EMS: Red River's Success Story

Oct. 1, 2014

Imagine you’re on the TV show “Jeopardy” with Alex Trebek and you take “Community Paramedicine” for $200. The answer pops up on the board: “In 1993, this fire department was the first community paramedicine program in the United States.” You immediately ring in and say “Red River Fire Department.” Alex tells you that are correct and you have control of the board.

With all the talk and interest in community paramedicine projects these days, it is interesting to note that the first such program in the United States was operated by the Red River Fire Department in New Mexico. The program has been around for more than 20 years.

Remote locale

The Town of Red River is in a remote area of northern New Mexico, some 20 miles south of the Colorado state line. If you look at Red River on Google Maps, it is a small community nestled in some mountains and even though there is no snow on the ground on the maps, you can clearly see satellite images of ski resorts. The main economy is based on tourism from downhill skiing in the winter and fly fishing, horseback riding and hiking in the summer. The population varies between 500 and 10,000, depending upon the time of the year.

The closest hospital, Holy Cross Hospital, is 38 miles away in Taos, NM. The drive takes about an hour through a narrow mountain canyon. When the Red River project started, there was practically no medical care available other than the EMS operation run by the Red River Fire Department. Recently, a clinic that is only open part of the year has been staffed by a physician assistant. There is also a nurse who runs a vaccination program in Red River on a part-time basis. You will not find any pharmacy, dental or physician services in town. When the Red River project started, the Red River Fire Department treated and transported usually between 200 and 300 patients a year.

In 1995, the New Mexico Senate passed Senate Joint Memorial 44 (SJM), which required the Department of Health (DOH) to study the implementation of an expanded EMS program and the impact that it may have on local healthcare delivery systems in communities throughout New Mexico. The SJM was intended to: better serve patients and communities earlier in the disease process; reduce unnecessary transports that remove needed emergency resources from the community; be cost effective and reduce the healthcare costs on society; and take advantage of a large, well-positioned grassroots workforce (EMTs).

Initially, five paramedics were trained and some other towns were included in the pilot project. The paramedics were trained with additional skill sets by doctors and other care givers. The training was 380 initial contact hours and 600 hours of clinical training. The program consisted of developing expanded scopes of practice, a community health maintenance program and a system of triage and referrals. The medical director of the program approved 76 different protocols covering various treatments and scenarios that the paramedics may encounter. Some of the protocols included long-term care for alcoholism, hypertension, diabetes and family planning.

The paramedics were trained to perform histories and physical examinations more advanced than their paramedic training. Procedures such as advanced wound care and suturing were also part of the training and the program. Additionally, the paramedics were trained to provide treatment for other primary care problems. A major part of the program consisted of triaging patients to avoid transport since the ambulance would be gone for at least 2½ hours because of the transport time.

The Red River clinic was on the second floor of Town Hall. As the program developed, it discovered that most of the care was provided out of the ambulance when patients called. Therefore, some of the needed supplies were transferred to the ambulance. There was medical oversight with the medical director reviewing all run reports mailed to his Santa Fe office.

The program is struggling for personnel a bit now, since four of the original trained personnel have left the system. There is currently a request to train more paramedics with the program.

After many years, a review of the program was done with a review of the medical charts. Patient information was compiled into a database consisting of 3,345 cases. After review of the medical charts, it was discovered very few residents used the program for primary care. It was assumed that they traveled farther distances since the paramedics could not dispense any medications or write prescriptions.

Although little outcome data was measured with the project, the information that was collected showed a valued benefit to the community. The usual ambulance transports to the hospital in Taos were reduced from 78% to only 11% of call volume. This helped the Red River Fire Department remain in the community for life-saving responses.

Much can be learned from this initial community paramedicine project. The whole concept of community paramedics will be an evolutionary process. Taking the lessons from Red River, it will help develop the programs of the future.

For more news and training on EMS, visit http://EMSWorld.com/.

Voice Your Opinion!

To join the conversation, and become an exclusive member of Firehouse, create an account today!