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Elizabeth Reeves is a paramedic in Topsham. But unlike her colleagues who primarily respond to medical emergencies, she spends most of her time delivering a different type of care.
For most of her 42-hour work week, she responds to scheduled calls in peoples’ homes, providing less urgent services such as blood work, or assistance with more general life tasks such as apartment-hunting.
Topsham is the latest Maine community to adopt this approach, in which specially trained paramedics provide a range of non-emergency services.
It’s called community paramedicine, and at a time when many Americans are struggling to afford or access basic health care, it’s meant to offer another model for providing that care while lessening dependence on the 911 system.
Maine first created the framework for paramedics to provide community-based care in 2012, with the goal of removing barriers in rural communities and lessening the strain on emergency medical services, according to Soliana Goldrich, the state’s community paramedicine coordinator.
There are now 19 agencies around the state that provide different forms of community paramedicine, serving roughly 3,000 patients, Goldrich said. In total, they’ve performed more than 21,000 visits.
Reeves first became involved with community paramedicine several years ago, as part of a pilot program in Boothbay. After seeing it in action, Reeves told her chief at Topsham Fire and Rescue about the program. They received a $60,000 grant from the state office of emergency medical services and started their own version in July.
So far, Reeves said she’s seen about 20 to 25 patients — some of them just once, others multiple times.
Topsham — a town of nearly 9,000 — is far less rural than many Maine communities, so the challenge is not that people can’t get to medical facilities. Rather, Reeves said she hopes to keep people from having to make unnecessary trips for medical care.
“If we can keep them from having to go to the doctor for just a lab draw or something like that that’s gonna expose them to possibly more illnesses or something, that works,” Reeves said.
The way each town gets the word out about their program is unique to the community, Goldrich said.
Topsham Fire and Rescue puts out letters to local physicians and has a pamphlet on its website. It also targets people who frequently require emergency medical care, reaching out to health care providers after they’ve seen the same patient two or three times.
For example, Reeves said, if someone calls an ambulance several times for falls, she might put a call out to that person’s doctor to sign them up for the program. Reeves may go check on the patient to see why they are falling and work on preventing falls in the future.
All patients must be referred by a health care provider, and the community paramedicine program is free to Topsham residents.
One benefit of community paramedicine is seeing the patient in their home, Reeves said. Often, when people go to the doctor, they dress nicely and minimize their health challenges. But in a person’s home, Reeves can learn more about how they’re actually living. And, she has the time to talk to people in the place they’re most comfortable.
“Being able to go to someone in their environment and see what’s real, what’s going on, there’s so many benefits to this kind of a program,” she said.
No day looks the same for Reeves.
Some people need help putting on heart monitors. Some need lab work done. Some are just lonely or depressed, or need help moving to a place with more people, or getting started with a substance use recovery program. Sometimes, they just need a ride home from the hospital.
However, Reeves stressed that if people do have a medical emergency, they should still seek help from the 911 system.
While the Topsham program is grant-funded for its first year, Reeves said she’s hoping the town will decide to fund it after that, or the state will bring in more funding, which might allow them to bring in additional resources such as another paramedic. Right now, Reeves is the only person going out on calls.
But, being the only person who answers the phone and sees the patients has its advantages, Reeves said. Instead of calling the phone number of a large medical organization, people get to talk directly to Reeves, over and over again, and can build rapport with her. It’s comforting to the patients, she said. It’s community medicine in its truest form.
“I think treating people is a holistic thing,” Reeves said. “It isn’t just the heart, or the organs, or whatever system is failing that day. It’s the whole person.”