Community Paramedicine for Alcoholics

Community response for alcoholics and domestic violence victims were among the topics at the the University of Cincinnati’s community paramedicine conference in July.

Cincinnati Fire Chief Richard Braun presented at the event on how he implemented a community response program for alcoholics while previously serving as assistant fire chief at the Columbus Fire Department. Here he discusses how he plans to apply the same principles locally in Cincinnati for alcoholics and for other segments of the population with specific needs.

Was this community paramedicine conference a new event?

“It was a first-time event but it’s being morphed into the university’s curriculum,” Braun says. “It’s taken on a life of its own and really grown.”

During his presentation, Braun detailed how his program in Columbus bucked the system of transporting alcoholics to the ER. Instead, they implemented a program in which responding paramedics now call upon trained outreach workers. “They pick the person up and take them to a rehab center,” Braun says. “It gets us away from the old, 'load them up and get them to the ER.'”

Where do you see the topic of paramedicine headed locally and nationally? It appears to have recently exploded.

“Exactly, I’ve never seen anything like it,” Braun says. Referring to the program for alcoholics in Columbus, he says, “If we can do that there, why not have paramedics trained so they can be more proactive and less reactive?”

Braun says he often uses his grandmother as an example. At 97 years of age she got her sleep pattern mixed up and would often call 911 in the middle of the night just to talk to someone. Her immediate family moved her into a nursing home, and when Braun asked her how she was doing there, she told him, “You know, I called 911 one too many times.”

“She knew exactly what she was doing but did need some kind of assistance,” Braun says. “How do we get someone like my grandmother the help they need, like getting their sleep pattern back on track?”

In Cincinnati they are at the ground level of implementing community paramedicine, Braun says, going through discussions with members, the union and city government. “We’re looking for the business model, and what this will look like for a fire-based EMS system.”

“Hopefully we can get something in place by the beginning of next year,” he says.

Do community paramedicine programs often include programs for alcoholics and domestic violence victims, or is this a new direction?

“It is a new direction,” Braun says. “We’re looking at a segment of our society that needs help, but not on an emergency basis. If we take them to the ER they take up a bed, they’re not getting the help they need and then they’re back on the street.

It’s frustrating for the medic because they don’t need the services they’re there to provide, and it’s frustrating for the patient.”

Could you discuss the details on community paramedicine for alcoholics? How does it work?

“I presented it the way we did it in Columbus. When our medics got there, they would call back the dispatch center to request the outreach workers,” Braun says.

The outreach workers are completely separate from the fire/EMS department, Braun explains. They are recovering alcoholics who go through training and volunteer their time for this program. They are on duty with a medic unit and a radio so they can be dispatched as needed, and when called, they report their estimated arrival time. This can sometimes be a while due to high demand, Braun says. The outreach workers then pick up the patient and take them to an appropriate care facility. “The beauty of it is that they’re trained to handle a specific kind of patient,” Braun says.

In the future, that patient can then call their treatment contact instead of 911 if they need help.

The program aims to be proactive and addresses patients through three avenues: those who come in via emergency calls; those referred for visits by hospitals; and those the EMS system knows as their frequent flyers.

Part of the training for paramedics is to be able to evaluate the situation, Braun adds. For example, they should look at the home and notice whether there’s any food, or the patient might be malnourished.

“That’s what we want to expand on—for people who need meals, transportation to the hospital…” Braun says. “For years EMS has been doing this for frequent flyers, but how do we handle this better?”

Why were alcoholics targeted right away as a group to address?

“It is easy to target and goes back to our problem with our so-called frequent flyers. They already had a support system there and the facilities to go to,” Braun says. The issue was simply, “how do we bridge this gap” between 911 and the support system already available, Braun says.

“We were able to put together this collaboration to take care of this specific problem. Now for other groups we can apply the same principles.”

Domestic violence victims, also discussed at the conference, are not Braun’s area of expertise but he says the group is an example where the same principles could be applied. “It’s another segment of the society that has a specific need, and we need to solve how to plug it into the system.” Additional populations to consider, as discussed at the conference, are older and disabled adults.

“It should be quite a roller coaster ride to see how all these pieces are going to fit,” he says.

Do you have any advice for other systems interested in creating similar programs?

“Just to keep an open mind,” Braun says. “Look for the collaborations that are out there. The agencies these people need often already exist and the goal is to build these bridges.”

“…I think it’s something that’s been needed for years and I think it will be a win-win for everyone.”