title: Prehospital Identification of Underlying Coronary Artery Disease by Community Paramedics.
abstract: There is a lack of definitive evidence that preventative, in-home medical care provided by highly trained community paramedics reduces acute health care utilization and improves the overall well-being of patients suffering from chronic diseases. The Expanding Paramedicine in the Community (EPIC) trial is a randomized controlled trial designed to investigate the use of community paramedics in chronic disease management (ClinicalTrials.gov ID: NCT02034045). This case of a patient randomized to the intervention arm of the EPIC study demonstrates how the added layer of frequent patient contact by community paramedics and real-time electronic medical record (EMR) correspondence between the paramedics, physicians and other involved practitioners prevented possible life-threatening complications. The visiting community paramedic deduced the need for an electrocardiogram, which prompted the primary care physician to order a stress test revealing abnormalities and thus a coronary artery bypass graft was performed without emergency procedures, unnecessary financial expenditure or further health degradation such as a myocardial infarction.
authors.forename: Martina
authors.initials: M
authors.lastname: Heinelt
authors.forename: Ian R
authors.initials: IR
authors.lastname: Drennan
authors.forename: Jinbaek
authors.initials: J
authors.lastname: Kim
authors.forename: Steven
authors.initials: S
authors.lastname: Lucas
authors.forename: Kyle
authors.initials: K
authors.lastname: Grant
authors.forename: Chris
authors.initials: C
authors.lastname: Spearen
authors.forename: Walter
authors.initials: W
authors.lastname: Tavares
authors.forename: Lina
authors.initials: L
authors.lastname: Al-Imari
authors.forename: Jane
authors.initials: J
authors.lastname: Philpott
authors.forename: Paul
authors.initials: P
authors.lastname: Hoogeveen
authors.forename: Laurie J
authors.initials: LJ
authors.lastname: Morrison
mesh_terms: D000488:Allied Health Personnel / Q000458:organization & administration*; D002170:Canada; D002637:Chest Pain / Q000175:diagnosis / Q000209:etiology; D003153:Community Health Services / Q000458:organization & administration*; D001026:Coronary Artery Bypass / Q000379:methods*; D003324:Coronary Artery Disease / Q000175:diagnosis* / Q000601:surgery; D004562:Electrocardiography / Q000379:methods*; D004632:Emergency Medical Services / Q000379:methods; D005080:Exercise Test / Q000379:methods; D005194:Family Practice / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D020380:Needs Assessment; D011315:Preventive Medicine / Q000458:organization & administration; D012008:Recurrence; D012307:Risk Factors; D012720:Severity of Illness Index
keywords: Community paramedicine; chronic care model; coronary artery bypass graft; electronic medical record; out-of-hospital care