How paramedics can reduce emergency department visits

“Please get me home” are words I often hear at a patient’s bedside while working in the emergency department.

One elderly patient I treated recently told me she had come to the emergency department only because she couldn’t reach her regular doctor. She looked scared of the prospect that she might be admitted overnight.

Even if they can’t get in touch with their personal doctor, many patients can avoid a trip to the hospital by taking advantage of telemedicine. The COVID-19 pandemic has altered the telemedicine landscape, making virtual visits more accessible to patients than ever before. Insurers and Medicare expanded coverage for telehealth, and federal regulators temporarily loosened privacy rules, making it easier to visit the doctor through your computer or over the phone.

Still, telehealth has its own challenges: Older adults, low-income people who don’t have internet access, people with limited education, and those who do not speak English may struggle to access care this way. When telemedicine isn’t feasible, people may be able to take advantage of another new care model designed to reduce hospitalizations: community paramedicine.

Through community paramedicine programs, paramedics visit patients at home to check their vital signs, assess their health, and connect them with a physician by telehealth to address any medical issues requiring follow-up.

These programs are not intended for people experiencing a true medical emergency. You should still call 911 if you’re having chest pain. But community paramedicine programs can help relieve pressure on local ambulance companies by fielding less-urgent calls and helping people stay on top of chronic conditions so that they do not become emergencies.

The community paramedicine model is still evolving, and so far, it has seen the most success in rural communities, where patients may have to travel farther to see their doctor in person. But the approach has a place in more populated communities, too. Main Line Health offers a community paramedicine program to patients with multiple chronic conditions who take several medications and are at elevated risk of being readmitted to the hospital.

An 87-year-old patient of mine was recently signed up for a community paramedicine program by his daughter, who said it was the best decision she ever made for her father. The man has been hospitalized nine times over the last year, and community paramedics gave him individualized care that he wasn’t able to get in the hospital. Like many people, this family first learned about home health and virtual care during the pandemic.

So far, community paramedicine programs have focused on patients with manageable, chronic health conditions. But soon, telehealth and community paramedicine may be an option for treating patients with heart conditions who require a high level of care. Weill Medical College of Cornell University and the Patient-Centered Outcomes Research Institute, a nonprofit health research organization created by the Affordable Care Act, are conducting a clinical study to test whether high-risk patients with congestive heart failure could benefit from at-home assessments by medics.

There is no one-size-fits-all in medicine, but the versatility of telemedicine is making it increasingly possible for providers to meet patients where they are.

Erik J. Blutinger is an emergency-medicine doctor in New York City.