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Emergency room visits are expensive, time-consuming, and — in a pandemic — potentially deadly. These risks are magnified for people with intellectual and developmental disabilities (I/DD), a group that has more emergency room visits than any other cohort. But thanks to a growing partnership between Mount Sinai Hospital and YAI, this dangerous trend is shifting down.

Launched in April 2017, the Community Paramedicine Program brings hands-on medical care into the home and reduces the frequency of in-person emergency room visits for people supported by YAI in Manhattan, Brooklyn, and the Bronx.

“Before this program was launched, staff would typically have to call a nurse and then bring the person to an Urgent Care or emergency room,” said Ravi Dahiya, YAI’s Chief Program Officer. “Now, a paramedic can come directly to the person’s residence and connect via video call with an ER doctor at Mount Sinai.”

According to Ari Breslauer, Operations Manager for Community Paramedicine Mount Sinai, the paramedic, who is specially trained to work with people with I/DD, can conduct a hands-on examination, monitor vital signs, administer IV fluids and medication, consult an ER doctor via video call, and immediately transport the patient to the hospital if needed.

“The paramedic is essentially the eyes and ears on the ground for the physician to understand what’s happening with the patient,” Breslauer said. “With this multi-faceted approach, the doctor and YAI staff can work together to form a treatment plan for the patient which, in most cases, helps them avoid the emergency room.”

A 2020 study published in the Patient Experience Journal revealed that community paramedicine programs geared toward people with complex disabilities reduced emergency room visits by 44 percent and hospital admissions by 61 percent within a year of implementation.

By closing the gap between telemedicine, which is more appropriate for routine medical appointments, and urgent care, which is typically in-person, Amanda Flood, YAI’s Nursing Supervisor for Manhattan, said the program came just in time for the people YAI supports.

“When the paramedicine program first began, it was slow moving because it was new and staff weren’t really familiar with it,” she said. “But during COVID, everything changed.”

Flood said that paramedicine visits to YAI residences jumped from an average of 10 per month prior to March 2020 to 60 per month during the peak of the pandemic in spring 2020. As a result, 74 percent of YAI’s paramedicine patients avoided a potentially deadly visit to the hospital during a chaotic time in which staff grappled with how to keep the people they support and themselves safe while seeking care.

“I’m confident the paramedicine program saved lives,” Dahiya said. “In cases where someone needed urgent care or where staff might have otherwise taken someone to an emergency room just to be safe, the paramedics were able to treat patients at home when the hospitals didn’t have the capacity to take in any of the people we support. The nurses were calling (the paramedics) ‘angels’ during that time.”

In addition to saving lives, the paramedicine program saved money and staff time, too.

“Many urgent care facilities don’t take Medicaid, so it’s either out-of-pocket for YAI or an emergency room visit which can cost thousands of dollars,” Flood said. “Paramedicine visits are just $400. On top of that, you save even more money because you don’t have to pay staff to sit in an ER. This is even more important now that we’re short-staffed and there’s less time to go on appointments or the ER. Plus, for YAI’s nurses and staff, it prevents them from having to make difficult decisions about whether to send someone to the ER if they’re simply not feeling well or have a rash, swelling, or cut.”

Today, YAI nurses and direct support staff rely on the paramedicine program three times more often than they did before the pandemic, Flood said, with around 30 calls per month. Given the success of the program in New York City, Breslauer said that talks are underway to expand the program and its services in the near future.

“We already have a pilot program in YAI houses in Nassau County and we’re planning to get to Westchester and Suffolk counties in 2022,” he said. “We’re also exploring more comprehensive point-of-care lab testing where the paramedic can draw the blood from the patient and then run the results in-house.”

Breslauer added that he hopes the program will eventually encompass a multidisciplinary team of medical experts who can address everything from routine health checks to mental health crises. Whatever the future holds, Flood said that she is simply grateful to never return to how things were before 2017.

“Sometimes I think of how we would have just been sitting, overwhelmed in the ER and probably never being seen,” she said. “It would have been a disaster. Every single person we supported and their staff might have ended up with COVID. I can’t even imagine how horrible it could have been. But it wasn’t, thanks to this.”

Photo courtesy of Mount Sinai