Bobby Bell (center) has been on the Community Care Paramedic Program for a year. He said Lt. Chad Robinson (left) and Sgt. Courtney Setzer have helped him turn a corner to a healthier lifestyle.

Not only does McDowell County EMS respond to emergencies, they also have a program that works on preventing them.

In 2013, McDowell EMS was one of only three programs in North Carolina and the first agency in a rural county approved for funding for a Community Care Paramedic Program. At the time, there were 250 such programs across the nation.

“McDowell EMS is an outstanding agency, especially to be rural,” said Regina Crawford, the retired chief of the N.C. Office of EMS (OEMS), who has worked with the local agency on inspections and other matters since 1993. “They are one of the hardest-working systems in the state. (Emergency Services Director) William Kehler sets the bar very high, and what he does is phenomenal. Being one of the first systems funded for a Community Care Paramedic Program was phenomenal.”

Chuck Lewis is the current assistant chief with OEMS. He’s been working with Kehler and crew since 2004, approving and licensing employees, inspecting vehicles and reviewing plans, protocols, policies and procedures.

“McDowell EMS is a very progressive agency, a leader to others in the state,” Lewis stated. “They have a very robust system, and I contribute that to William. He has done a lot to advance things. Rural communities often become stagnant. McDowell EMS is not that way. The EMS staff should be commended for their hard work, but none if it can be done without great leadership.”

Funded by Healthy Places NC, which is an initiative of the Kate B. Reynolds Charitable Trust, the program has three main objectives:

 Assist high utilizers of Emergency Medical Services and emergency room services in transitioning to primary care physicians, to obtain care for non-emergent issues, freeing up resources for acute emergencies. Lt. Chad Robinson and Sgt. Courtney Setzer, both community paramedics, work daily with elderly and at-risk patients to connect them with community resources that can help improve their quality of life. Community Care paramedics work directly with the patient, their family and other care providers within the community to ensure coordinated care is being delivered.

 Work in partnership with McDowell Hospital to provide follow-up care to patients being discharged home who are at high risk of being readmitted. Some patients are not eligible for home health after being discharged. This is where the Community Care Paramedic Program serves to bridge this gap.

 Conduct wellness events within the community to raise awareness of uncontrolled high blood pressure, diabetes and other conditions. Partnering with a number of healthcare providers, community paramedics work within the heart of each community to improve overall health and wellness.

“McDowell EMS community paramedics work closely with various community partners to ensure we take a holistic approach to meet the individual needs of each patient,” said Kehler. “This non-traditional service has proven extremely effective by establishing patients with a primary care home, reducing the number of EMS transports and non-emergent visits to local ERs. Through strong partnerships with community agencies, the Rural Community Care Paramedic Program will continue to enhance the level of service provided to our patients.”

In 2016, the program was selected as a pilot site for behavioral health diversions. When available, community paramedics respond to all behavioral health emergencies in McDowell and utilize a rigorous medical clearance screening protocol. Patients suffering a mental health emergency need immediate treatment by a professional mental health clinician. The program provides alternative destination transport to a behavioral health clinic for patients meeting specific criteria.

As of today, Robinson and Setzer have 58 patients ranging in age from 18 to early 90s. The number of patients has been as high as 103, but they say many have advanced so well that they are now able to do more things independently and could be removed from the program. Most are elderly and most live alone, but there are no age criteria. It all depends on need, and patients can be referred by EMS, family members, DSS, doctors’ offices or hospitals.

3-year cost savings


Total preventions

1,154 EMS/emergency room visits

79 hospital re-admits

48 behavior health diversions (taken to behavioral health facilities instead of the emergency room)


1,360 wellness visits

158 EMS transports

57 public assists

110 phone follow-ups


63 primary care referrals

12 fall preventions

16 DSS transportation

22 medication assistance

31 mental health referral

7 DSS adult services

17 food pantry

10 pharmacy pickup

9 DSS food stamps

Others include: cooling and heating assistance, clothing center, counseling, dental, DSS Housing Coalition, Meals on Wheels and occupational, physical and speech therapy.