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Minnesota Community Paramedic Program Keeps Patients Out of Hospitals

MINNEAPOLIS - As a paramedic, Peter Carlson is used to racing to people's homes. But on his way to see 86-year-old Erika Bruvelis earlier this month, he stopped for coffee and parked outside her Minneapolis house for several minutes - reluctant to arrive too early.

In this case, no one called 911, and with any luck, no one would go to the hospital.

Carlson, 28, is one in the first wave of "community paramedics" in Minnesota and the nation. Instead of responding to emergencies, his job is to try to prevent them.

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Since October, Carlson has been paying house calls on dozens of patients as part of an innovative program to keep the frail and elderly out of the emergency room. Depending on what they need, he might do a blood test, call Meals on Wheels or help arrange for a wheelchair ramp.

In the last two years, Minnesota has become the epicenter of the community paramedic movement, which advocates say could save a fortune in health-care costs if it helps patients stay out of the hospital.

In 2011, the nation's first training program opened at Hennepin Technical College and Minnesota became the first state to adopt a formal certification program. The first graduates, including Carlson, were certified last summer.

"We are kind of inventing this," admits Carlson, one of nine community paramedics for North Memorial Medical Center in Robbinsdale, Minn.

Carlson dropped his oversized backpack on the bed and greeted his patient.

"How are you feeling?" he said, raising his voice so she could hear him.

Bruvelis put on a game face. "Feeling OK today," she said softly. But she clearly was not.

"Today is kind of a low-energy day," explained her 44-yearold son, Paul Bruvelis. For the last three weeks, he said, his mother had been too weak to leave the second-floor bedroom of her century-old house. Normally she's a "very independent woman," he said.

When he called her doctor's office several weeks back, a nurse suggested sending a community paramedic to check on her. "I'd never really heard of it," Paul Bruvelis said, but he was grateful - he dreaded having to take his mother to the clinic in this condition. Carlson unzipped his backpack and took out a stethoscope and blood pressure cuff, and a couple of kits for blood and urine samples. "Are you dizzy?" he asked. She nodded. "What's going to make you feel better?" he said. "That is a good question," she replied. Carlson suspected a urinary tract infection, but he would have to send the samples to the lab for testing, just to be sure. There's no calling 911 for a community paramedic. Visits are set by a doctor or clinic. "The doctors really see the paramedic as an extension of their eyes and ears," said Dr. Mark Bixby, medical director for North Memorial's 12 primary care clinics.

Bixby said paramedics can be especially helpful when patients have chronic illness. As a doctor, he said, he might wonder why a patient with diabetes is having trouble controlling his blood sugar. By going into their home, the community paramedic may spot the trouble: The patient didn't fill a prescription. Or the refrigerator is empty. "They can figure out stuff that you can't from an office."

Not all patients like the idea, Bixby said. "People are private," he said, and some "see this as an intrusion." But already, there's evidence it's kept numerous patients out of the emergency room.

Carlson sees himself as a troubleshooter and he's armed with a long list of social services to refer to patients who need extra help.

"We don't look to be in somebody's life for a long time," he said. "I don't like the idea of forming dependency. We like to get in, figure out what needs to be done, and 'See you later.'"

For now, there's no charge for his visit - North Memorial is covering the cost for patients at its own clinics. They expect insurers to cover it eventually.

For Bruvelis, the visit paid off quickly: Lab tests later that day confirmed she had a bladder infection, and she got antibiotics.


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