Webinar Examines Pediatric Asthma Community Paramedic Project, Out-of-Hospital Death Responses

In children, asthma is the most common chronic illness. In Indiana, one in 10 children have asthma, and statistics show that 30% of children who have been hospitalized require readmission shortly following discharge.

To help combat this trend, Indianapolis EMS and the Indiana University School of Medicine tested a community paramedicine program.

This program was detailed in the March 23 Emergency Medical Services for Children National Resource Center’s webinar, “A Community Paramedicine Approach to Pediatric Asthma Care and Compassionate Options for Pediatric EMS.”

Andrew Stevens, MD, and deputy medical director at Indianapolis EMS, described the program in depth.

Funded by a grant from an agency in the U.S. Department of Health and Human Services, the program was intended to prevent emergency department readmissions for pediatric asthma patients, improve their healthcare access, develop a workforce that is specially trained in out of hospital care to implement various prevention strategies and examine the sustainability of such a program, Stevens says.

The program consisted of home visits for patients between the ages of two and 17 that were discharged from a hospital stay that were deemed likely to return. Stevens says there were a number of criteria that would deem a patient high risk, including referral from their physician.

Stevens says the home visits by paramedics would include clinical assessments, education on asthma and the medications that had been provided for the patient, smoking cessation education when necessary and assessments of the environment the child was living in.

Intervention came in many different forms, Stevens says. Nearly 90 patients were found to have environmental asthma triggers in their home and were given further education on how to help with that. Others were given mask spacers to help treat their asthma at home. The program even provided about 10 vacuums to families who were unable to get rid of pet dander or other issues that were exacerbating the patient’s asthma.

The program, which began in 2013, has collected about 630 analyzed patients to date, Stevens says, and the results are generally positive. There were improvements in the readmission rates in 30-, 60- and 90-day intervals, peaking with a 4% lower readmission rate for patients who participated in the program after 90 days.

Although these results weren’t technically “statistically significant,” Stevens says, they have big impact on lowering costs. They found the average cost of an asthma-related hospitalization was about $13,500. By 90 days, the number of patients who were able to avoid readmission saved a total of nearly $560,000.

The program also provided users with a post-visit survey, although Stevens says they had a low response rate. About 50 people took the survey, but responses were overwhelmingly positive. The survey asked questions such as if IEMS staff members seemed to care about the family and if they were satisfied with the home visits. From the responses, they averaged a score of 4.9 out of 5.

In all, Stevens says they have been able to accomplish many of their goals, including identifying in-home asthma triggers, lowering readmissions, providing education and helping lower costs for low-income families.

“The program really provides a benefit for the lower socioeconomic populations in large urban areas,” Stevens says.

The project expects to have data collected for all three years of the program by May of 2016. Stevens says at that time, it will be easier to examine ways to keep the program sustainable.

Another program discussed during the webinar was the Compassionate Options for Pediatric EMS (COPE) project, presented by Mary Fallat, MD and surgeon-in-chief at Kosair Children’s Hospital in Kentucky.

The project aims to develop education and training for EMS providers in the situation of pediatric, out-of-hospital death through the use of technology.

The team is developing an app that Android users can download to act as a library of resources to learn about how to handle a pediatric, out-of-hospital death.

As part of the project, Fallat and her team have developed two videos to help put paramedics in those situations, and see how parents and other family members who are present may react, Fallat says.

Fallat says another goal of the project is to educate about the inclusion of children in termination of resuscitation protocols and declaration of death protocols.

Included in the information on how to handle pediatric deaths will be information on self-care for paramedics, as Fallat says secondary trauma in paramedics who respond to these types of scenes is another large-scale issue that needs to be addressed.

The next steps in the COPE project are to continue developing the app and partnering with an organization who can house and support the app.

To learn more about these projects and to listen to the full version of the webinar, visit the EMSC NRC website.