Geisel students work to increase rural access to healthcare with paramedicine

by Gigi Grigorian | 4/18/18 2:00am

Geisel School of Medicine students Nick Valentini '13 MED’20 and Karissa LeClair MED’20 launched a paramedicine program that partners medical students with local paramedics and emergency medical technicians to provide primary care service for residents in the Upper Valley, the first of its kind in New Hampshire. The program serves individuals who have specific illnesses that require medical attention but do not necessitate emergency hospital treatment.

Currently, the program operates in Orford and Piermont, serving 12 patients who are being treated by primary care providers at Dartmouth-Hitchcock Lyme clinic, Valentini said.

According to Valentini and LeClair, the program began as a way to fill what they perceived as a gap in the rural healthcare system and provide preventative care to patients in their homes. For many patients in the Upper Valley, visiting their primary care providers poses a significant obstacle to proper care because it can take more than 40 minutes to physically get to their appointments, LeClair said. She noted that this issue is not specific to the Upper Valley, but applies to any rural community. The pair began planning their project in the fall of 2016, when Valentini and LeClair were both selected for the Geisel’s Pano Rodis Fellowship, an eight-month fellowship for first-year Geisel students to design and launch a project in compassion-centered medical care.

Before coming to Geisel, both Valentini and LeClair worked as EMTs in New England, and their experiences in these jobs influenced their decision to launch their program in the Upper Valley. As an EMT, Valentini observed that some patients would call daily with health issues that did not require emergency treatment. Often, patients do not need hospital care, but the only resource that EMTs can offer is transport to an emergency department, he said.

According to LeClair, these repeated 911 calls and emergency transports for non-emergency health issues pose a significant financial burden to the healthcare system. Thus, the pair’s program aims to improve patients’ health and living conditions as well as reduce pressure on healthcare systems, LeClair said.

“We’re trying to fill a gap that we noticed in the healthcare system between patients who might require visiting nurses and more intense daily care and patients who could be totally self-sufficient,” Valentini said. “There’s a big gray area in the middle of people who could benefit from once or twice per week check-ins, or who might not be able to make it to their primary care office for visits, so we can send people out to them.”

The extent of care provided by the community paramedics varies with each patient’s needs, Valentini said. Sometimes, primary care providers will request that community paramedics check one specific concern that, while urgent, does not require emergency treatment. On the other hand, for patients with chronic illnesses, paramedics monitor ongoing problems with weekly or biweekly visits, Valentini added.

“The ability to monitor patients with severe chronic health problems helps keep them as healthy as possible and out of the hospital,” said Clay Odell, executive director of Upper Valley Ambulance, an ambulance service that serves several New Hampshire and Vermont towns in the Upper Valley.

Odell said that the program serves as “a partnership between the EMS service and a primary care practice.” Valentini and LeClair worked closely with Odell to obtain the proper licenses to operate the paramedicine program in conjunction with existing services provided by Upper Valley Ambulance.

Valentini and LeClair also worked with Cheri Mather, a physician at Dartmouth-Hitchcock Lyme clinic, and Thomas Trimarco, the EMS medical director for Dartmouth-Hitchcock Medical Center and an assistant professor of medicine at Geisel, to obtain licenses to run the project in the state of New Hampshire. Mather and Trimarco serve as community medical director and an emergency medical director for the program, respectively. According to Valentini, Mather and other physicians at the Lyme Clinic have identified and recommended patients who would benefit from community paramedicine check-ins to participate in the program.

This past winter, Valentini and LeClair also established an elective course at Geisel in which medical students care for the patients involved in the program. This year, eight students enrolled in the elective, Valentini said.

In the future, Valentini and LeClair said they hope to continue to expand the program both by recruiting more medical students to serve in it and by expanding to more towns in New Hampshire and Vermont.

Correction appended (April 18, 2018): This article has been updated to include Nick Valentini '13 MED'20's undergraduate class year.