Paramedic roams the county, preventing emergencies

EVERETT — Paramedics know the single-wide mobile home well.

They’ve been there 53 times since 2010, sometimes crawling through the kitchen window.

There once were two people with significant medical issues inside the tidy, well-maintained residence south of Everett.

These days, Dale Jeremiah, 59, lives there alone. His wife, Leslie, died a couple of years back. She was bed-ridden toward the end, unable to help when he’d lapse into a diabetic coma.

His Type 1 diabetes was diagnosed in his teens. As a younger man, he worked as a Volkswagen mechanic and for a television production company. In recent years, the disease has become debilitating. His life revolves around frequent blood glucose readings and insulin injections. It is a series of measurements of time, food and expending his limited energy.

Yet Jeremiah is doing better than he has in a long time. His calls for emergency care have dropped off sharply.

There’s a reason for that.

For more than a year now, Shane Cooper has kept track of an evolving list of people with medical maladies in south Snohomish County. He’s what’s known as a community paramedic. Instead of responding to emergencies, he tries to prevent them from happening in the first place.

Jeremiah is on Cooper’s list. They visit by phone or in person once a week and Jeremiah’s family also checks on him often.

On any given day, Cooper is in contact with 10 people with medical or mental health issues, sometimes both. They either are frequent 911 callers or were referred to him by his fellow Snohomish County Fire District 1 paramedics. On his immediate list are 53 names, but he’s monitoring more than 200 during the course of a month.

He’ll visit three to five of people a day, assessing how they are doing while trying to help them connect with social agencies and medical help. It’s a modern-day twist on Benjamin Franklin’s saying: “An ounce of prevention is worth a pound of cure.”

And it seems to be working.

An independent study of the first year shows promising results. The number of 911 calls and emergency room visits dropped significantly among the people on Cooper’s case load.

“This is a program that is doing good and making a difference,” said Robin Fenn, who is research manager for Snohomish County Human Services.

Fenn conducted the study, following 72 patients.

During the six months before Cooper started working with them, medics were called to their homes 268 times.

In the six months after Cooper intervened, there were 169 emergency contacts. That’s a 37 percent drop.

More than two-thirds used emergency medical services less often.

Half made fewer emergency room visits.

The Verdant Health Commission, an offshoot of the Snohomish County Public Hospital District No. 2, found merit in the fire district’s vision. It’s providing $144,426 annually over two years to get the program off the ground.

Fenn said it became apparent to her that the entire program was built on many levels of trust beginning with Verdant’s investment.

The one-year evaluation shows the community paramedic concept is effective, said George Kosovich, Verdant’s assistant superintendent.

“I think it is a clear success,” Kosovich said. “You are keeping people out of the hospital and these are pretty high-need folks. I think that makes their reduction even more impressive.”

Dr. Richard Campbell is medical director for Fire District 1. He said the community paramedic idea has exceeded expectations. At the same time, it has pointed out unmet medical need.

“We feel like we are scratching the surface for what we can do, what Shane can do, where this program can go,” he said. “I think five to 10 years from now you are going to see a whole different program doing a whole lot more.”

Gov. Jay Inslee recently signed a bill into law that gives the community paramedic concept stronger footing. Among other things, it will allow the paramedics on non-emergency calls to make minor medical interventions.

“I think it was critical,” Fire District 1 Capt. Shaughn Maxwell said. “It’s critical because we are operating in a gray area. We are definitely operating in a nontraditional area. We have been focusing on making social connections and now we can now start exploring how to help people medically.”

Maxwell and others from Fire District 1 approached state Sen. Marko Liias with their proposal last fall. It became law months later.

This week, Maxwell and three other Fire District 1 workers were flown to Colorado to help lead what amounts to a boot camp for fire departments across the country interested in community paramedic programs.

Back in Snohomish County, Cooper makes his rounds.

Jeremiah invites him into his home where there are seven birthday cards on his coffee table.

The paramedic and patient talk about cars and blood sugar, Jeremiah’s plans to scatter his wife’s ashes and his upcoming move to Colorado to be closer to family.

“The older I get, the harder it is getting,” Jeremiah confided. “When I get low (blood sugar), I act like a 2-year-old.”

During the half-hour conversation, Jeremiah’s blood sugar dropped 53 points.

Cooper won’t leave until he makes sure Jeremiah drinks juice and eats some food.

“I don’t want to hear your address on the radio,” Cooper tells him.

That same morning in late April, Cooper paid a visit to Julia Williams in north Edmonds.

Paramedics first visited the home when Williams’ mom took a fall. Her mom, who was in her 90s and has dementia, eventually was placed in a Shoreline rehab center. It became apparent that Williams, 72, also needed help. She was overwhelmed, struggling to make house payments and in need of counseling.

Cooper helped her understand medical bills and found her help, making follow-up calls to make sure appointments were made and kept.

That Thursday morning was the last time Cooper would visit her in the home.

The house, once cluttered, was empty and being prepared for sale.

All of which was a relief for Williams.

She was moving to Everett where she would have company and not face the depressing pile of bills alone.

A week later, Cooper got a voice mail message from Williams. She wanted him to know that she was happy and doing well.

Mainly, she wanted to say thank you.

Eric Stevick: 425-339-3446; stevick@heraldnet.com.

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