State Aims to Reduce Unnecessary ER Visits (Honolulu Civil Beat)



State Aims to Reduce Unncessary ER Visits By Empowering Paramedics

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State Aims to Reduce Unncessary ER Visits By Empowering Paramedics

Hawaii is creating a community paramedicine program that officials hope will mean fewer ambulance trips to hospitals.

Minor wounds, rashes, gout pain — these are some of the many medical conditions that should be taken seriously, but they may not merit a 911 call or a trip to the emergency room.

Hawaii health officials are considering how to reduce unnecessary ER visits through a community paramedicine program. The revised emergency transport system that could begin next year would allow medical professionals to transfer patients to predesignated destinations, such as urgent care clinics, or even provide complete treatment at the scene.

“Can paramedics go treat people in the field, in the community setting under a physician’s direction, and offer a treatment when they don’t need to go anywhere?” asked James Ireland, a nephrologist and the former director of the Honolulu Emergency Services Department. “Can they do some simple wound cleaning and start the patient on some antibiotics under the guidance of a physician? I think that’s where the huge cost savings can be.”

When Gov. David Ige signed Act 140 into law June 25, it marked the latest development in an effort to make Hawaii’s emergency response system run more smoothly. Starting as early as next year, the law will allow paramedics or other medical professionals to treat some patients at the scene of an emergency — or nonemergency — and navigate them to appropriate care at other clinical sites.

The Hawaii Department of Health has until July 2020 to outline the program’s parameters, such as how many additional people will be hired, what kind of vehicles it will require and how to delegate medical treatment.

It likely won’t provide service 24 hours a day. A 2016 Community Paramedicine Working Group recommended the program involve certified health workers, social workers, doctors and a medical director.

Officials say the program could alleviate pressure on overloaded ERs and save the state money, but it will require careful planning, training, partnership-building and vetting. And no one knows exactly how it will be structured yet, especially without a monetary appropriation from the state.

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Aashish Maskey

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