Example of Community Paramedicine in Action: Colorado Springs CARES Program

Everyone likes a map before venturing into the unknown. Below, we’ll analyze an example of the community paramedicine with the Colorado Springs CARES program, using their approach as a compass for success.

In this article, you’ll see how Colorado Springs Fire Department (CSFD) has implemented a multi-layered outreach program and how the program has impacted the community.

Here are several questions we’ll address:

• Why did Colorado Springs start the program?
• How did they obtain funding?
• What types of programs do they offer?
• Did they see good results? 

Let’s read this map.

The Need for Integrated Community Outreach

The CARES program (Community Assistance Referral and Education Services) began in 2012. Colorado Springs states they saw a discordance in their emergency response and the needs of their community. 

Here are several issues they faced: 

1. Discordance in response. Many people call 911; however, not all need a full emergency response. Without a tiered response, the wrong resources often end up in the wrong places. 
2. Super Utilizers. Specific patients who activated the 911 and emergency systems at significantly higher rates than average. 
3. Psychiatric patients and PD. Police departments respond to a larger pool of psychiatric calls than EMS. Psychiatric treatment was overlooked as patients changed hands from PD to ER and then back home. 
4. Homeless patients. Homeless patients with no medical care. They wanted to offer these patients a real line of care, particularly in their downtown area.

Below, you’ll see how Colorado Springs overcame the barriers, achieved funding, built partnerships, and established a program that provides lasting and measurable results. 

How Does Colorado Springs Fund Their Community Health Programs? 

This section will look at how Colorado Springs Fire Department (CSFD) began funding its program – and how they finally achieved a sustainable model. 

Funding is difficult for community paramedic programs. However, CSFD adapted and overcame. 

Here’s how Colorado Springs funded their CARES program: 

1. Grants. This is a common place for many community paramedic programs to start. The grant gets the gears turning – like the battery that starts the car. However, they were soon able to transition to more sustainable funding.
2. Municipal tax. The fire department takes in some tax revenue, allowing it to supplement its budget for community health programs. 
3. Community partners. There is strength in numbers, and Colorado Springs found a way to create symbiotic relationships with many organizations, making partnerships more likely. 

Colorado Springs uses a braided funding system. Just like diversifying an investment portfolio, diversifying your funding sources will create sustained longevity. Since their initial grant, they’ve achieved independent funding, relying on their partners and personal budget. 

When it comes to funding your community paramedic program, there will be no one-and-done solution. It’s an ongoing exploration. As many start-ups will tell you, “Seek funding early and often.” 

Always looking to add another strand to the rope will provide the optimal chance of survival. Also, it shifts the focus from a rigid funding source to a more liquid, ongoing system. 

For more on funding MIH-CP, read this article on seven ways to fund your community paramedic program.

Note: EMS and fire departments could see the floodgates of opportunity open up in the future. As states like Minnesota lead the way for paramedics to receive payment for their services, more departments will find the means to start an MIH-CP program. 

Examples of Partnership in Community Paramedicine 

Colorado Springs has taken the idea of partnerships to heart. By stepping back and observing their healthcare landscape, the Fire Department was able to identify partners with common goals.

Here are a few partners involved in their program: 

• Hospital. They had to get on board with physicians and administration to create procedures and protocols for new referral programs. Other community members need to remain informed when bypassing the emergency department, as we’ll discuss.
• Police department. Colorado Springs state that their relationship with PD has allowed them to address an issue within the system: psychiatric patients who slip through the cracks. 
• Community mental health. As their community paramedic program began direct-admit protocols, community mental health needed to have a hand in developing policy for intaking those patients. 
• Primary care physicians. Bringing local physicians onboard increases the community health programs’ ability to refer patients who may not receive adequate primary care. 

Colorado Springs’s proactive approach has led to positive partnerships. For example, in an interview, the medical director stated that the police were very excited about freeing their officers with an alternative option for psychiatric patients. 

Furthermore, when psychiatric care professionals observed patients in their homes, they were surprised how many patients slipped through the cracks. 

If you’re curious, read this interview with some of the founders and leaders of the Colorado Springs Community Response Team. 

Below, we’ll explore how these partnerships manifest themselves: including the Aging in Place Program, Community Response Team, and CARES program for high utilizers. Then, we’ll highlight the results.

Aging in Place Program (APP)

The aging in place program helps older adults create a safe home environment. The goal is to maximize independence, prevent unnecessary ER visits, and improve patients’ overall health and quality of life.  

Here are several aspects of the aging in place program (APP): 

1. Self-sufficiency assessment. The professionals will look at the patient’s home, identifying any potential barriers to the patient’s ability to thrive independently. If additional resources are required, the APP team facilitates these improvements. 
2. Referral. If the patient needs routine home care, the professional in the APP and refer them for more care. Also, if required, the APP team helps facilitate the transition to a different living situation.
3. Go between. Establishing a regular line of communication and assessment between physicians and patients ensures nobody feels alone and that conditions are treated before they get out of hand. 

Now, let’s discuss another popular program. 

Community Response Team (CRT)

The CRT responds to patients presenting with a behavioral or psychiatric condition. The team usually consists of a mental health professional, a paramedic, and a social worker.

Colorado Fire observed that many of these patients were placed in the emergency department and missed definitive care. They believe the ER is not always the place for these patients.

Here’s how they’re helping: 

1. Holistic assessment. The CRT goes directly to the patient from a 911 cell or a state hotline. With in-home assessments, the CRT can clearly understand the patient’s condition. Often, patients may show a stable persona; however, a more accurate depiction can be gathered by observing them in their environment at the time of the incident.
2. Bypass the ER. Colorado Springs has facilitated direct communication between the field and the mental health facilities. This direct link helps them quickly get the patient the care they need. 

Colorado Springs has used the CRT team to adapt to their needs. Now, let’s address how they use this program to reach out to super-utilizers. 

Colorado Springs CARES and Frequent Utilizers

CSFD has clear criteria for who is admitted into the program. For example, if the patient uses the 911 system or ER more than six times in six months, they are a candidate for their program. 

Here’s how they help: 

• Assessment. By contacting the patient, they can determine the causal factor for regularly activating the 911 system. 
• Address. After listening to the patient’s issues, they can determine any fixes. Then, their team works to facilitate solutions. 
• Referral. If the patient qualifies, they will refer them to more regular primary care appointments or provide in-home treatment. 

With this system, Colorado has observed measurable improvements.

Below, you’ll find the numbers.  

Results from CSFD’s CARES

This section will highlight some of the direct results Colorado Springs has observed from implementing these programs. 

Here they are:

• Benefits of CRT: They saw an 85% reduction in ED visits within 30 days (of those enrolled). Also, before CRT, 98% of behavioral and psychiatric patients were transported to the ED. After implementation, they only transport 13% to the ER. 
• Benefits of CARES Super Utilizers Program: They’ve seen the overall ED and 911 usage decline 70% by those enrolled in the program – beating the goal of a 40% reduction. 
• Units Released. This term represents the number of units released to continue providing emergency coverage. In 2019, The CRT team allowed over 3500 units back into service for emergency coverage, 2906 PD units, and 674 FD units. 

If you’d like to read more about the Colorado Springs program and review some of the sources for this information, you can follow the link below. 

• 2019 Colorado Springs community and public health annual report.

Now for the key takeaway.

The Engine that Drives Community Paramedic Programs 

Professional providers are the driving force behind mobile-integrated healthcare and community paramedicine. Therefore, health and safety professionals must stay connected. 

“Look, listen, connect.” – that’s the slogan of the CSFD CARES team. 

Julota is here to help organizations connect. Using Julota’s software, programs like Colorado Springs Fire have maintained healthy connections. These relationships create opportunities for expansion, funding, and enhanced care. 

Contact Julota to see how their services will help you advance a strong community paramedic program.