Community Paramedicine Practices Grow in Arkansas

Jul 26, 2018

A Harrison community college and a regional hospital have partnered to form a community paramedicine program, one of four in Arkansas.

Specially trained mobile paramedics travel across the seven-county North Arkansas region assisting at-risk patients in their homes, at no cost.

Jason Moshier, Section Chief of Community Paramedicine at North Arkansas Regional Medical Center,  operates out of new EMS headquarters in Harrison. The 24-year veteran paramedic says the program was initiated two years ago.

“Basically, we take paramedics who have been working in the field for a long time, and we cross train them and send them on home-style visits,” Moshier says.

Community paramedics step outside their traditional roles of treating acute-care patients in emergency settings to tend to high-risk patients in their homes. Some are pre-hospital patients; others may be recovering from a hospital visit, suffering with an acute illness or struggling with a chronic disease.

“By doing that, we decrease the need for hospitalizations [and] improve their health, and physicians are happier because their patients are more healthy.”

Jason Moshier has served as Section Chief of NARMC's Community Paramedics Program for several years.
Credit North Arkansas Regional Medical Center

Moshier says the new program is a safety net, especially for patients who don’t qualify for Medicaid- or Medicare-funded home health care.

“We are funded through our hospital," he says. "There is no billing to our patients.”

Community paramedicine, also known as mobile integrated health, was first tested in Arkansas by Baxter Regional Medical Center in nearby Mountain Home in 2013 and later by the Bella Vista Fire Department.

Metropolitan Emergency Medical Services in Pulaski County also has an established community paramedicine program. 

Patients who are chronic medical emergency users or repeatedly re-admitted to hospitals are top program candidates.

The North Arkansas Regional Medical Center community paramedic team sees as many as 60 patients from babies to seniors every week, Moshier says. Patients are referred by their primary physician, social worker, area agency on aging, or by EMS team members.

North Arkansas Regional Medical Center operates a new Emergency Medical Services (EMS) center in uptown Harrison, equipped with a large ambulance fleet.
Credit NARMC EMS

“Ambulance staff go to people’s homes on a regular basis so if they see something out of the ordinary — we have taught them what to be looking for — we may get a referral from one of our own crew members.”

Moshier was hired to lead Harrisons’s far-reaching community paramedicine program several years ago, says Jessica Kibling, North Arkansas Regional Medical Center spokeswoman.  

North Arkansas Regional Medical Center operates one of four community paramedicine programs in Arkansas.
Credit North Arkansas Regional Medical Center

“While we are based in Harrison we also have a network of clinics out in the rural communities: up in Lead Hill, in Jasper, in Berryville and Marshall," Kibling says. "So we can better serve those people where they live.”

Kibling says the community paramedicine program costs the hospital money to operate but in the end conserves hospital resources.

“Which is huge,” she says, “because if someone has a chronic illness they are going to the hospital a lot, visiting the ER a lot, or having to call an ambulance. And it’s also a toll on their bodies. So we can get involved and help them manage their illness day-to-day. We can sometimes help them avoid having those emergencies.”

Uniformed community paramedics, who have access to patient medical histories and records, show up by appointment in equipped marked minivans. Trained in acute and emergency medical care, they also assist home patients manage chronic disease, behavioral health, end-of-life care, medications, and proper nutrition, says Jason Moshier.

“And on top of that we provide that medical side, medical evaluations: we listen to their lungs, we take their blood pressure, we listen to their heart. We do a full assessment to find out where they are at physically.”

"Basically we take paramedics who have been working in the field for a long time and we cross-train them and send them on home-style visits," says Jason Moshier.

Checks are also made on a patient’s mental health status, for possible referral Moshier says.

One of his first and favorite patients is 87-year old Julie Younes who says she resisted having a stranger in the house at first.

“I didn’t really want someone to come and call on me every week,” Younes says. “But Jason started coming and he came every week. And after a while I fell in love with him. He brought much encouragement to me. And I haven’t been in the hospital since the program started.”

Younes says she was hospitalized three times prior to enrolling in the program. While data on community paramedicine remains scant because the practice is so new, one program in Milwaukee reportedly has reduced emergency medical calls by 62 percent last year. 

Outside the busy Harrison EMS station, community paramedic Gina Ray, a 21-year EMS veteran, has just returned from a home visit.

“We take care of them, and help them like nobody else can,” Ray says, beaming with pride.

She's one of a half dozen community paramedics certified through North Arkansas College in Harrison with funding from workforce development grants.

North Arkansas College offers community paramedicine certification courses.
Credit NAC

The community college offers courses in nursing, medical lab, surgical, and radiologic technology, and emergency management technician and paramedic certificates. Community paramedicine classes take place inside a special simulated lab, featuring a faux living room which contains a mannaquin of an elder female patient wearing a gray wig and flowered dress reclining on a sofa, watching a silent TV.  

KC Jones, emeritus director of the college’s Emergency Medical Services program, says the course is rigorous.

North Arkansas College EMS programs director emeritus, KC Jones, stands in the community paramedic simulation training room equipped with a life-sized elder mannequin.
Credit Jacqueline Froelich

“There are about 250 hours with clinical training and didactic training,” Jones says. “Once they are certified by us, they submit it to the Arkansas Department of Health to get their licenses.”

The Arkansas Department of Health regulates the program.

Paramedics who apply for a mobile integrated health team positions must be currently licensed, actively employed and have 1,000 hours of field experience, he says.

“So they have to be seasoned medics,” he says. “We don’t want green people out there touching these patients.”

Candidates, who will earn on average $56,000 annually, also train in hospitals, hospices, and in the field with other community paramedics. Jones, a 30-year paramedic veteran, says precious relationships are often a result of the program.

North Arkansas Regional Medical Center Community Paramedicine graduates take a moment to celebrate.
Credit North Arkansas Regional Medical Center

“In some ways the community paramedic is being accepted like a family member,” he says, “like a long-lost cousin. They are glad to see them come. There’s a connection there.”

Arkansas’s community paramedic program is regulated by the Arkansas Department of Health. It was created by an act of the state legislature in 2015, sponsored by state Rep. Scott Baltz (D-Pocahontas), a retired fire chief and former EMT.

According to the health department, a community paramedic subcommittee of the state’s EMS Advisory Council has begun to gather metrics on the four programs.

The University of Arkansas for Health Professions Arkansas Community Paramedic Initiative is also coordinating with mobile integrated health stakeholders around the state to establish standards as well as quality measures for identifying program success, as mandated by state law.

This story is produced by Arkansas Public Media, a statewide journalism collaboration among public media organizations. Arkansas Public Media reporting is funded in part through a grant from the Corporation for Public Broadcasting, with the support of partner stations KUAR, KUAF, KASU and KTXK and from members of the public. You can learn more and support Arkansas Public Media’s reporting at arkansaspublicmedia.org. Arkansas Public Media is Natural State news with context.