Discussion and possible action on any and all matters regarding Resolution No. 1191.  A resolution of the Mayor and City Council of the City of San Luis, Arizona approving and adopting an agreement with the San Luis Walk-In Clinic, Inc. to create San Luis Community Paramedicine Project.  (Hank Green, Fire Chief)

The City of San Luis Fire Department (SLFD) is requesting authorization to collaborate with the San Luis Walk-In Clinic (SLWIC) to provide coordinated community paramedic integrated and preventative care through the San Luis Community Paramedic Project, to their program participants.

This Community Paramedicine Program, with oversight provided by the Regional Center for Border Health (RCBH) through its San Luis Walk-In Clinic, would enable paramedics of the City of San Luis Fire Department with clinical and patient demographic information to visit their health care clients at home.  These visits would focus on follow-up care for medical conditions for which they were recently seen in any of the RCBH clinics or facilities.

The benefits of this collaboration are widespread;
1. The follow-up visit by SLFD paramedics will provide assurance to RCBH that their patients and clients are compliant with the prescribed course of treatment; taking their oral medications as prescribed, proper care and dressing to any wounds and living in a safe environment. 
2. RCBH will work toward reducing the impacts and frequency of their clients requiring an appointment for routine follow-up and/or seeking treatment at an Emergency Department or accessing 9-1-1 for a routine matter.
3. SLFD will be able to limit those who access 9-1-1 medical services as a routine course of action when questions arise regarding treatment, and/or when they are unable to make an appointment with RCBH for follow-up care or when the patient/client is concerned about their medical condition and feel they have no other option for treatment than to access 9-1-1 and be seen through the Hospital Emergency Department.
4. SLFD will be able to access the patient’s residence during these routine visits to perform a residential safety evaluation; looking and advising on fire hazards, exit problems or considerations or accumulation of trash and housekeeping issues.

SLFD has been meeting with RCBH for the past several months, working through the details of operating the Community Paramedicine in the City of San Luis.  RCBH has been operating a similar system within the City of Somerton for almost a year.  Our program would pattern very closely with their program.

SLFD would receive a listing on a regular basis from RCBH of clients to be seen by SLFD Paramedics.  The frequency of visits for these patients will vary, depending on the medical condition of the patient and the progress of the course of treatment.  For example, if a patient had been seen at RCBH for a chest cold or pneumonia, where they were given an injection of an antibiotic when seen at the RCBH Clinic and sent home with an oral antibiotic to be taken three times a day for 10 days (30 capsules).

RCBH will notify SLFD of this patient and an on-duty apparatus with on-duty personnel (a minimum of one Paramedic) would visit the patient within a day or two of treatment.  With the arrival of SLFD personnel (at a pre-determined date and time) would meet with the RCBH client, check on their general health condition (record their blood pressure, heart rate, respiratory rate), rudimentary check of their remaining prescription to validate treatment compliance (pill count), the safety of their environment (general cleanliness and neatness of their residence) and a general safety inspection (check for excessive extension cords, broken cover plates, trip hazards).  A visit report would be forwarded to RCBH.  These types of visits by the SLFD personnel would continue until completion of the course of treatment, as determined by RCBH/SLWIC.

If SLFD personnel were to determine at the time of the visit that the client was in distress, they would activate 9-1-1, obtaining additional assistance from SLFD personnel and transport the patient to YRMC, if appropriate.

There would be no change to the scope of practice of our paramedics or services currently provided by SLFD.  To draw another parallel; SLFD goes to the Senior Center on a very regular basis to take blood pressures.  If everyone there has “normal” blood pressures, all is good, SLFD spent a little time building good will and we go on our way.  Should we encounter a client with very high blood pressure, slow heart rate, very rapid heart rate or another obvious medical concern; SLFD personnel would initiate patient treatment under YRMC protocols.

SLFD is asking for approval of Resolution No. 1192 authorizing the appropriate action to enter into the attached Agreement with  San Luis Walk-in Clinic to create the San Luis Community Paramedicine program.