Over the past three years, Montgomery County Hospital District’s community paramedicine program has operated with the goal of reducing the number of frequent 911 callers.

The program serves roughly 160 patients countywide per year, freeing up paramedics and ambulances to respond to other acute emergencies.

“Since [emergency medical services] was established, it’s been a reactionary system,” Community Paramedicine Coordinator Andrew Karrer said. “What this program allows us now to do is be more proactive. We’re going out and contacting and knocking on doors of people who, historically, have chosen to use EMS for primarily nonemergency reasons and reasons that could be better managed through a primary care physician.”

Program details

Community paramedicine programs started as a way for EMS agencies nationwide to approach different problems in their communities, Karrer said.

“That’s the beauty of it—it allows each community to address their specific issues,” he said.

When MCHD officials first started looking into the numbers, they found individuals countywide who were calling 911 as often as 150 times a year, Karrer said, resulting in the focus on that issue. Having insurance, or lack thereof, is not a qualifier for the program. Instead, patients qualify if they have called 911 three or more times in a year. There are currently 255 enrolled clients in the program.

“What we also found is that it’s not an intentional abuse of the system,” Karrer said. “They don’t have a primary care doctor or transportation to get to a doctor.”

Most of the patients in the program do have a significant disease, whether it is a mental illness such as bipolar disorder, or a physical illness such as diabetes. But the goal is to teach them how to become an independent self-manager without calling 911 repeatedly.

“There are going to be emergencies with this population; they’re the sickest of the sick,” Community Paramedic Sara Horton said. “Our goal is to teach them how to prevent it as much as possible.”

After contact is made, if patients agree to participate in the program, the EMTs on staff formulate a plan after establishing why they are calling 911 repeatedly.

“We schedule a visit to do a holistic assessment, and then we usually contact them via phone and a home visit once a week,” Horton said. “Our day-in and day-out are those home visits and phone calls of working toward meeting the goals we set on that first visit.”

The paramedicine program does not use taxpayer money. Instead, it is funded through a Medicaid 1115 Waiver.

Karrer said one outcome of the paramedicine program is having more resources and ambulances on the road for other emergencies that occur daily, such as heart attacks, car crashes and strokes.

“If you have seven calls drop in 30 minutes in Splendora, then trucks in The Woodlands are affected because you have to disperse [them] to the entire county,” Karrer said. “Even though it’s hard for us to pinpoint when and where we’re reducing those calls, we know there are reductions. So those ambulances are freed up more often for other calls, and that benefits everyone in the county.”

Residents in need

Patients served by the program in Montgomery County come from all backgrounds and ages, even some young adults in their late teens and early 20s.

“Diabetes seems to be one of the biggest [conditions] that spans across the age spectrums,” Horton said. “We’ve had some [patients] in their early 20s that were diagnosed with diabetes at a young age, so they grew up not being taught how to manage it.”

Medical Director Dr. Robert Dickson said he has wondered throughout his career in the hospital industry how many patients are discharged with severe disabilities and injuries.

“It’s heartbreaking to see these people who are losing so much of their quality of life,” he said.

Community Paramedic Nivea Wheat said there are no boundaries for the clients served by the program across Montgomery County.

“We have door-knocked on some patients in The Woodlands who showed up on that list, and it’s been a situation we could help with because they’ve fallen on financial hardship,” Wheat said. “There’s people on the brink of losing their home, but no one knows about it because everything aesthetically looks fine.”

Although Montgomery County is designated as an urban county, unless a person works and has a vehicle they will not be able to get anywhere, Karrer said. Shifting demographics have also contributed to the challenge.

“You have downtown Conroe, which is urban, and then you have The Woodlands, which is suburban, and then you have people living in the national forest,” Horton said. “There’s people who are disabled and elderly and can’t drive, and there’s not any kind of transportation system put in place for that.”