(a) The Guam EMS Commission and the Office of EMS, in coordination with the Guam Fire Department and other government of Guam agencies, shall establish a Community Paramedic Outreach Program (CPOP) as part of the EMS Comprehensive Plan established in § 84105 of this Chapter no later than October 1, 2020.

(b) The Guam EMS Commission and Office of EMS shall develop, no later than October 1, 2020, the scope of care, training requirements and initial certification requirements for the CPOP. It is understood that the training required to achieve full NEMT EMT-O certification will take time to develop. Therefore, the initial phase of the CPOP may be limited to a visitation program utilizing current scope of care criteria. Full certification criteria will not preclude the development and implementation of the initial CPOP.

(c) The Chief of the Guam Fire Department or designated representative, working with the EMS Commission and Office of EMS, and local civilian, public, and military hospitals, shall develop a process of identifying patients discharged from the hospital that request participation in the CPOP. This process will become part of the comprehensive EMS plan and subject to the CPOP.

(d) The Chief of the Guam Fire Department or designated representative, working with the EMS Commission and Office of EMS, shall work with the Mayors Council of Guam to establish a process in identifying village residents that would like to participate and will benefit in the CPOP.

(e) The Chief of the Guam Fire Department or designated representative, working with the EMS Commission and Office of EMS, shall work with local health care providers on Guam to establish a process in identifying village residents that would like to participate and will benefit in the CPOP.

(f) Prospective EMT participants in the CPOP shall attend a culturally and linguistically appropriate services (CLAS)

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training conducted by the Guam Office of Minority Health, DPHSS, prior to initiation of outreach services.

(g) The Chief of the Guam Fire Department or designated representative, working with the EMS Commission and Office of EMS, shall develop reporting criteria for the management of the CPOP. At a minimum, the reports shall include the number of residents who have used program services, and the types of program services used, as a measurement of any reduction in the use of the 911 systems for nonemergency, non-urgent medical assistance by residents. Reports shall not include any personally identifiable information concerning a resident in the program.

(h) On or before March 31 of each year after the establishment of the CPOP, the Guam Fire Department, in coordination with the Office of EMS, shall compile annual reports in the previous year into a single report and post it on its website.

(i) The Guam Community College School of Allied Health, the Guam Fire Department, the University of Guam, and other EMS training service providers approved by the DPHSS Office of EMS, shall provide training courses in community paramedic and are subject to the provisions of § 84110 of this Chapter.

(j) The CPOP shall strive to incorporate concepts of the Primary Care Medical Home model of extending the care provided by a patient’s primary care provider. This can be achieved in many different manners:

(1) linking patients with primary care providers;

(2) future innovations may include linking EMT-Os in
the patient’s overall care plan developed by the PCP; and

(3) it is not the intent of the CPOP to be a patient’s
medical home.

(k) Use of the CPOP should be a part of the patient’s care plan ordered by the primary care provider in consultation with the medical director of the EMS.

(l) The CPOP shall augment and integrate with other services such as home health care and community nursing programs. The CPOP is not a home health nursing service and as

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such is not subject to home health licensure or other home health regulatory requirements.

(m) EMT-Os, working under the physician’s direction and approved patient care protocols to ensure patient safety, shall work with recently discharged patients. During downtime, the EMT-O will follow up on healthcare provider referrals in the patient’s home; and

(1) must be currently certified as an EMT;

(2) must successfully complete training prescribed by the EMS Commission; and

(3) must comply with the defined scope of care set by the EMS Commission or as described in the PCP care plan.

(n) Scope of care may include: (1) Assessments:
(A) checking vital signs;

(B) blood pressure screening and monitoring; (C) prescription drug compliance monitoring;
(D) assessing patient safety risks (e.g., risk for falling); and

(E) home safety checks. (2) Treatment/Intervention:
(A) breathing treatments;

(B) providing wound care, changing dressings; (C) patient education; and
(D) intravenous monitoring. (3) Referrals:
(A) mental health and substance use disorder referrals;

(B) social services referrals;

(C) collaboration with the DPHSS programs; and

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(D) referral recommendation to higher levels of nursing care.

(o) Training coursework of the EMT-O may include: (1) social determinants of health;
(2) illness preventions;

(3) advanced wound care; (4) health promotion;
(5) risk assessment; and

(6) community resource availability.

(p) Patient eligibility for the CPOP should be liberal but at a minimum should include:

(1) recently discharged patients;

(2) high utilizers of 911 services, defined as individuals who have received ED services three (3) or more times in a period of four (4) consecutive months in the past twelve (12) months;

(3) patients identified by the individual PCP for whom CPOP services would likely prevent admission to or would likely prevent readmission to a hospital or nursing facility;

(4) residents identified by a Mayor for whom CPOP services would likely prevent admission to or would likely prevent readmission to a hospital or nursing facility; and

(5) residents identified by social service agencies for which CPOP services would likely prevent admission to or would likely prevent readmission to a hospital or nursing facility.

(q) Coordination.

(1) Services provided by the CPOP to an eligible resident who is also receiving care coordination services must be in consultation with providers or the resident’s care coordination service.

(2) The care plan or services rendered by the CPOP

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should not duplicate services already provided to the patient, including home health services.

(3) The CPOP should also coordinate with other visitation to the patient, to include mayoral, clergy, or other non-profit organizations to the satisfaction of the patient.

SOURCE: Added by P.L. 34-168:14 (Dec. 29, 2018).