2020-014 ParamedicineDate: February 14, 2020 Report No. 2020-014
INFORMAL STAFF REPORT
TO MAYOR AND CITY COUNCIL
SUBJECT:
Provide information on Community Paramedicine in the City of Denton.
BACKGROUND:
After the February 3 City Council Luncheon, Council Member Davis requested a staff report about
Community Paramedicine in Denton; things the City has done before, things happening doing
now, or useful things that the City might be able to do in the future.
DISCUSSION:
The Denton Fire Department (DFD) does not currently have a formalized Community
Paramedicine Program. DFD does have several community EMS based Outreach Programs in the
City. A few of the Outreach Programs are monthly public CPR training, senior health issues in
which we send paramedics to the City’s Senior Center bi-weekly to conduct basic health checks
on seniors at the facility (blood pressure, blood sugar, etc.) for free, and we are also actively
involved in the City’s Homeless initiatives, including sending paramedics out bi-weekly to visit
homeless encampments with the cross-sector Street Outreach Team.
When our paramedics visit encampments, they are there to assess the overall health of the residents
and to see if they have any immediate needs. The goal is to take care of minor medical issues
before they become serious medical issues that require an actual EMS response and transportation
to a hospital. Most of the aid that this team has given is wound care by supplying individuals with
the proper bandages, antibiotic cream, and instructions on how to keep their wounds clean and free
from infections. Recently we had an individual experiencing homelessness with pneumonia that
had just been released from a local hospital. This individual did not have money for the
prescription medication, so our paramedics, with the assistance of the entire Street Outreach Team,
found an outreach group that arranged for payment of the prescription medications. If this
individual had not received the medication, there’s a good probability that this individual would
end up back in the hospital. While these paramedics are focusing on reaching individuals
experiencing homelessness in our community, this could be considered a component of an
“informal” Community Paramedicine Program.
Several “formalized” Community Paramedicine Programs throughout Texas and the country do
have components that focus on serving individuals experiencing or at-risk of experiencing
homelessness, but their primary focus is centered around the home-based, mentally stable patient.
They focus on meeting these patients’ needs, so they can continue to live in their homes by
remaining healthy and safe. To accomplish this, most plans establish care plans for the paramedics
to follow on scheduled (or unscheduled) visits to an individual’s home. These care plans generally
include a wide variety of interventions including medical assessments, ensuring that the patient is
taking their prescribed medications, and even following up with the patient’s primary care
physician on any changes in a patient’s condition. Another part of the program is to reduce the
Date: February 14, 2020 Report No. 2020-014
number of individuals that call 911 several times in a short period of time for minor issues
(Example: Medstar in Fort Worth places individuals in a high utilizer group if they call 911 15 or
more times in 90 days). These are probably 2 of the largest components, along with our homeless
initiatives, of what a paramedicine program in Denton may include if a formalized program is
started. While these programs can reduce the number and costs of ambulance transports conducted
in a system, they greatly reduce the costs that the hospitals must absorb for patients that are under
insured, have no insurance, or that are readmitted to a hospital within 30 days of last admission.
The 30-day readmission policy is a change that was part of the Affordable Care Act and effects
the way that Medicare/Medicaid and other insurers pay hospitals.
CONCLUSION:
The Denton Fire Department does not plan on reducing any EMS related Outreach Programs that
we offer. We are also continuously monitoring our call volume and frequent users of our EMS
services. Currently there is not a problem with high utilizers of the EMS system in Denton. Rarely
do we encounter patients that fall into the category of 15 or more 911 calls within a 90-day period.
More frequently, we find individuals that are not sick or injured but may need some additional
help. In those cases, we refer them to an appropriate agency.
As the City continues to grow, our needs may likely change, which is why we are constantly
exploring ideas and trends in EMS Outreach and Community Paramedicine Programs. A few
initial high-level conversations with local hospitals have occurred in which the DFD transports
most of our patients to. We believe that if the City would establish a formalized Paramedicine
Program sometime in the future that buy-in and cost-sharing from our local hospitals would likely
be the best option to make the program feasible for the hospitals, the City, and our Citizens.
STAFF CONTACT:
Kenneth Hedges
Fire Chief
940-349-8840
REQUESTOR:
Council Member Davis
STAFF TIME TO COMPLETE REPORT:
2 hours