Community Health Paramedic Team
Community Health Paramedicine is designed to target and meet specific community needs. Our EMS system was originally seen as a system to respond to acute life-threatening emergencies, but responding to emergencies only makes up 14% of the work we do on a regular basis. Over 70% of our work is providing necessary medical care to patients. In Austin, EMS plays a larger role in improving health beyond the traditional resuscitating and delivering patients to the emergency department. Over the past decade, we’ve expanded our programs and services to include solutions to integrate public health and EMS in an effort to help build community resilience and reduce dependency on emergency services. Along the way, our Community Health Paramedic team identified gaps in the healthcare system that can now be addressed with innovative programs and services that allow paramedics to operate in expanded roles by assisting with public health, primary healthcare and preventive services and resources to underserved populations in the community.
Persons Experiencing Homelessness (PEH) Support Program
These activities are conducted by CHP Case Managers with the following goals:
Improve the quality of life and health of PEH
Reduce the reliance of PEH on the emergency system
Help PEH learn to proactively manage their health and care on their own
PEH Support CHPs are assigned coverage based on regions of the county – North, South, and Central.
Homeless Outreach Street Team (HOST) - PEH Support in the Downtown Area
The HOST program functions as a collaborative team under the direction of the Austin City Council. To learn more please visit http://austintexas.gov/homelessness/host
Pop-Up Resource Clinic Program
The Pop-Up Resource Clinic (PURC) Program is a proactive approach to providing for the needs of the homeless population in Austin. The program hosts multi-agency, multi-disciplinary resources clinics at locations throughout the city. The Pop-Up Clinics are organized by ATCEMS CHP with support from Central Health, and partner with service agencies from the city, county and federal government, clinical providers, as well as non-profit organizations to bring a wide offering of on-site services. Services provided to attendees typically include connection to PCP with immediate physician evaluation as needed, prescription services, identification and document procurement, HIV screening and substance abuse counseling enrollment, assistance with legal needs, housing needs assessment and assistance, medical funding enrollment and more.
High Utilizer Group (HUG) Program
The HUG program is an effort by CHP to reduce certain individual’s reliance on the 911 system and emergency departments for controllable and preventable needs that can be well managed with other resources. Clients are identified via internal surveillance of PCRs, as well as through external referrals. Identified candidates are reviewed for their use of 911/EMS over a period of months. Once enrolled, a CHP Case Manager completes a universal needs-assessment and develops a plan to address the gaps and connect the client to resources. This may include medical funding and benefits, primary and specialty medical care, mental health care, prescription services and delivery, social and basic needs support services, and more.
Managed Populations Program
The managed populations program is an initiative by CHP that seeks to address specific groups of persons, typically living in the same location with a changing population, who because of their situation or history have a high reliance on 911 and the hospital system for non-emergent needs. This program, through a CHP Case Manager, evaluates new “residents” of the site or location to complete a universal needs-assessment. The CHP CM then works to connect the client to resources necessary to help them proactively manage their medical and mental health needs without reliance on the 911 system. The CHP CM also receives regular notification of residents at the location who call 911 for EMS, evaluates the event, and provides direct follow-up and coaching the resident with the goal of improving their situation and avoiding future needs.
Current Managed Populations
Community First! Village
Austin Transitional Center – this program has evolved following several years of CHP guidance and interaction to a state where CHP presence is no longer required. A CHP CM will connect with and address residents anytime a concern is noted that is not managed by the site staff.
ReAdmission Prevention Program
This program is intended to focus on conditions which are identified as having a high risk of readmission to the hospital following discharge that is believed to be able to be reduced through regular at-home medical evaluation and care. The goals of this program include improved patient outcomes and satisfaction with care, reduced non-reimbursed hospital costs, and reduced incidence of medical emergencies in the enrolled patient population. The program utilizes regular at-home medical evaluations following discharge and provides patient reassurance, self-care coaching, support service connections, and when necessary, medication adjustments or necessary treatments in coordination with the treating physician. The typical enrollment period is for 30 days.
Opioid Emergency Response Program
This program aims to directly reduce the morbidity and mortality associated with overdoses on opioids. CHP Responders respond directly to 911 calls for apparent opioid overdoses when available to establish a connection with the patient and/or their friends and support network. This technique has proven to be more effective at gaining engagement with the patient, and often results in the connection to others suffering from Opioid Use Disorder (OUD). CHP Responders are also assigned follow-up calls for apparent overdose patients for whom a CHP was not available to respond to the scene within 24 hours of the event. Patients are offered connection to OUD treatment including Medication Assisted Treatment (MAT) utilizing a warm-hand-off process rather than referrals. CHP Case Managers can assist with routine CHP support such as funding, medical and mental health support as well to meet established CHP objectives. Finally, all OUD patients, their families, friends and support network are offered Opioid Overdose Rescue Kits.
Buprenorphine Bridge Program
The BBP is a sub-program of the Opioid Emergency Response Program that provides immediate, on-site treatment for Opioid Withdrawal, and daily withdrawal prevention treatment while the patient is being placed in a Medication Assisted Treatment program. CHP paramedics bring treatment with withdrawal-ending medication directly to the patient, and meet with them daily to administer the medication while establishing their entrance into an MAT program.
Scene Response Program
The Scene Response Program is an initiative within the CHP team to bring CHP resources and skills to the scene of 911 calls with the goal of identifying alternatives to traditional routes of care. CHP Responders are on duty 24 hours a day, 7 days a week and focus on two primary categories of 911 calls: patients experiencing mental health crises, and low acuity medical needs. Responding to 911 calls involving mental health crises the objectives are to address the patient’s needs through EMS resources rather than law enforcement, and to avoid unnecessary use of the ER for mental health crises. Available assets include the Integral Care EMCOT team, Integral Care and other mental health providers, and DSMC “yellow pod”. Responders are often co-staffed with behavioral health practitioners from EMCOT.
The goal for medical calls is finding alternatives to ER transport for non-emergent medical needs. This may be accomplished using clinics, our PA, our Street Med partner, or additional CHP follow-up and care. In the event that a CHP Responder determines that further action by CHP may help prevent future emergencies and reliance on 911, the CHP Responder may refer the patient to a CHP Case Manager for follow-up.