Guam § 84123 - Community Paramedic Outreach Program.

§ 84123. Community Paramedic Outreach Program.

(a) The Guam EMS Commission and the Office of EMS, in

coordination with the Guam Fire Department and other

government of Guam agencies, shall establish a Community

Paramedic Outreach Program (CPOP) as part of the EMS

Comprehensive Plan established in § 84105 of this Chapter no

later than October 1, 2020.

(b) The Guam EMS Commission and Office of EMS shall

develop, no later than October 1, 2020, the scope of care, training

requirements and initial certification requirements for the CPOP.

It is understood that the training required to achieve full NEMT

EMT-O certification will take time to develop. Therefore, the

initial phase of the CPOP may be limited to a visitation program

utilizing current scope of care criteria. Full certification criteria

will not preclude the development and implementation of the

initial CPOP.

(c) The Chief of the Guam Fire Department or designated

representative, working with the EMS Commission and Office of

EMS, and local civilian, public, and military hospitals, shall

develop a process of identifying patients discharged from the

hospital that request participation in the CPOP. This process will

become part of the comprehensive EMS plan and subject to the

CPOP.

(d) The Chief of the Guam Fire Department or designated

representative, working with the EMS Commission and Office of

EMS, shall work with the Mayors Council of Guam to establish a

process in identifying village residents that would like to

participate and will benefit in the CPOP.

(e) The Chief of the Guam Fire Department or designated

representative, working with the EMS Commission and Office of

EMS, shall work with local health care providers on Guam to

establish a process in identifying village residents that would like

to participate and will benefit in the CPOP.

(f) Prospective EMT participants in the CPOP shall attend

a culturally and linguistically appropriate services (CLAS)

training conducted by the Guam Office of Minority Health,

DPHSS, prior to initiation of outreach services.

(g) The Chief of the Guam Fire Department or designated

representative, working with the EMS Commission and Office of

EMS, shall develop reporting criteria for the management of the

CPOP. At a minimum, the reports shall include the number of

residents who have used program services, and the types of

program services used, as a measurement of any reduction in the

use of the 911 systems for nonemergency, non-urgent medical

assistance by residents. Reports shall not include any personally

identifiable information concerning a resident in the program.

(h) On or before March 31 of each year after the

establishment of the CPOP, the Guam Fire Department, in

coordination with the Office of EMS, shall compile annual reports

in the previous year into a single report and post it on its website.

(i) The Guam Community College School of Allied Health,

the Guam Fire Department, the University of Guam, and other

EMS training service providers approved by the DPHSS Office of

EMS, shall provide training courses in community paramedic and

are subject to the provisions of § 84110 of this Chapter.

(j) The CPOP shall strive to incorporate concepts of the

Primary Care Medical Home model of extending the care

provided by a patient’s primary care provider. This can be

achieved in many different manners:

(1) linking patients with primary care providers;

(2) future innovations may include linking EMT-Os in

the patient’s overall care plan developed by the PCP; and

(3) it is not the intent of the CPOP to be a patient’s

medical home.

(k) Use of the CPOP should be a part of the patient’s care

plan ordered by the primary care provider in consultation with the

medical director of the EMS.

(l) The CPOP shall augment and integrate with other

services such as home health care and community nursing

programs. The CPOP is not a home health nursing service and as

such is not subject to home health licensure or other home health

regulatory requirements.

(m) EMT-Os, working under the physician’s direction and

approved patient care protocols to ensure patient safety, shall

work with recently discharged patients. During downtime, the

EMT-O will follow up on healthcare provider referrals in the

patient’s home; and

(1) must be currently certified as an EMT;

(2) must successfully complete training prescribed by

the EMS Commission; and

(3) must comply with the defined scope of care set by

the EMS Commission or as described in the PCP care plan.

(n) Scope of care may include:

(1) Assessments:

(A) checking vital signs;

(B) blood pressure screening and monitoring;

(C) prescription drug compliance monitoring;

(D) assessing patient safety risks (e.g., risk for

falling); and

(E) home safety checks.

(2) Treatment/Intervention:

(A) breathing treatments;

(B) providing wound care, changing dressings;

(C) patient education; and

(D) intravenous monitoring.

(3) Referrals:

(A) mental health and substance use disorder

referrals;

(B) social services referrals;

(C) collaboration with the DPHSS programs; and

(D) referral recommendation to higher levels of

nursing care.

(o) Training coursework of the EMT-O may include:

(1) social determinants of health;

(2) illness preventions;

(3) advanced wound care;

(4) health promotion;

(5) risk assessment; and

(6) community resource availability.

(p) Patient eligibility for the CPOP should be liberal but at

a minimum should include:

(1) recently discharged patients;

(2) high utilizers of 911 services, defined as

individuals who have received ED services three (3) or more

times in a period of four (4) consecutive months in the past

twelve (12) months;

(3) patients identified by the individual PCP for whom

CPOP services would likely prevent admission to or would

likely prevent readmission to a hospital or nursing facility;

(4) residents identified by a Mayor for whom CPOP

services would likely prevent admission to or would likely

prevent readmission to a hospital or nursing facility; and

(5) residents identified by social service agencies for

which CPOP services would likely prevent admission to or

would likely prevent readmission to a hospital or nursing

facility.

(q) Coordination.

(1) Services provided by the CPOP to an eligible

resident who is also receiving care coordination services

must be in consultation with providers or the resident’s care

coordination service.

(2) The care plan or services rendered by the CPOP

should not duplicate services already provided to the patient,

including home health services.

(3) The CPOP should also coordinate with other

visitation to the patient, to include mayoral, clergy, or other

non-profit organizations to the satisfaction of the patient.