Last week, some folks received a visit from Miami Township Fire-Rescue’s newest hire, who brought with her not a fire hose, but a wide array of health and safety information and community and area resources.

Steffinie Brewer began work late last year as MTFR’s first community paramedic, a position Fire Chief James Cannell pitched to Township Trustees as a prevention-focused complement to the department’s ongoing emergency response work. Trustees approved Brewer’s hiring in December; her role officially began Dec. 27, and the new program launched Thursday, Feb. 19.

Brewer has been in EMS work for nearly five years, beginning with an EMT class in high school before becoming a paramedic. She has worked in Harrison Township in Montgomery County and Union Township in Miami County, and serves on the Greater Miami Valley EMS Council. Speaking with the News this week, she said she’s also one of only a few dozen in the state to hold licensure in community paramedicine.

Brewer credited a family connection with bringing her to Yellow Springs: her brothers, Casey and Cassady Brewer, are firefighter/EMTs for MTFR, and she said it was the latter brother who suggested to her and to Cannell that she would be a good fit.

Since taking the job, Brewer said she has been laying the groundwork for a program that operates outside the traditional emergency system, visiting residents in their homes to identify risks before they become emergencies and connecting people to needed services.

MTFR Community Paramedic Steffinie Brewer (Photo courtesy of Miami Township Fire-Rescue)

“Community paramedicine can be very broad,” Brewer said, describing a field that can range from providing help navigating social services to intensive medical monitoring at home. MTFR is starting with what Brewer called “the more social services aspect,” with hopes of expanding as the program grows.

Community paramedicine programs are becoming more common in the Miami Valley: The Dayton Fire Department has partnered with Premier Health to offer community paramedicine, and late last year, the City of Xenia authorized a one-year community paramedicine pilot within Xenia Fire & EMS, which will include home visits, medication reviews, safety assessments and partnerships with health and social service agencies.

Here in Miami Township, Brewer said, one big local focus is on falls, to which MTFR crews routinely respond with “lift assists.”

“Lift assist is one of our number one nonremoval calls,” Brewer said, referring to calls where MTFR doesn’t transport a patient to a medical facility.

Looking through the department’s reports, she said, one resident called for lift assistance “over 20” times in the past year. Sometimes, she added, lift assists are provided for folks who haven’t fallen, but who otherwise need help getting up or even out of a vehicle.

Those calls are a prime example, Brewer said, of how community paramedicine can be of use: identifying why someone is falling and what supports could be added to the home to reduce the risk of injury.

“Falls can be detrimental to the elderly, so we’re trying to prevent that as best as possible,” Brewer said, adding that the Greene County Council on Aging and CareSource offer free installation of “grab bars” — safety handles used to pull oneself up — for those who qualify.

Brewer said much of the community paramedic job is connecting people with “the right resources,” like those grab bars, and helping residents learn what help is already available. Thus far, MTFR has identified about 20 potential clients and has begun enrolling and working with a small number of initial participants.

She noted that community paramedicine has some of its roots in emergency response to calls related to congestive heart failure. Data collected by emergency services agencies nationwide since the early 2000s found that patients with congestive heart failure were frequently readmitted to hospitals within 30 days of initial treatment. As a result, Brewer said, programming was built up to enable paramedics to help those patients by administering medicine and education on how to manage congestive heart failure, as well as follow-up visits to check in and make sure management was going smoothly.   

“The goal was to decrease unnecessary trips to the hospital,  because it’s expensive — and nobody likes to go to the hospital if they don’t have to,” Brewer said.

A few national studies within the last several years support the success of the model: peer-reviewed evaluations summarized by the National Institutes of Health and the Rural Health Information Hub have reported drops in readmission rates by 30% or more within 30 days for patients participating in community paramedicine programs.

Brewer noted that the Ohio Legislature is currently weighing Senate Bill 220, which would encode community paramedicine programs in state law and require insurance coverage for services provided under those programs.

She said she believes the passage of the bill would be a boon for community paramedicine programs, particularly with regard to funding via insurance; presently, most programs offer their services for free. MTFR’s “Community Paramedicine” page lists its offerings as including in-home assessments, medication reviews, fall risk evaluations, post-hospital follow-ups and help connecting to medical and social supports, most of which are offered at no cost.

Brewer said she’s modeled MTFR’s up-and-coming program in part on established community paramedicine operations in Trotwood, Montgomery County; and Violet Township, Fairfield County, where programs also emphasize proactive outreach and follow-up. Sustained contact and relationship-building, she said, is a foundational part of community paramedicine.

“As much as I love the fast-paced aspect of EMS … I’ve also come to realize in my career that we don’t make that much of an impact just doing 911 calls,” she said. “I’ve really grown to appreciate the aspect of community paramedicine where you foster relationships and you see the same people over and over, and it’s more possible to really change their life for the better.”

That relationship-building is also where MTFR’s new program overlaps with the YS Police Department’s community outreach specialists, Florence Randolph and Danny Steck. As the News reported last year, the pair connect residents and visitors to food, housing, transportation and other supports.

Brewer said Randolph and Steck have already helped MTFR overcome some barriers for participants in the community paramedicine program. In one case, Brewer said, a resident needed help reaching a nursing home more than an hour away; she called Steck, who found an option within minutes.

“We’re going to have every-other-month meetings to integrate [our services], so that way we know who’s receiving what, and we don’t double up or miss anyone,” Brewer said.

The community paramedicine and community outreach specialists also recently began a joint wellness check program, “Safe at Home.” The program offers scheduled weekly calls, as well as calls before forecasted severe weather, to at-risk residents within Yellow Springs, Clifton and the unincorporated areas of Miami Township.

Brewer said the community paramedicine program is also looking at ways to reach residents who don’t have a permanent address. She pointed to MTFR’s in-station exam room, a small clinical space the department may use to visit with community members who are unhoused or transient.

“We have been exploring that as an option,” Brewer said, adding that the room also offers a place for a “quick exam” for potential walk-in patients with minor injuries.

She said good candidates for the local community paramedicine program include older adults who fall frequently, as well as those struggling with mobility, medication compliance, chronic disease management, hoarding, food insecurity, housing insecurity or unsafe home conditions. She added that new parents are on her radar, too.

“In the last week, we’ve responded to two calls from people in active labor,” she said. “I’m hoping to reach out after they settle in at home and make sure they have everything they need for their babies, educate them on safe sleep and just make sure mom and baby stay safe, healthy and happy.”

Referrals to MTFR’s community paramedicine program can come from family members, neighbors, caregivers, hospitals, social service agencies or residents themselves. At present, Brewer said the community paramedicine program does not offer mental health services — the Village’s community outreach specialists do offer such resources, she said — but said MTFR may include such services as the program grows.

And she said she’s optimistic that it will, indeed, grow.

“I truly believe that if a program like this is going to succeed, it’s going to succeed in a community like this,” she said. “This is such an involved community, and people care about their neighbors.”

For more information on MTFR’s community paramedicine program, to make a referral or to be added to the “Safe at Home” call list, go to http://www.mtfr.org; email communityparamedic@mtfr.org; or call 937-767-7842, ext. 4. Program hours are Monday--Friday, 7 a.m.--7 p.m., excluding major holidays.