fire Rescue and Marion County Fire Rescue now have CP programs. The MCFR program began in early 2021. It has a marked SUV, two staff members (Lt. Tyrone Edwards and firefighter/paramedic Jason Mann), and an AdventHealth stipend of $126,760 for that year.
Battalion Commander Bradley Olmsted oversees the MCFR program.
The Community Foundation of Ocala/Marion County manages program funding and seeks additional grants for local CP programs.
The OFR and MCFR programs both have a rotating load of approximately 20 patients. Patients in the OFR/CP program are typically seen about a dozen times over a period of about three months.
MCFR public information officer James Lucas said targeted patients, such as repeat emergency department visitors, often have an underlying problem. Education, like diabetes management, is part of CP’s mission, as is connecting patients with agencies like senior services and the Veterans Administration.
The Marion County Board of County Commissioners’ website (marionfl.org) says the CP program will focus on the medically underserved and “work with the Marion County Florida Department of Health to improve the health of the county’s population. “.
AdventHealth Satisfied with Community Paramedic Programs
Phil Wright, president of business development for AdventHealth Ocala, said the OFR and Marion County Fire Rescue CP programs have been very successful.
“Over 100 patients have gone through the program and I know of only one patient (in hospital) readmitted,” Wright said.
Wright said patients are referred by ER nurses and staff who remain alert to the right candidates. He said outreach activities such as interfaith emergency services and local clinics are also involved.
Wright said AdventHealth is interested in expanding the programs.
Here are some of the patients who benefit from the program
Katinna Jackson, 18, is in the CP program. She has a baby, Kaedy’Anna Kinsler.
“(Hickman) came to see me in the hospital (and said) ‘We can help you with your baby,'” Jackson said.
During a recent home visit, Hickman checked Jackson’s blood pressure and chatted with her about the baby’s sleeping habits and what he was eating.
“He helped a lot,” Jackson said. She welcomed the help.
Hickman also recently visited April DeFrank, 50, who had multiple health issues, including seizures. She was hospitalized in November for pneumonia.
She suffered a seizure during one of Hickman’s visits. She was stabilized and taken to hospital.
DeFrank described difficulty communicating with her primary care provider and was concerned about reactions to a mixture of medications.
She wears a “life jacket” issued by the hospital, which monitors her vital signs.
Marge Henderson temporarily houses DeFrank and DeFrank’s mother, Andrea Langley, at her home in Southeast Ocala while DeFrank recovers.
Henderson said Hickman’s visits there have been “wonderful, awesome” for DeFrank.
“It’s comforting to know that on the other end of a phone call (there is) help,” she said.
Gainesville has a similar program
Gainesville Fire Rescue launched a Community Paramedic Resource Program, supported by the University of Florida, in 2017. The CRP program includes at least three full-time field medical personnel. Kamelia Klejc is the program coordinator.
Klejc wrote in an email that the CRP program includes home telehealth calls, chronic disease management, recovery response (substance abuse mitigation program), and homelessness awareness and prevention.
The CRP conducted 332 health visits and administered 834 COVD vaccine inoculations in 2021, Klejc said.
MCFR Deputy Chief Robert Graff said he thinks local CP programs in Marion County are likely to become regular weapons of fire rescue services.
Graff would like to see a CP platform for each MCFR battalion serving at 31 fire stations.
“It may take five years, but in the meantime we will save a ton of lives,” he said.