Kendria Donaldson thought the career she wanted was traditional nursing. Then, when her boyfriend’s brother joined the Milwaukee Fire Department, she saw a different option open: Becoming a firefighter would still allow her to help people with their health, but she could do so in a way that would build long-term wellness rather than just dispense spot care.
Donaldson discovered that running into burning buildings is a relatively small part of the job. Far more common are health-related emergency calls. The department responds to so many health calls that aren’t true emergencies that officials devised a system of ferreting out the frequent callers, those who call 911 on a regular basis because they aren’t equipped to manage chronic diseases like asthma, diabetes and heart conditions.
“A lot of times, when we get there, the person tells us they just don’t feel good. That’s where the conversation starts,” Donaldson said. “We have to find out why they are not finding the right care. With those patients, we are forming a long-term relationship. When you spend two hours with a patient you can have an impact.”
In 2015, the Milwaukee Fire Department partnered with the UWM College of Nursing and Milwaukee County Emergency Medical Services to train firefighters who are already paramedics as “community paramedics,” whose role is educating, fact-finding and relationship-building with patients whose calls are not urgent.
A drop in 911 calls
The purpose was to determine whether the new platform would improve people’s health competencies, while reducing the number or non-emergency calls coming in.
The strategy worked. Under the program, which the fire department calls Mobile Integrated Healthcare (MIH), 911 use across all demographics for Milwaukee County dropped significantly from 2014 levels. According to Michael Wright, MIH care coordinator for the Milwaukee Fire Department, the calls were down 56 percent in 2016 and 62 percent in 2017.
UWM so far has trained 73 community paramedics at fire departments all over Wisconsin, 34 of them in Milwaukee. The fourth class will be offered this fall.
Community paramedics try to uncover a patient’s underlying barriers in managing their own health, whether it’s finding transportation to clinics or understanding correct use of their medications. While they are making a home call, the community paramedics also check for safety hazards in the environment and give patients information on other programs that can help them.
In contrast, the job of traditional firefighter paramedics is to perform triage in order to quickly transport a patient to a hospital for treatment.
“The community paramedics program capitalizes on the strengths of all participants,” said Kim Litwack, dean of the UWM College of Nursing. “Our expertise in health promotion and health education paired with the knowledge of fire department paramedics in neighborhood-centered care can lead to improved health outcomes for the citizens of the state.”
Employing a community-based health care curriculum used nationally, UWM’s nurse-trainers expose the firefighter paramedics to different parts of the medical field, from giving refreshers on chronic conditions like asthma to addressing pregnancy issues.
Then they get experience in navigating the challenges that many people in poverty face: how to get around on a bus with children, where to go when you are homeless, how to obtain and use food stamps.
“It was very eye-opening,” she said. “Sometimes people are stuck between paying their energy bill or buying their medications. By telling them about various other programs available, we may give them some more options.”
For Donaldson, the most valuable aspect of the training was learning to interact with people who may be struggling with untreated mental health needs.
“We covered basic issues like dealing with depression,” she said. “Maybe their first problem is they are not able to communicate their needs.”
Several insurance companies contract with the Mobile Integrated Healthcare program, using community paramedics to handle customers who otherwise might visit a hospital emergency room for a health concern that isn’t life-threatening. Community paramedic consultation is less expensive, but Donaldson said the real satisfaction comes with improving a community’s health.
“I like the idea of treating our own frequent callers,” she said. “We’re a brotherhood and sisterhood. And if we’re helping our own, it will ultimately lead to fewer calls.”