From Putting Down Fires to a ‘Telebehavioral’ Health Presence

Fires were down in Fishers, Ind., and the fire department wanted to maintain its value to the city. So the department expanded its role in the community and changed its name to Fishers Emergency Services.

The department still puts out fires, but now, with the WeCare community paramedicine program started in November 2014, also tends to elderly patients who need followup care after hospital stays and youngsters who have had mental health problems.

“It was pretty exciting because we wear so many hats nowadays,” said Fire Chief Steve Orusa. “Anything you need without a gun we get called, including community paramedicine and mental health, two of our biggest initiatives.”
Orusa said the department’s mentality is that they are responsible not only to help deliver quality health care, but also to help control cost.

They started out simply — with blood pressure screenings, home safety surveys, CPR instruction — and have rapidly expanded to improve the department’s value while improving the city’s health care and curtailing cost.

When an elderly person is discharged from the hospital, that person is vulnerable in the first few weeks to having to return to the emergency room for complications. The WeCare program will track these patients for 30 days after discharge, checking on meds, safety at home and even what the patient is eating.

It has worked, reducing the readmission rate from 22 percent to 7 percent.
“Sometimes dumping an elderly person at the ER isn’t in their best interest,” Orusa said. “We are creating a telebehavioral health presence for generations. We’ve been able to reach back to a health professional and get advice,” before transporting that person. “That person can talk to a patient on an iPad, visualize them, articulate with them and we can then transport that patient to a treatment facility.”

There was also a gap in mental health care for young people, Orusa said. “We’ve got a mental health initiative in the community, and we realize that mental health is not only the worst-kept secret in the country but the worst-kept secret in our own community.”

Prior to the initiative, a young person who was taken to the hospital for exhibiting behavior that endangered themselves and others fell through the cracks after being released. There was no followup. That’s changed and now, with a partnership with local schools and a referendum that captured some tax dollars, the at-risk students will receive a continuum of care from WeCare, and the schools now have a mental health professional on staff.

“What we did was used HIPAA paperwork to get releases from the parents so when a child is released into the community, the school knows and can provide services privately and we can follow up with the community paramedicine program privately,” Orusa said. “Now there are no gaps for those kids.”

 Shelley O’Connell, director of Touchpoint Geriatric Services in Fishers said, “It’s truly a community program,” providing health benefits and saving money in the long run.