It’s a late September morning and paramedic Darren Forman walks up to a front door covered in dried corn stalks and fall-themed decor. Forman, holding a bag in one hand and a scale in the other, arrived for his second date of the day.
Ashley Newkirk, 31, opens the door. Inside the house hang scary wedding photos with her husband.
“I love fall,” Newkirk said. “We got married on Halloween. This is our favorite.
Forman greets Newkirk’s twin toddlers – his son wears a baseball cap and his daughter wears a bow. Forman speaks to them in a gentle cadence that contrasts his normally serious demeanor and graying mustache. On the sofa, Newkirk’s husband holds their five-week-old newborn, Wilder.
Forman asks Newkirk if she has any questions, then checks her blood pressure and weight. Then he puts Wilder on a scale and listens to his heart and lungs.
Forman has led Project Swaddle for the Crawfordsville Fire Department since its launch in 2018. It is a service that aims to provide health care to mothers with at-risk pregnancies. Every day, he meets at-risk pregnant women and new mothers and their newborns with the goal of improving maternal and child outcomes.
Forman, a longtime paramedic, was recruited for Project Swaddle because of his more than 20 years of experience as a car seat technician for the fire department. Also – his love for working with moms and children.
“Every medical has a social aspect, and every social has a medical aspect,” Forman said.
The project, which runs alongside several other community health initiatives at the fire department, is part of how Crawfordsville, Indiana is redefining emergency medical services.
Usually an ambulance arrives to find someone in crisis and in need of immediate care. But this new approach – called community paramedicine – aims above all to prevent emergencies. Many consider it the most developed program in the state and it has gained national attention.
“He’s still here,” Newkirk said of Forman. “He’s just a phone call away.”
During Newkirk’s first pregnancy, she developed gestational diabetes. Because of this condition, her second pregnancy was deemed riskier. As a participant in The Swaddle Project, she met Forman regularly throughout her pregnancy to monitor her diabetes or other issues that might arise. Preventive care will continue until Wilder is 1 year old.
The Swaddle Project aims to help moms whose pregnancies are expected to have complications. Foreman said that when he’s able to help women reach nine months of age, which directly correlates with better outcomes for mothers and children, it keeps him going.
“They just aren’t any better,” Forman said. “I get this photo of the baby in the hospital with the mother and all is well with the world.”
But Forman faces challenges with some patients. One of the goals of the program is to explain how health and lifestyle changes can lead to better health outcomes for them and their newborns. Recently, a young pregnant woman arrived for her appointment in the community paramedic building with a lit cigarette. She turned it off and stuck it behind her ear.
Integrated mobile health, or community paramedicine, is an emerging approach to healthcare that strives to meet people where they are. When a paramedic walks into someone’s house, they can better identify barriers to health: food insecurity, difficulty paying bills, or unsafe conditions.
“Provide more holistic services, make sure all social determinants are taken into account and really identify the needs that would be barriers to keeping a person healthy,” said Paul Miller, head of the EMS division of the service. Crawfordsville Fire Department.
The goal of community paramedicine is to improve health outcomes by connecting EMS, patients and physicians. The impact is lower costs by reducing hospital admissions and keeping people out of assisted care. There is not much data on the effectiveness of the Swaddle Project in Crawfordsville, as it has only been operational for about three years. But research on similar mobile health programs suggests it works.
In a study of an integrated mobile health initiative, there was an 83 percent reduction in inpatient use among patients seen by community paramedics.
Since 2017, the Crawfordsville Fire Department has been expanding its community paramedical program to meet the needs of the community. Its services now range from helping people manage chronic disease, accessing treatment for substance use disorders, helping older people stay at home and improving health outcomes. vaccination rate.
Soon the fire department will offer drug treatment for drug addiction at home. This is a marked difference from clinics that would require patients to show up every day to take their medication.
“Fire departments – 80% of their call volume is actually medical in nature,” Miller said. “We need to tackle many of these health issues preventively and we can do that through community paramedicine. “
The community paramedical care program partners with the local hospital to create continuity of care. Doctors at the hospital can look up notes written by paramedics in a patient’s medical history. The hospital helps the department financially.
A role model for others
Crawfordsville’s community medicine program has grown with the help of grants, a cooperative mayor and city council, as well as a committed hospital and fire department.
Now the idea is growing in popularity and some public health and safety officials are trying to replicate the Crawfordsville program.
“The idea was to take the model that is in Crawfordsville and then replicate it in at least three different locations with different sets of resources and different circumstances and benefits,” said Amnah Anwar, senior director of Indiana Rural Health. Association.
Anwar manages a grant from the United Health Foundation that helps hospitals develop community allied health programs inspired by Project Swaddle. Unlike Crawfordsville, hospitals hire and train their own community paramedics outside of a local fire department.
Anwar said she now knows the obstacles other communities face in implementing their own community paramedical program.
For example, a volunteer fire department may have extremely limited manpower and funding, local leaders may be reluctant to the idea, and it may be difficult to recruit paramedics interested in leaving the rapidly changing field. to help moms and babies.
“The need to provide this access is there,” Anwar said. “But the resources are not there in terms of manpower, as well as vehicles, as well as the appropriate training.”
As with many grant-funded projects, sustainability is also a concern. Will hospitals be ready to continue with the program when they need to support it themselves?
“One of the reasons we wanted to replicate what is happening in Crawfordsville, in different adaptations of the same model, is that we really want to collect evidence that it really helps hospitals in terms of ROI,” said Anwar .
This return on investment is the prevention of costly emergency room visits, hospitalizations and repeat admissions, which will reduce hospital costs. However, it remains to be seen whether these findings will convince hospitals and communities to consider this type of innovative health care.
This story was produced by Side effects of WFYI in the public media, a Midwestern news collaboration covering public health.