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Though the Laguna CPs are now seeing patients on their own, they’re
still part of a multidisciplinary team charged with managing the health
needs of each patient on the CHR census. By working with the CHRs,
public health nurses and the medical director, the Laguna CPs are per-
haps better described as “CHR extenders.”
The program continues to use the term “community paramedic”
because it’s a term familiar to the EMS community. However, the
skill-by-skill development of the Laguna Community Paramedicine
scope of practice is very different from the more comprehensive train-
ing and scopes of practice that CPs in other areas employ.
Formal MIH-CP training curricula are often aimed at creating
semi-independent practitioners. In contrast, though the Laguna Community Paramedics have had specialized training to treat specific conditions, they aren’t semi-independent practitioners like their counterparts
in some of the more well-known, urban and suburban MIH-CP programs. This approach to program development has allowed the Laguna
Community Paramedicine Program to grow based on the needs of the
residents of the Laguna Pueblo, without subjecting the providers to
lengthy, more formal MIH-CP training.
In fact, all of the Laguna community field providers—the CHRs,
the public health nurse and community paramedics—work closely and
communicate frequently with the program medical director. To better
facilitate direction of the entire team, the role of the Laguna Fire Rescue
medical director was recently expanded to medical director of Community Health and EMS Programs, covering both the lights and siren
aspects of EMS as well as the community health and MIH-CP activities
on Laguna Pueblo. This has helped with program operation and development as well with coordination between the team and the patients’ PCPs.
Relationships with the PCPs are critical to the success of patient treatment plans—and to the success of the Laguna Community Paramedicine Program itself.
Laguna CPs saw their first patient in September 2015. By mid-2017,
they’d visited 11 unique patients a total of 221 times. Anecdotal results
are especially promising among wound care patients, and patient/fam-ily testimonials are very positive.
Medical cost savings and quality of life improvements are more
difficult to quantify, since the program is now treating patients whose
medical needs were previously unmet or underserved (i.e., they’re
now generating treatment costs in instances where, in the past, there
Though we’ve discovered specific examples of missed appointments, patients languishing while waiting for appointments far
off the reservation and patients “slipping through the cracks,”
we’ve yet to quantify the degree to which medical needs are unmet
We’re attempting to estimate the costs of the specialist care and
off-reservation/out-of-IHS-network care that patients should’ve been
receiving but weren’t, and comparing them to the costs of care under
the CHR/CP model.
To date, we don’t have hard numbers, though the impact of patient
and family testimonials can’t be underestimated—especially upon members of the Laguna Pueblo Council and CHR, who allocate funding for
Laguna Community Paramedics saw their first patient in September 2015 and by
mid-2017, they’d visited 11 unique patients a total of 221 times.