THE PROGRAM’S FUTURE
As the second year of the program draws to a
close, we’re looking to expand both the scope
and the number of providers in the program
in a thoughtful and deliberate fashion. We’re
also looking to align the program more closely
with the lights and siren side of Laguna fire
Rescue by making it easier for any Laguna
Firefighter/EMT to refer a patient with social
or chronic medical issues to CHRs for help.
More importantly, although the program
enjoys strong financial support from Laguna
Pueblo, efforts are underway to access third-party payers to help support the costs of the
program for patients who have insurance plans
in addition to IHS coverage.
The Laguna Community Paramedicine program is an example of a meaningful MIH-CP
program that’s been built on a small scale, one
skill at a time, to address the specific needs of
a community. Targeted special skills training
and close collaboration with medical direction is essential, but starting a program doesn’t
require semi-independent practitioners or the
training to become one.
This “grassroots” approach puts such a
program within reach for smaller, more rural
departments that may not have the personnel or financial resources to send providers to
lengthy general MIH-CP training.
Though other tribal community
paramedicine programs will benefit from the
CHR infrastructure available in reservation
settings, such programs don’t require CHRs,
and are conceptually within reach of non-tribal
communities as well.
The very first Laguna Community Paramedicine patient is now 91 years old, and is still in
the program. She has chronic lower extremity ulcers, and though they look much better
than when she entered the program, they’ll
probably never completely go away. The team
visits her three times a week, and helps take
her back and forth to primary care and specialist appointments that are no longer as frequent as before.
It’s clear that the team is treating more than
just her wounds: her face brightens when the
CPs arrive, and she relishes the personal attention they give to her during treatment. She pays
attention to them as well; it’s hard to leave her
house without some sort of a snack or other
tasty treat. Since her mother lived to 108 and
her grandfather to 119, she’ll be on the Laguna
Community Paramedicine census for many
years to come. JEMS
Chelsea C. White IV, MD, NRP, FAEMS, is the medical director
for community health and EMS Programs for Laguna Pueblo.
He’s an emergency and EMS physician for the University of
New Mexico (UNM) and is also the director of both the UNM
Center for Rural and Tribal EMS and the UNM EMS fellowship.
Kimberly Pruett, MD, is the 2017–2018 University of New
Mexico rural and tribal EMS fellow. She’s particularly interested
in community paramedicine in rural and tribal communities.
Anthony Braunschweiger, EMT-P, CWCP, is the lead community paramedic for Laguna Pueblo and is the A-shift lieutenant for Laguna Fire Rescue.
Acknowledgement: The authors would like to thank the
Laguna Pueblo Community Health and Wellness Director
Ramona Dillard, Fire Chief John Garcia, Community Health
Representatives, Public Health Nurses, Community Paramedics, and most of all, the people of Laguna Pueblo for the
support of this program.
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Though the Laguna community paramedics 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.