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Q&A: Creating a healthier, safer community with fire-based MIH-CP

Chief Porter R. Welch shares factors to consider before and while implementing a MIH-CP program


This feature is part of our special coverage series; Diffusing Community Paramedicine, which explores how mobile integrated healthcare programs are overcoming the barriers to CP to reduce non-emergent EMS transports, lower admissions and provide appropriate levels of care.

Community paramedicine-mobile integrated healthcare is growing as a service line as resistance from external stakeholders decreases, according to results from the 2017 NAEMT MIH-CP Survey.

As chair of the Ohio Fire Chiefs’ Association MIHC Committee, Porter R. Welch, JD, OFE, OFC, chief of the Scioto Township (OH) Fire Department, has helped draft and adopt legislation that permitted community paramedicine in Ohio. Chief Welch is past-president of the Ohio Fire Chiefs’ Association and general counsel to the Ohio State Firefighters’ Association.

FireRescue1 spoke with Welch, a member of the IAFC’s PPACA and MIH Task Forces, about his experiences diffusing community paramedicine and mobile integrated healthcare at the state and national level.

Chief Welch has helped draft and adopt legislation that permitted community paramedicine in Ohio. (Photo/Scioto Township Fire Dept.)
Chief Welch has helped draft and adopt legislation that permitted community paramedicine in Ohio. (Photo/Scioto Township Fire Dept.)

FireRescue1: How is current-day legislation impacting the diffusion of community paramedicine?

Chief Porter Welch: I believe the biggest impact current legislation has on mobile integrated healthcare and community paramedicine is in two areas:

  1. Current private pay and government insurance programs are not set up to fund MIH programs.
  2. Current liability and medical control laws do not always allow “treat and release” or non-traditional treatment scenarios that are part of mobile integrated healthcare.

How does mobile integrated healthcare impact community health?

The impact of mobile integrated healthcare or community paramedicine varies based on the community and the type of program implemented. Overall, I believe CP and MIH definitely make a community healthier and safer.

What tools have the Ohio Fire Chief’s Association MIH Committee identified to help members implement MIH programs in their communities?

The Ohio Fire Chiefs’ Association has created a committee to facilitate representation of fire chiefs on the issue of mobile integrated healthcare. We’ve been active at the Ohio State House working to get the enabling legislation passed and at the Ohio Division of EMS ensuring relevant rules are adopted with respect to MIH. We’ve also provided instructional opportunities at our annual conference to help fire chiefs understand the issues and make informed decisions regarding MIH.

What factors should be evaluated before implementing a MIH program to ensure it will impact care?

Agencies looking to implement CP-MIH initiatives should evaluate the following factors to ensure impact:

  1. What are the healthcare and/or service gaps in the community?
  2. Can mobile integrated healthcare initiatives fill the gaps identified in the community?
  3. Can the local agency provide the service(s) to fill those gaps?
  4. What is the cost to the agency and/or the community to fill those gaps?
  5. What equipment, education, training, processes/procedures are necessary to fill the gaps?
  6. What funding sources are available to sustain a community paramedicine program?

How is the IAFC ACA Task Force helping to grow community paramedicine?

The Task Force produced an electronic book that is essentially a handbook providing information and resources for fire chiefs who are considering adding a mobile integrated healthcare program to their department. This handbook provides information on MIH programs and discusses how to decide when it is appropriate to implement an MIH program.

How can agencies collaborate across public safety disciplines to adopt MIH initiatives?

There are communities that have partnered between law enforcement, community paramedics and rehabilitation services to help heroin addicts get immediate treatment rather than being sent to jail. There are some anecdotal reports of success here in Central Ohio with this program.

What are your top tips for agencies looking to implement community paramedicine programs?

My top three tips are the following:

  1. Survey and/or talk with your community members and partners about what they need – do not try to repeat services already provided.
  2. Do not expect to make money at it or find an immediate funding source.
  3. Take your time and analyze the situation – mobile integrated healthcare and community paramedicine are business initiatives and need to be treated as such.

Is community paramedicine diffusing fast enough to improve prehospital care?

I don’t think improving prehospital care is necessarily the end goal. Mobile integrated healthcare and community paramedicine are fulfilling an unmet need within the community. For my community that may mean providing indigent primary care services, while for my neighboring department that may mean implementing a congestive heart failure program and for the city down the road it may be focusing on heroin interdiction. These systems would all improve the health and well-being of our communities, but not necessarily in the traditional sense of prehospital care.

An organization needs to be strategic about what it does in terms of community paramedicine or mobile integrated healthcare. What works for my department will probably not work for my neighboring department.

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