For two years, Erath County’s Community Resource Paramedic program has helped save lives – not just with medicine but by putting the pieces together to help solve difficult patient situations.
CRP, also known as Mobile Integrated Health, allows paramedics to extend past their roles of traditional emergency response and transport to provide healthcare in the community.
Community paramedicine is a relatively new and evolving healthcare model that allows paramedics and EMTs to operate in expanded roles by assisting with public health and primary healthcare and preventive services to underserved populations in the community.
Some rural patients lack access to primary care and use 9-1-1 and emergency medical services to receive healthcare in non-emergency situations. This can create a burden for EMS personnel and health systems in rural areas.
After much research, the program was launched. Currently, Swearingen and Stephen Jacobsen serve as CRP. The program was started as a way for the county to save money since bringing on an additional ambulance would be extremely costly, and would not solve the root issues for the patients anyway.
“What we found is we have great organizations in this county. We love working with them and they love working with us,” Swearingen said. “I don’t know what it is about a fire department or EMS asking for help but immediately people respond.”
CRP is bridging the gap between organizations, patients and medical care.
“It’s more relying and working with various resources that we have around here, that people don’t know exist, or don’t understand what they do,” he said.
An example given was AccelHealth who operates on a sliding scale to provide appointments for low income.
As far as Erath’s CRP, there are zero things to qualify patients.
“It costs you zero ... we don’t even ask for your insurance,” he said. “It is paid for through already existing property taxes.”
Currently, within the EMS charting system there is a way throughout the county for all EMTs, paramedics and even police officers to set up a referral for someone to see a CRP paramedic.
Swearingen said many entities in the county were completely flabbergasted at the referral process.
“They’re always asking me what forms they need to fill out or how someone qualifies,” he said. “I’ll always say, I need you to call, text or email me.”
The information is then put into a secure system and followed up with a phone call where CRP paramedics offer assistance through a simple visit.
“Most of these people just need to be heard out,” he said. “Then we can begin to help with the appropriate resources.”
One reason CRPs save money is by eliminating repeated use of 9-1-1 to go to the ER.
“A lot of times it will be they don’t drive, they can’t get to their doctor. When they get prescriptions, they can’t afford them. They feel like they are trapped,” he said. “A big part of this is advocating for patients.”
When spending the day with Swearingen, a patient visit was conducted (with their permission).
The patient, an elderly female, had struggled with homelessness in the past and had limited family help. Still in a less than ideal living situation, the CRP program has been able to assist with getting her medication stabilized including insulin. Needing a place to keep their medicine cool, CRP through the aid of community resources was able to get a mini refrigerator and a window unit.
Since income is limited by disability that is received, the patient utilizes food pantries for food stability.
The patient would like to find some kind of work but currently if they make more than $1,250 a month they will lose all benefits. They currently receive $1,200 a month through disability leaving only the ability to make $50 through work.
Currently, CRP and the patient are working together on a work program with Texas Workforce Commission called Ticket to Work. The program could possibly allow the patient to earn more income without being penalized.
The patient is also utilizing Cruising Care, a recent addition to the CRP program where individuals without reliable transportation are able to use Cruising Care to get to and from medical appointments.
“They are literally angels,” the patient said. “I don’t know what I would do without them.”
Another interesting aspect of the CRP is having more advanced training for paramedics since all of them in the program are required to be either a Critical Care Paramedic or a Flight Paramedic.
This additional training allows them to place patients on a ventilator, advance lab reading, more extensive cardiac monitoring, give blood transfusions and even do a quick sonogram scan of someone who has suffered trauma to see if there is internal bleeding.
With a specialized set of tools in their own vehicles, CRP paramedics will often roll to major car wrecks or scenes in order to provide a more advanced level of care, if needed. If not, they can act as an extra set of hands for the EMT/Paramedics assigned to the call.
“We aren’t there to take over their calls at all,” Swearingen said. “We simply are there if we are needed.”
As part of the program, a delivery for whole blood is done through Carter Blood Care. The unit stays in a refrigerated unit inside the CRP vehicle ready to go if needed. So far, the blood has been utilized a handful of times in order to save patients with severe blood loss, including a stabbing in Stephenville.
“What I love about it is doesn’t matter what color the truck is or which uniform. We are simply doing the right thing for the patient,” Swearingen said about CRP.
A new partnership with Cross Timbers Family Services is also underway where Swearingen is meeting quarterly for a domestic violence high-risk team.
Eventually, the goal is for CRP to become more involved with domestic violence survivors.