Paramedic-Led Service

SeniorCare is proud to identify itself as the only ambulance service in New York run by a paramedic, Michael Vatch, who has over 30 years of experience.

SeniorCare began operating in April 2005 with a handful of employees and three ambulances serving five accounts in the Bronx and Queens. The company has since grown to more than 1,000 employees, with over 150 ambulances and several response vehicles. The company’s dispatch center is equipped with a computer-aided dispatch (CAD) system capable of instantly recalling information on previous patients and simplifying call taking and tracking. Dispatchers are highly trained in prioritizing calls based on the severity of illness and injury. GPS is used to track the location and status of resources and personnel in real time, enabling dispatchers to send the closest appropriate unit to a call.

“From leadership on down, every person is a trained EMT or paramedic,” says Robert Ackerman, director of clinical services and safety for SeniorCare. “Even our CFO is an EMT. There is a real understanding among all levels of administration what goes on in the street.”

Evolution of the CP Program

In 2014 the Icahn School of Medicine at Mount Sinai received a $9.6 million grant to establish a mobile acute care team program to provide acute care services to eligible patients in their homes. A 2015–2016 pilot program returned encouraging results: Only 5 of 36 patients (14%) required transport to the hospital, 13 emergency department visits and six admissions were avoided, and the 30-day total cost of care for the patient group was reduced by over $50,000—a savings of almost $1,400 per encounter. Learning from this pilot program, SeniorCare relaunched the program using more selective criteria for paramedics, improved training methods, and a coordinating center at Sinai.

Current data include:

• Steadily increasing volume over the past 3 years with more than 1600 encounters, roughly 75 per month
• A total of 249 patients seen in a single month during the COVID surge
• Alternatives to transport in more than 60% of cases, preventing admissions in 17% of cases

What’s more, physicians, paramedics, and patients reported very high satisfaction rates with the program, Lax says.

“We began with our critical care paramedics—they are our ‘elite,’” Lax explains. “We built the program into our existing matrix. The paramedics transitioned into this new role flawlessly.”

The regulations of New York State currently dictate that community paramedicine operates on an “on-demand” model. During an encounter, patients call the Mount Sinai call transfer center and provide their chief complaint, medical history, prior treatment, location, and other key factors. Common reasons for patient calls include shortness of breath, generalized weakness, chest pain, and altered mental status.

Community paramedics are dispatched and complete calls that include a physical assessment, video conference with a physician, advanced diagnostics if warranted (12-lead ECG, pulse oximetry, temperature, etc.), and advanced treatments such as IV fluids, albuterol, and pain management. An action plan is then developed, including self-care instructions, medication adjustments, and follow-up appointments if necessary.

Thorough electronic documentation and a constant feedback loop among all partners leads to adjustments as needed. Thirty-day postencounter outcomes and formal medical case reviews include the referring practice, EMS agency, and medical director.

Future Directions

Based on the successes they’ve had, the SeniorCare team is examining additional expansion areas and markets—pediatrics, point-of-care lab testing, nurse triage, alternate destinations, and expanding to serve more healthcare organizations.

Hospice patients are a natural fit for SeniorCare’s CP program, says Lax. Hospice patients have made the decision to remain at home but may still require acute care and medication adjustments.

“It is truly an honor to be part of such a program that enables patients to be treated and remain in their house,” says SeniorCare community paramedic Eli Wein, CCEMT-P. “They can be more comfortable and surrounded by family, friends, and aides, instead of spending countless hours in an overcrowded ED.”

“We are fortunate to be partnered with Mount Sinai and Dr. Kevin Munjal, well known as a great champion of CP-MIH,” adds Lax. “With Dr. Munjal’s leadership, dozens of our paramedics have been trained to deliver this cutting edge medicine. When COVID-19 struck and CP volume began to increase rapidly, Dr. Munjal quickly ramped up training to increase our CP presence on the road, enabling us to play our part in the overall healthcare continuum and its response to the pandemic in New York City.”

Sidebar: MIH-CP During COVID

In addition to a 500% spike in its critical care transport segment—the result of transporting patients away from the center of the COVID-19 outbreak during its peak—SeniorCare EMS has seen a significant increase in its community paramedicine segment as a result of the COVID pandemic. People are choosing to stay home rather than visit hospital EDs.

As a critical care partner and community medicine provider for large New York City hospitals, SeniorCare takes COVID precautions seriously. Every employee undergoes a temperature check and symptom screen and fills out a self-wellness form at kiosk stations before every shift, says Robert Ackerman, director of clinical services and safety. PPE and patient-contact limitations are followed as strictly as the encounter allows.

“Right now we are starting to flatten out,” says Ackerman of the COVID calls handled by his crews. “We are seeing a return to pre-COVID levels of ‘stat’ calls, strokes, heart attacks.”

“COVID is pointing to the future of EMS,” adds Mordy Lax, CCEMT-P, CIC, community paramedicine program director and training and education manager. “It’s helped demonstrate the value of community paramedicine and treatment without transport.”

In addition to clinical reviews, Ackerman’s role includes daily reviews of fleet operations and crew safety, which is becoming more dynamic as New York’s theaters, shops, restaurants, and public venues begin to reopen.

“We’re starting to lose mirrors on our ambulances again,” quips Ackerman of the busier streets. “COVID changed so many things about EMS, and we’re still seeing new effects all the time.”

Jonathan Bassett, MA, NREMT, is editorial director of EMS World. Reach him at jon@emsworld.com. 

Source: emsworld.com