EMS program keeps patient out of ER
By Julian Eure
Monday, July 15, 2019
Second in a series
Between January and April of this year, Pasquotank-Camden Emergency Medical Services transported Debra Bankford to the emergency room at Sentara Albemarle Medical Center eight different times.
Bankford, 61, needed to go to the hospital because she suffers from chronic obstructive pulmonary disease, or COPD, an incurable condition that makes it hard for her to breathe.
Bankford has lived with COPD for 18 years, managing it pretty well up till this year. But starting in January, she began having more trouble breathing. She also experienced dizziness and felt lethargic more often.
Up until April, Bankford’s only option was to call 911 and go to the emergency room. On her last visit, she ended up staying in the hospital a total of 13 days.
In the past two months, however, Bankford’s only been to the ER once. And that was after a fall in her home, not because of her COPD.
What’s been the difference?
Bankford is convinced it’s the community paramedicine program, a new initiative started by Pasquotank-Camden EMS in mid-April that is attempting to reduce, through in-home visits by an emergency medical technician, EMS’ number of repeat ambulance runs to the emergency room.
Twice a week, Olivia Doherty, an advanced emergency medical technician with EMS, visits Bankford’s home in Elizabeth City to check her vital signs, make sure she’s taking her medications and to talk to her about her CPOD. Critically, Doherty monitors Bankford’s oxygen and carbon dioxide levels, making sure the first is not too low and the second is not too high.
“With her COPD, her body is not able to move fluid around, so it sits on her lungs,” Doherty explained during a visit to Bankford’s home last month. “She takes a fluid pill to shift that fluid around so she can expand her lungs, which she’s not able to do (on her own).”
The pill may not always work the way it’s supposed to, however. Because Bankford can’t expand her lungs properly on her own, carbon dioxide, or CO2, builds up in her lungs. Doherty says the normal range for CO2 in the body is 35-45. Bankford’s level, however, hovers at 50.
That’s why it’s important to monitor Bankford’s CO2 level once a week, Doherty says. It sets a trend line that lets Doherty know whether Bankford’s condition warrants another hospital visit.
“If we were to get something in the 60 range (during our monitoring), we’d obviously get way more concerned,” Doherty said. “She would have to go to the hospital for that.”
On this particular visit, Bankford seems to be doing OK.
“Your O2 (oxygen) level is pretty good today. It’s 99,” Doherty tells her.
“Oh great,” Bankford replies from the hospital-style bed in her living room.
That’s not always been the case. Doherty recounted how Bankford seemed extremely lethargic during one of her visits. After a little troubleshooting, it turned out the seal on the CPAC machine Bankford uses to help her sleep — another of her ailments is sleep apnea — wasn’t sealed properly. As a result, she hadn’t slept properly the night before so her oxygen level wasn’t what it normally is.
“We try to work through those kinds of problems,” Doherty explained. “We try to see if there’s something in-home that’s causing the issue. We see if she needs to go to the hospital to lower the fluid level in her body, or is the cause something else.”
Communication and education are two key tools of EMS’ community paramedicine program, and Doherty tries to take full advantage of both.
Because she keeps trends of Bankford’s COPD, she’s able to keep officials at Sentara Albemarle Medical Center abreast of it, and they in turn talk to Bankford’s doctor and keep her updated.
“I think that’s one of the best parts about this program — that we’re all on the same page,” Doherty said. “So that if she does happen to have to go to the hospital they already know, even though they haven’t seen her for the past month and a half, this is where she’s at, this is what her vital signs have been, this is what her complaints have been, if any, so that they can continue to give her the care she needs but not have to ask a hundred questions and backtrack.”
Doherty also communicates with other agencies involved in Bankford’s care. For example, she contacted a technician about Bankford’s CPAC machine to make sure it was calibrated properly.
“That’s one of the things we can do with this program,” she said. “We can reach out to other agencies and people at other departments and just ask questions so we can bridge that gap and make sure she gets the care she needs.”
Doherty also has worked to educate Bankford about her CPOD, talking to her about the things she can do to help monitor the disease.
“I don’t think she understood the disease itself, so we were kind of waiting for the point of no return,” Doherty said. “She would wait until things were bad to call 911. That’s why she was going to the hospital so frequently.”
By understanding her CPOD better, Bankford now has a better handle on when she needs to call EMS and when lesser intervention is needed. Sometimes, she’ll call Doherty and they’ll discuss her symptoms.
“We know if it’s the dizziness, the difficulty breathing, those kinds of symptoms, then she’s retaining too much CO2 and she needs to call 911,” Doherty said.
Bankford was one of the first two people Doherty signed for the community paramedicine program. Doherty, who before being named the program’s coordinator made emergency runs on EMS ambulances, had met Bankford on one of those runs when she was being transported to the hospital. When Bankford was being discharged, Doherty asked her about participating in the program and she agreed.
“She came out and told me about this program. She told me that instead of calling 911 I could call her,” Bankford said. “She now comes out twice a week. ... She’s like a nurse. She knows exactly what I’m dealing with. She keeps my (CO2 and oxygen) levels under control.”
Bankford said since Doherty has been visiting her home, she hasn’t felt like she needed to go to the hospital.
“It’s a wonderful program,” Bankford said. “It keeps me out of the hospital.”
To find out more about the Pasquotank-Camden EMS’ Community Paramedicine program, contact 335-1524.