Would love to see this in the US....

[mobey]

That too...

Being unemployed is starting to really hurt.

Come on over my friends, We just hired a PCP from Ont to come work here starting Feb 1st.

Like he said to me... ``the pay may be lower, but the scope of practice is wider and I can find a frickin job`` (Like I say PCP level)

[spenac]

It sounds like we are getting closer and closer to putting PAs in the field. Why not?

We already have PA's in the field we call them EMT's. :shock: :twisted:

PA= Paramedic Assistant

[JPINFV]

We already have PA's in the field we call them EMT's. :shock: :twisted:

PA= Paramedic Assistant

Naw, that's "Paramedic Associate." 8)

http://paprogram.med.yale.edu/

[usmc_chris]

Hi, I'm new here, and have been monitoring the forums for a while, but decided to jump in on this one. In my region, they have already implemented something like this. Unfortunately, the program was abruptly terminated, I believe due to a lack of funding. Under the "Alternative Destination" pilot project, ALS providers could, with an online med control consult, decide to transport certain patients that had been EMD coded as low-priority, and assessed to have no priority symptoms, to designated urgent care facilities rather than emergency departments. It was a neat concept and it's a disappointment to see it go.

[JPINFV]

Just curious, what sort of funding was needed for that program?

[usmc_chris]

To be perfectly honest, I don't know. There was an announcement a few months that the pilot program was being terminated, and the REMAC has since removed all references to the program from its website with the exception of monthly meeting minutes. I can't even find the justification for ending the program anymore, that is what I vaguely remember as their reason. I suspect much of the reason had to do with under-utilization of the program for three reasons:

1) Laziness/apathy of some ALS providers - under the protocol, transportation to the alternative destination required the ALS provider to tech the call. Providers would say, hey, if we go to the hospital, it's BLS, and I can get my EMT partner to write the chart. So that's easier, especially on a day when you've had a lot of ALS calls.

2) Attitude of urgent care facilities. The only urgent care facility I have any experience with is also our local psych hospital, and they're not too keen on receiving psych patients by ambulance, let alone low-acuity medical patients. My best guess is they took in the patient, then called one of the commercial services to take the patient to their partnering medical hospital anyways. (We have two large commercial agencies, who do all transfers and a majority of 911 calls in the county - and these were the only two agencies participating in the pilot anyways - why take somebody to the urgent care, then turn around and take them to the hospital, when you could just take them to the hospital in the first place?)

3) I'm not sure, but I would suspect insurance compensation for ambulance transport to an urgent care is somewhat lower than to a regular hospital. Some agencies would not want to utilize the program for this reason.

So, my assumption is the justification given may have been more of a "keep the peace" PC excuse rather than a legitimate explanation for the failure of the program. That being said, there could have been legitimate funding issues, but I simply don't know what they would be.

[Doczilla]

It sounds like we are getting closer and closer to putting PAs in the field. Why not?

I'd rather put a PA in triage. We'd have a much larger impact on the volume and throughput of an ED. At least, I think so.

I think that an extended care paramedic would be useful in certain situations, but really, how many calls are we talking here? What volume of patients would not still require a trip to the ED? Would we really impact ER wait times that much? Add in the extra training, certification, oversight, etc., is this worth it for a 911 provider? And if they are providing this advanced care, would this lengthen or shorten on scene times and overall call duration? (factoring in the amount of time the medics have to wait at the ED with the patient to get a bed)

In my ER, ambulances pile on patients when things are already difficult, but the EMS patients are not the cause of our overcrowding. Our real crush comes walking (or dragged) in through triage. While having a medic that is able to divert some of this in the field seems appetizing, think of the additional burden on the EMS system. The "urgent care" type of patients are many, and urgent care docs see up to 60 of them in a shift. In our "less acute" station, I will see 40 in conjunction with a PA, and that's at a really good clip (most ER patients, I average 3/hour. In that station, I'll average 5/hour). Factoring in response times (longer, since you wouldn't want to go to these with lights and sirens) and scene times, as well as paperwork, I don't really see them seeing more than 1-1.5/hour, and that would be if they stacked up in the call que and ensure a steady volume. This will be less with the natural ebb and flow of patient call volume. I don't think having extended care paramedics treat some of these in the field will impact the volume we see significantly, at least, not in a typical 911 system. In a very remote setting, where transport times are very long and volume is low and one call can rob an area of an ambulance for quite a while, there is potentially more benefit.

'zilla

[Dustdevil]

Just curious, what sort of funding was needed for that program?

Money for the extra liability insurance for when they inevitably fark it up and kill someone.