Prehospital Identification of Underlying Coronary Artery Disease by Community Paramedics

Abstract

There is a lack of definitive evidence that preventative, in-home medical care provided by highly trained community paramedics reduces acute health care utilization and improves the overall well-being of patients suffering from chronic diseases. The Expanding Paramedicine in the Community (EPIC) trial is a randomized controlled trial designed to investigate the use of community paramedics in chronic disease management (ClinicalTrials.gov ID: NCT02034045). This case of a patient randomized to the intervention arm of the EPIC study demonstrates how the added layer of frequent patient contact by community paramedics and real-time electronic medical record (EMR) correspondence between the paramedics, physicians and other involved practitioners prevented possible life-threatening complications. The visiting community paramedic deduced the need for an electrocardiogram, which prompted the primary care physician to order a stress test revealing abnormalities and thus a coronary artery bypass graft was performed without emergency procedures, unnecessary financial expenditure or further health degradation such as a myocardial infarction.

Patient Perspectives on EMS Alternate Destination Models

“…Furthermore, our findings on patient comfort with EMS speaking to a primary care provider compared with an EMS supervising physician via phone or videophone inform a burgeoning debate on the type of physician supervision required for involvement in EMS community paramedicine/mobile integrated healthcare programs. [33][34][35] While our results provide much-needed evidence of patient agreement with a patient-centered approach to emergency response, many relevant questions remain. Currently, it is unclear whether primary care offices, urgent care centers and other alternative transportation destinations would be willing to accept ambulance transfers.…”

Designing and Governing Responsive Local Care Systems – Insights from a Scoping Review of Paramedics in Integrated Models of Care

“…– People with multiple chronic diseases such as congestive heart failure (CHF) and chronic obstructive pulmonary disease (COPD) [ 81 82 83 ]…”

“…– Informal, ad-hoc collaboration and consultation with primary care physicians, community nurses, pharmacists and social workers [ 50 55 69 83 90 ]…”

Does the chronic care model meet the emerging needs of people living with multimorbidity? A systematic review and thematic synthesis

“…Only four studies actually took work off the patient’s plate without adding any additional work. [ 33 – 36 ] Examples of how to reduce patient work can be gleaned from these studies. One intervention changed the role of paramedics, such that they conducted regular home visits with patients, rather than having patients come to clinic unless absolutely warranted.…”

“…One intervention changed the role of paramedics, such that they conducted regular home visits with patients, rather than having patients come to clinic unless absolutely warranted. [ 33 ] Another traced patients lost to follow-up by conducting home visits, and for patients unable to travel to the clinic, they introduced outreach visits. [ 34 ] Roland et al, described the evaluation of multiple pilots for care of elderly patients, which offloaded work from patients through intensive team communication about patients most at risk for admission to the hospital and rapid follow-up by phone or home visits as needed for patients.…”