A mobile integrated healthcare (MIH) program in Sacramento County (CA) under development to be implemented as an alternative model for response to low-acuity calls and high utilizers of emergency services was quickly brought to an operational status. It was then redesigned and redirected to serve a new purpose as the COVID-19 pandemic struck northern California and challenged patients’ access to appropriate healthcare.
Upon the outbreak of COVID-19, three Sacramento-area fire departments joined forces with local hospitals to rapidly mobilize a MIH program to deliver patient-centric care, testing and education to out-of-hospital settings to reconnect patients with essential treatment.
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The three fire agencies answered a call for help from Sacramento County Department of Public Health to implement the special response program. Sacramento Metropolitan Fire District (Metro Fire), Sacramento Fire Department and Cosumnes Fire Department coordinated with their local hospital systems, UC Davis Medical Center, Sutter Health, Common Spirit and Kaiser Permanente, to staff volunteer disaster medical workers and mobilize four community care response units (CCRUs) to bring professional care to skilled nursing facilities, alternative living facilities and other known COVID-19 hotspots, where patients had limited to no access to physicians.
So the CCRU program was modified and fast tracked by Metro Fire Captain/Paramedic Scott Perryman, a physician assistant who had been developing implementation guidelines for mobile integrated healthcare.
Increasing community access to care was not a new idea to Perryman, who had been working alongside Metro Fire Assistant Chief and Director of EMS Barbara Law, for more than two years to build a framework for a program of this nature. He just never imagined his region would be called upon to implement it virtually overnight.
“When the Department of Public Health quickly reached out and said we need this program, all the area fire agencies came together asking what they could do to help,” says Capt. Perryman. “We were going into a world that was still very new and untouched; so there were challenges, but the fire services are used to adaptability and that’s what makes this so great.”
Before the COVID-19 outbreak, Assistant Chief Law, who’s been with her department nearly 30 years, and Capt. Perryman, identified their community’s largest healthcare needs by identifying high EMS utilizers in the area to better understand the care and resources this population needs.
With an awareness of the community needs they were then able to work toward formulating a proactive approach to fixing patients’ issues at home as well as relieving the emergency department of excess patient volumes. Their earlier planning in developing a MIH program ensured they were ready to serve the community when the pandemic compelled their departments to pivot.
“When the pandemic hit, the county didn’t have the ability to get out to some of the congregate living settings to provide testing and get a handle on the scope of the problem here in Sacramento,” said Assistant Chief Law. “The county had to multiply the workforce, and since we had already been working with ImageTrend on building our mobile integrated health data module, we were the first agency in the area that had a platform ready to go.”
Each participating fire department provided a vehicle and paramedics to staff each community care response unit and the hospital system provided physician assistants or registered nurses to provide a joint approach to staffing and care.
The rapid mobilization of the CCRUs as a result of COVID-19 resulted in a solid proof of concept for the program Capt. Perryman and Assistant Chief Law were working to create. Since the CCRUs were deployed in April 2020, more than 4,500 COVID-19 tests were administered over a three-month period to help identify the virus early on in populations with limited access to testing, and care and for those exhibiting minor symptoms.
More importantly, these CCRUs that are staffed by firefighter/paramedics, physicians, nurse practitioners and physician assistants are able to provide care beyond the virus itself. This ensures patients have access to the proper treatment, follow-up care and resources such as food and medications they need.
“These people may no longer test positive for COVID-19, but they still require care,” said Capt. Perryman. “It’s important that patients who transition from a ventilator to oxygen receive the proper discharge follow-up, or those who are on their own and too frail to collect their own resources get what they need to survive.”
In a recent event, Capt. Perryman worked with a newly diagnosed diabetic patient. He was able to educate the patient and their family on how to properly check and monitor blood glucose levels and safely administer insulin at home.
In a post COVID-19 setting, Capt. Perryman’s and Assistant Chief Law say their goal will remain the same – connect communities with the right resources for better treatment and overall wellness. Reflecting on one of the largest healthcare concerns in the region, behavioral health, also a concern and priority in the Sacramento area and the nation, Capt. Perryman says that EMS isn’t the most effective way to treat mental health in most cases, but an MIH program can be utilized effectively to help guide patients to more appropriate and effective forms of healthcare.
“You’re simply trying to find out what a patient’s specific need is and then direct them onto a more appropriate path, whether that’s an educational component of getting the patient in with their primary care physician more often, or getting them connected with better mental health facilities,” says Perryman.
Although each county, department and program already had their own unique set of challenges to respond to during the COVID-19 pandemic, the evolving CDC guidelines and procedures brought on a new set of challenges as the CCRUs rapidly deployed at the start of the pandemic.
Despite the trials faced and those yet to come, Captain Perryman found the silver lining, stating the pandemic was an opportunity to promote better cooperation and understanding between all community stakeholders in regard to everyone’s role in a public health emergency.
“It’s amazing to see the collaboration that can be done under these difficult times and it shows that bridges can be crossed, and bonds can be made,” said Captain Perryman. “It’s really nice to see that it’s all being done in the name of patient care.”
Both Assistant Chief Law and Captain Perryman agreed that the program has been openly accepted by Metro Fire, Sacramento County Public Health, the hospital system, the volunteer disaster workers and most importantly, the patients that they see. The support and praise that the CCRUs and the program’s volunteer practitioners received has made the whole process worth it, Captain Perryman said, showing that the barriers in healthcare can be overcome during even the most pivotal times to positively impact communities and their surrounding healthcare systems.