Pulsara Blog

EDITOR'S NOTE: The following is an excerpt from an article by Larry Beresford, originally published on EMS World on April 3rd, 2024. Check out the full article here. 

Telemedicine for the EMS personnel of MedStar Mobile Healthcare, a governmental EMS system in Fort Worth, Texas, is linked through an app on their Android hand-held phones, says Matt Zavadsky, MS-HSA, NREMT, MedStar’s chief transformation officer.

“The crew does everything with their Android phone. They get their calls and their post moves, they get routed by the live routing system, they text with dispatch, they text with each other,” Zavadsky explains. “When they get to the scene of a call, they pop the phone out of its drop-in cradle charger at the front of the truck and bring it with them.”

Telemedicine, which can connect them virtually with physicians from integrative emergency services and the physician with the patient, has been a positive experience for MedStar’s field staff, Zavadsky says. “Every EMT or paramedic who works out in the field knows that a fair percentage, some might say the majority, of our patients, don’t actually need to go to the emergency room.” Is it safe for this patient to go to urgent care? Can they get a prescription written for a new medicine or refill an existing prescription?

A virtual physician visit can answer these questions, and having that telemedicine backup facilitates the paramedics and EMTs to provide more patient-centric care, says Zavadsky, who also takes occasional EMT shifts himself. “We are helping the patient navigate the health care system to the most appropriate setting. One of the tools we use is telemedicine, just like we use a 12-lead EKG monitor.”

EDITOR'S NOTE: This article originally appeared on FireRescue1.com. Special thanks to our guest author, Courtney Levin, for FireRescue1 BrandFocus Staff.

Now that you’ve developed the initial groundwork, these next steps are key to finding success

The fire service is pivotal in caring for their community’s underserved population. Introducing a community paramedicine program allows public safety to dynamically meet those needs.

Yet, developing and successfully implementing a community paramedic program can be daunting. “Generally, anytime you’re implementing a new program, specifically a community paramedicine program, the challenge is you’re doing something you haven’t done before – and there’s nothing more comforting than tradition,” said Kris Kaull, chief growth officer at Pulsara. “If you lead the change, it means you’re a disruptor. There’s certainly something glamorous about that, but there’s also something very disrupting about being a disruptor.”

Developing a community paramedicine program involves several steps before visiting your first patient. After creating departmental buy-in from the top down, thoroughly evaluating the medical needs of those in your community, and selecting a few specific areas for your program to focus on, it’s time to put your plans into action. Yet even if it appears that your department has crossed every t and dotted every i, you might still find the execution of your program doesn’t start smoothly.

EDITOR'S NOTE: This article originally appeared on FireRescue1.com. Special thanks to our guest author, Courtney Levin, for FireRescue1 BrandFocus Staff.

Departments can play a large role in supporting the health and safety of underserved residents

The inherent nature of the fire service means that responses to community needs are usually reactive. Whether a 911 call is for a fire, a serious vehicle collision, or a medical emergency at someone’s home, firefighters can’t predict ahead of time where these instances will occur.

That’s not to say the fire service hasn’t made great strides to be proactive about their day-to-day operations when and where they can. For example, departments routinely engage in fire inspections to bolster the safety of local buildings. After all, reducing the likelihood of a fire starting is certainly a more preventative route to take than fighting a fire once it’s begun.

Proactivity isn’t limited to structure fires, though. Fire departments can also apply this line of thinking to the individual residents in their community by developing a community paramedicine program.

[While we are using the term “community paramedicine” for simplicity, there are other similar terms, including “mobile integrated health” and “community integrated health.”]

Many EMS agencies across the country already engage in community paramedicine programs, and the fire service can and should play an important role in those programs. Whether your area already has this type of care in place or not, there’s always an opportunity to provide greater support for the underserved residents in your community.

EDITOR'S NOTE: This article originally appeared on EMS1.com. Special thanks to our guest author, John Erich, for EMS1 BrandFocus Staff.

Once you’ve determined what your program will do, you face some practical questions

The proverbial table is set, and you’re ready to begin your EMS agency’s community paramedicine program. You’ve evaluated the needs of your patients and community, identified care gaps you can fill, planned how you’ll do it, and lined up appropriate partners to assist.

Now, however, you face a new round of challenges – and these are more practical than theoretical. Who will comprise your team? What tools will they carry? How will they communicate and document care? And, once they’re out in the field and helping people, how will you evaluate their success?

Alexandria Fire Department in Alexandria, Virginia, chose fall prevention for its initial foray into community paramedicine back in 2017. Focusing on falls made a lot of sense for a new program with limited means: Data on local frequent fallers was available and accessible, and the interventions that could help them – good shoes, handrails, securing rugs, controlling pets – were low-cost and straightforward. The program would be a manageable lift to get off the ground.

And, given its targeted scope, easier to keep upright as it found its footing and began moving forward.

“You have to figure out what’s easy,” said Jeff Woolsey, a department captain and registered nurse who took over Alexandria’s program in its early days. “Pick something you know you can succeed at – and falls are something you can succeed at. If you go out there and say, ‘I want to solve mental health! I want to solve drug addiction!’ you’re going to lose. There’s just no way, without 14 people in your program and a 10-bed hospital someplace, that you can manage those things.”

EDITOR'S NOTE: This article originally appeared on EMS1.com. Special thanks to our guest author, John Erich, for EMS1 BrandFocus Staff.

It’s not as hard to get started as you might think – follow these initial steps

Few experienced paramedics need to be persuaded of the value of community paramedicine – they’ve seen the repeat 911 callers, the chronic problems and the social factors that trap people in cycles of poor health. But against so many problems so large, it’s hard to know where to begin. Who should a CP program serve? What should it try to do?

The good news is, the answers to those questions aren’t unknowable, and it’s not as hard as you might think to get a basic program up and running. Here is a guideline for departments willing to take that step toward more comprehensive care for the vulnerable in their communities.

Step #1: Assess your needs

You might have certain interventions in mind from the outset. But whatever your program does should be based on data, not impressions or anecdotes. Focus on what your population needs, not what you want.

“It really is important that you do what’s right for your community,” said veteran EMS writer and educator Hilary Gates, MAEd, NRP, director of educational strategy for Prodigy EMS and a volunteer paramedic with the Alexandria Fire Department in Virginia, whose community paramedic program she helped found in 2017. “If you start by saying, ‘I’d like to help solve the opioid crisis,’ you might find there’s actually more meth in your community than opioids.”

Identifying appropriate areas for intervention best begins with a needs assessment – an evaluation of areas where current conditions fall short of expectations. Veteran providers may already have a sense of such areas in their communities, and agency ePCR data can yield insights into call types and frequencies. Sources like NEMSIS (the National EMS Information System), CARES (the Cardiac Arrest Registry to Enhance Survival) and top EMS software companies can also provide data to get you started.

EDITOR'S NOTE: This article originally appeared on EMS1.com. Special thanks to our guest author, Carol Brzozowski, for EMS1 BrandFocus.

Prior to the COVID-19 pandemic, Teller County, Colorado, had a successful community paramedicine program in place. But as the pandemic hit the U.S., they knew they'd need to leverage new tools to continue treating their patients. Fire and EMS leaders partnered with Pulsara to enhance their community paramedicine program with telehealth. Since then, the program has evolved into a thriving partnership between EMS and a local organization of board-certified emergency physicians, allowing them to work together via telehealth to help address healthcare disparities and improve access to care in rural areas.

In a recent webinar, EMS leadership in Teller County, Colorado, shared their experiences around building the program, and how they are using telehealth as a force multiplier to preserve resources while also better meeting the needs of their community. Here are 7 top takeaways from their experience. 

Prior to the COVID-19 pandemic, Teller County, Colorado, had a successful community paramedicine program in place. But as the pandemic hit the U.S., they knew they'd need to leverage new tools to continue treating their patients. Fire and EMS leaders partnered with Pulsara to enhance their community paramedicine program with telehealth. Since then, the program has evolved into a thriving partnership between EMS and a local organization of board-certified emergency physicians, allowing them to work together via telehealth to help address healthcare disparities and improve access to care in rural areas.

In a recent webinar, Dr. Jeremy DeWall, EMS Medical Director at UCHealth Pike's Peak Regional Hospital, and James McLaughlin, Director of Community Paramedicine at Ute Pass Regional Health Service District, shared about their experience with building the program, and how they are using telehealth as a force multiplier to preserve EMS resources while also better meeting the needs of their community. 

While it’s essential that EMS providers stay on top of core clinical skills for the most critical calls, such as sudden cardiac arrest and airway management, it’s also important to keep up with the skills to address issues you may not see as often. From treating burns to managing pain in pediatric patients to responding to mental health calls, new information on best practices can help you hone your practice. 

In partnership with EMS1, Pulsara is releasing a free eBook collection of popular "10 Things You Need to Know" articles, with recent input from EMS professionals on subjects that can help improve clinical practice and save money for EMS organizations. 

GET THE GUIDE - Closing the Gaps: Plug Holes in Your Skillset and Cracks in Your Budget

2023 UPDATE: As reported by JEMS.com on 6/28/23, the federal government is ending the ET3 program. According to the Centers for Medicare & Medicaid Services, “This decision does not affect Model Participants’ participation in the Model through December 31, 2023.” Read the full article on JEMS for more details: ET3 Program Comes to an Abrupt End. Please be advised that Mobile Integrated Healthcare and Community Paramedicine are separate initiatives unaffected by the ET3 program termination.

EDITOR'S NOTE: This article originally appeared on EMS1.com. Special thanks to our guest author, Cole Zercoe, for EMS1 BrandFocus.

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Here’s how your agency can use telehealth and community paramedicine to deliver more personalized care to patients

Community paramedicine, mobile integrated healthcare and ET3 are rapidly becoming hot topics in EMS as the profession evolves, especially as the long tail of the COVID-19 pandemic exacerbates issues like ambulance turnaround times.

As ambulance agencies worldwide struggle with long waits at the ED, it’s become even more vital to find solutions to issues like ED overcrowding and long wall times. Community paramedicine, MIH and ET3 possess the unique ability to reduce transports while simultaneously improving care for patients.

Here’s a look at 10 ways EMS agencies can use telehealth and community paramedicine to deliver high-quality care to patients, some of the advantages of implementing such strategies, and how the ET3 model supports this approach.

Editor’s Update: As reported by JEMS.com on 6/28/23, the federal government is ending the ET3 program. According to the Centers for Medicare & Medicaid Services, “This decision does not affect Model Participants’ participation in the Model through December 31, 2023.” Read the full article on JEMS for more details: ET3 Program Comes to an Abrupt End. Please be advised that Mobile Integrated Healthcare and Community Paramedicine are separate initiatives and are unaffected by the ET3 program termination.

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When the COVID-19 pandemic first surged across the U.S., it created many new problems for EMS organizations everywhere. Some patients infected with COVID-19 urgently needed care at the hospital, while others were best served by staying home. It was difficult to tell which was which. Patients with other ailments were stuck at home, unable to receive regular needed medical care. And on top of that, the pandemic was a major provider safety issue; medics and hospital staff put their lives on the line daily to care for patients, constantly risking exposure to the virus.

Austin-Travis County EMS (ATCEMS) based in Austin, Texas, knew they needed to deploy an innovative solution, and fast. They responded by forming what came to be known as the C4 unit: the Collaborative Care Communication Center.

The C4 is an elite team of twelve EMS-trained clinicians who manage calls and connect patients with a variety of resources. At the start of the pandemic, they began using Pulsara, a healthcare communication, telehealth, and logistics platform, to build better communication with their teams. Through Pulsara, they sent alerts to the hospital about crews bringing in COVID-19 patients, giving hospital staff more time to prepare. And since the providers on-scene wore heavy PPE, making it difficult to communicate verbally, the C4 was able to use Pulsara to facilitate communication for them and manage the case remotely.

But as the pandemic evolved, so did the challenges faced by healthcare providers. By the time ATCEMS was facing its third wave of the pandemic in August 2021, local hospitals were maxing out capacity and lacked both the beds and the bandwidth to care for every patient that came through their doors. ATCEMS knew they needed a way to reduce the burden on emergency departments.

The past two years have done a great deal to redefine the shifting identity of EMS. COVID-19 changed a lot about how we provide care, and some of the solutions we came up with have led to a watershed of self-discovery. With that, though, comes an equal number of questions. What does the shifting landscape of healthcare mean for EMS? What will the role of EMS be going forward? As the identity of EMS evolves and medics are given more agency, will they be able to help find solutions for problems like overcrowded emergency departments, while also giving patients both a better and more appropriate care experience? 

Corey Ricketson, Pulsara's Vice President of Strategic Accounts, recently had the opportunity to discuss these and other hot topics in EMS with Chris Cebollero on The Inside EMS podcast, hosted by EMS1. Corey shares his experiences visiting multiple EMS agencies throughout the country, as well as some top takeaways from how leading EMS agencies are finding solutions to issues like ED overcrowding. Chris and Corey talk community paramedicine, how EMS needs to adapt for the future, the importance of meeting patients where they are, and how interoperability, connection, and communication should be a main focus for EMS agencies.

Listen to the podcast below, and read on for part 2 of the interview! (If you missed part 1, check it out here.)

The past two years have done a great deal to redefine the shifting identity of EMS. COVID-19 changed a lot about how we provide care, and some of the solutions we came up with have led to a watershed of self-discovery. With that, though, comes an equal number of questions. What does the shifting landscape of healthcare mean for EMS? What will the role of EMS be going forward? As the identity of EMS evolves and medics are given more agency, will they be able to help find solutions for problems like overcrowded emergency departments, while also giving patients both a better and more appropriate care experience? 

Corey Ricketson, Pulsara's Vice President of Strategic Accounts, recently had the opportunity to discuss these and other hot topics in EMS with Chris Cebollero on The Inside EMS podcast, hosted by EMS1. Corey shares his experiences visiting multiple EMS agencies throughout the country, as well as some top takeaways from how leading EMS agencies are finding solutions to issues like ED overcrowding. Chris and Corey talk community paramedicine, how EMS needs to adapt for the future, the importance of meeting patients where they are, and how interoperability, connection, and communication should be a main focus for EMS agencies.

Listen to the podcast below, and read on for part 1 of the full interview! 

Teller County, CO develops a first-of-its-kind telehealth program using Pulsara as the backbone for rural health communications

BOZEMAN, Mont., August 16, 2021 — Pulsara, the leading mobile telehealth, communication, and logistics platform that unites healthcare teams and technologies across organizations during dynamic events, published new details on Teller County, Colorado’s groundbreaking community paramedicine and telehealth program. Reporting on their initial challenges, the solutions they found, and results, the “911-INITIATED TELEMEDICINE: Next-Level Patient Care for Rural Colorado” case study reveals a new pathway forward for EMS agencies across the globe.

As COVID-19 escalated across the country in early 2020, EMS and hospital leaders in Teller County, CO identified that residents were reluctant to seek care—for any condition—at the hospital. “Up to 40% of our EMS volume does not want to go to the hospital once 911 arrives,” said Dr. Jeremy DeWall, EMS Medical Director for the Teller region. “Looking at our numbers, the fear was that we were missing a large group of people who were without healthcare or afraid to go to healthcare because of COVID-19.” 

Leveraging their already thriving community paramedicine program, Teller County’s Ute Pass Regional Health Service District and Emergency Medical Specialists, PC set in motion a new 911-initiated telemedicine program, utilizing Pulsara’s telehealth capabilities to address the acute needs of the community. 

Mental health is a growing need around the world. Over 50 million people in the United States alone—1 in 5 adults—are dealing with mental health issues. And the trend extends to all ages; 1 in 6 young people in the U.S. between the ages of 6 and 17 struggle with mental health. Living through a global pandemic has only made matters worse. In May 2021, Children's Hospital Colorado declared a state of emergency for pediatric mental health. 

Over the past few years, Ute Pass Regional Health Service District in Teller County, Colorado, has set out to improve care for mental health patients. They built a top-tier community paramedicine program uniquely trained to respond to mental health calls. They also equipped their community paramedics with Pulsara, a healthcare communications, telehealth, and logistics platform. The result is a dynamic program that meets mental health patients where they are. 

EDITOR'S NOTE: This article originally appeared on EMS1.com. Special thanks to our guest author, Sarah Calams of EMS1 Frontline Voices. 

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Community paramedics are pioneering new ways to care for mental health patients – here’s how

Since the COVID-19 pandemic, EMS providers have seen an alarming uptick in patients refusing to go to their doctor’s office or the emergency room. Many others – including those with urgent conditions – have even been hesitant to call 911.

“We saw patients who were just foregoing all of their medical care – they were ignoring their emergency conditions,” said James McLaughlin, director of the community paramedicine program at Ute Pass Regional Health Service District in Woodland Park, Colorado.

To ease his community’s fears, McLaughlin introduced a new Healthcare Options Mobility and Engagement, or HOME, program, which pairs an in-home paramedic visit with a telehealth consult by a physician – like Dr. Jeremy DeWall, EMS medical director at Ute Pass Regional Health Service District.

EDITOR'S NOTE: This article originally appeared on EMS1.com. Special thanks to our guest author,  Marianne Meyers, BS, for EMS1 BrandFocus. 

EDITOR'S UPDATE: The ET3 program is mentioned throughout the below article. Please note that, as reported by JEMS.com on 6/28/23, the federal government is ending the ET3 program. According to the Centers for Medicare & Medicaid Services, “This decision does not affect Model Participants’ participation in the Model through December 31, 2023.” Read the full article on JEMS for more details: ET3 Program Comes to an Abrupt End. Be advised that Mobile Integrated Healthcare and Community Paramedicine are separate initiatives and are unaffected by the ET3 program termination.

A Canadian study published prior to the COVID-19 pandemic indicates that community paramedicine programs are improving care and outcomes for patients. 

According to researchers Michael J. Nolan, Katherine E. Nolan, and Samir K. Sinha, there is a growing need for a more flexible, sustainable model of care to deliver high-quality healthcare within communities—and in Canada, community paramedics are being recognized as uniquely positioned to deliver exactly that. 

Wow! Was 2020 a doozie or what? COVID-19 took a toll on our healthcare system, resources, economy, and the way we do business. We survived rolling epicenters of virus surge on a national scale. Needless to say, it’s been a chaotic year.