When Candy Davis first started working as an EMT in St. George nearly 25 years ago, the town’s ambulance service was an all-volunteer organization. Today she is one of the town’s paid paramedics providing 24/7 coverage for 911 calls and is in charge of a “community paramedicine” pilot project—one of 12 in Maine—that is now in its fourth year of implementation. Her long years of service to this community where she grew up has put her in a particularly good position to understand how a paramedicine program could be a real benefit to people here.
“I started with the service in about 1992,” she recounts, “I started as a basic volunteer EMT providing basic life support. Then I went back to school and obtained my intermediate license which allowed me to start IVs, give a limited amount of medications and use a cardiac monitor. So I worked at that level for a while. And then I obtained my paramedic certification—that was a few years prior to starting my paid position in July of 2011. So you can imagine if I’ve been with the service since 1992, I’ve had the opportunity to watch people age, to witness the services we have and to see areas where there could be improvement. So when I looked at community paramedicine programs that were happening in rural areas across the country I could see it was a footprint that really fit us well. With our call volume in the 200-300 range, we certainly had enough down time that we could provide those community paramedicine services—medication reconciliation to see that a medicine is being taken correctly, blood pressure monitoring,
glucose level monitoring.”
Davis and other ambulance service members who have had the requisite training can provide those services to community members only if their primary care physician has ordered them. They can also assist care providers like Kno-Wal-Lin, nurse practitioners, and hospice.
“Our community paramedicine care in St. George is not meant to replace any existing services,” Davis notes. “We identify our program as an opportunity to augment other services. So let’s say Kno-Wal-Lin has a client who has been discharged from the hospital and who lives alone here in St. George. They might come in once a week on Monday. We would try to come in later in the week to check in on that client so both ends of the week are covered. In addition to that, when the Kno-Wal-Lin services stop, we can continue to provide those services if the primary care physician has asked us to do that. We can also provide wound care if asked. For example, a Kno-Wal-Lin nurse might have someone who needs wound care in St. George, but she’s in Union during a blizzard. She can ask the patient’s doctor to give us an order to make that visit.”
The needs assessment Davis conducted while setting up the pilot community paramedicine program in St. George—each pilot program in Maine is community specific—identified serving the town’s aging population as a particular priority. “We have an aging population and as a result of that our community needs assessment identified elderly folks who really want to stay and age in place in their homes,” Davis explains. “So think of an individual in their 80s driving up the peninsula in winter to their doctor’s office and they have blood drawn for testing. The round trip drive is about 42 miles. Then let’s say they get home and there’s a call from the doctor’s office saying we need you to come back for another blood draw. That is a lot for that individual. It gets dark early in the winter and the weather conditions just aren’t always feasible for driving the peninsula for an individual of that age. So that’s an area where, if the physician orders it, we can help by taking a blood draw or take a urine sample or whatever the case may be and drive that to the lab and keep that person from having to leave the peninsula again.”
Sometimes, Davis says, a paramedicine visit also has an added benefit. She cites the case of a 90-year-old woman whose blood pressure and glucose levels she was monitoring per a physician order. “She did not drive—she relied on her neighbors to take her to church and different social events and she went grocery shopping once a week with one of her neighbors. I called her on my way to visit her and I asked do you need anything? I’m going by Harborside Market. She said she needed milk, didn’t know what had happened to the milk she bought two days ago but it had gone bad. When I arrived at her house I opened the refrigerator to put the milk in and noticed the light didn’t go on. The refrigerator didn’t work. And there was lots of other spoiled food. She had lost her sense of taste and had no idea she was eating bad food. So I got on the phone with her family who lived out of state and they got the ball rolling on getting the refrigerator cleaned out and repaired. That visit made it possible to circumvent a horrible event.”
There is a lot of record keeping involved with the pilot community paramedicine program, Davis admits. But the hope is that between all the pilot programs in Maine and across the country there will eventually be enough data to show that the services being provided represent a real cost savings. “Medicare needs to recognize the benefit,” she says. “The program is preventing hospital re-admissions and reducing emergency room visits. Sometimes just having the human interaction of a regular visit prevents someone from feeling isolated and getting depressed, which can then lead them to become non-compliant with their medications.”
Davis often refers to herself as a “community paramedic,” which is perhaps a big reason that the pilot paramedicine program seems so well suited to the St. George ambulance service’s overall philosophy. “Everything for us circulates around attention, prevention, action. We just try to be aware of what’s going on. If we notice that someone has developed swollen ankles or has labored breathing we’ll suggest, ‘Let’s call your primary care physician and let them know.’ That’s not a community paramedicine service because the physician didn’t ask us to check on that person, that’s just being aware and doing something about it.”
Reflecting further on her approach to her work, Davis adds, “You have paramedics who like high-volume 911 calls and these are the people who live in cities where they run hundreds of calls in a month and thousands a year. It takes a certain type of individual to be a community paramedic. If you don’t have the empathy, the compassion, the understanding—that bedside manner—if you don’t have it you’re not a community paramedic.” —JW
PHOTO: Julie Wortman