EMS Insider, News

Reno’s Three-Pronged Approach to Mobile Integrated Healthcare

The community paramedicine program is one part of a three-pronged approach taken by REMSA to find ways to provide the most appropriate and safest care for patients with low-acuity medical conditions at lower overall cost. The other two include a nurse health line and ambulance transport alternatives. These programs are funded by a Centers for Medicare and Medicaid Services (CMS) Health Care Innovation Award, with the aim to reduce total patient care expenditures by $10.5 million over three years.

Nurse Health Line

The nurse health line promotes a nonemergency number available to all Washoe County (Nev.) residents to provide 24-hour help and information, including assessment, clinical education, triage and referral to healthcare and community services. The line is staffed by nurse navigators who are colocated with the public safety answering point, allowing for seamless transfer between the nurses and 9-1-1 call takers when necessary. Since its inception in October 2013 and on through June 2014, the nurse health line experienced a higher-than-anticipated level of calls, averaging 2,000 calls per month with outcome data showing costly ED visits and ambulance transports avoided.

Community Paramedicine

The community paramedicine program utilizes specially trained community paramedics to improve the transition from hospital to home, with the ultimate goal of reducing hospital readmissions to certain patient populations. The program focuses on patients who are discharged from the hospital following myocardial infarctions or with conditions such as congestive heart failure and chronic obstructive pulmonary disease, as well as frequent users of EMS resources. Results show that since it began in June 2013, REMSA’s community paramedics have helped patients safely avoid hospital readmissions while improving care coordination, as well as patient quality of life and satisfaction scores.

Ambulance Transport Alternatives

The Ambulance Transport Alternatives initiative allows paramedics to provide alternatives to the hospital emergency department for 9-1-1 patients after an advanced assessment in the field. This includes transport to urgent care centers and clinics for those with non-emergent medical conditions, to a mental health hospital for psychiatric patients, and directly to the detoxification center, where appropriate. While there are still some barriers for the program—including availability and hours of operation for alternate destinations, and patient education and consent—data has shown 550 ED visits were avoided between December 2012 and June 2014 due to alternative transport options.


“The preliminary results of the community paramedicine program show that the EMS community can play a significant role in helping people improve their quality of life and access to the right level of care when needed,” Brenda Staffan, the director of REMSA’s community health programs, said. “As we continue to validate our data and refine our programs, we expect to see an even greater positive impact on patient care and healthcare costs.”


To learn more about community health programs offered by REMSA, visit www.remsacommunityhealthprograms.com. For more information on the CMS Innovation Center, go to http://innovation.cms.gov.