Advanced Practice Paramedic

[BAYAMedic]

I was very surprised to see some of the responses to this. Although I am in complete agreement that we shouldn't be doing nurse aid work in the field, I believe this program has some merit, as well as some steps in the right direction. Although I understand Dustdevils sentiments as us being EMERGENCY MEDICAL SERVICES, I have ran enough calls that fail to meet that as well. I prefer to embrace the concept of paramedic, as in the extra set of hands the doctor has out in the field. I didn't spend two years in school to earn a bigger paycheck ( if that was the case I would nave gone to nursing school), nor to get the privilege to perform the godlike still of intubation (insert angel chorus ), or to have a card that says I am smart enough to decide who gets what meds, I became a paramedic to provide a greater level of patient care to each and every patient I encounter. Not all paramedics operate in a system where those kind of care would be beneficial or appropriate, and no I don't think we should be home health nurses, but I can see where there is a place where a trained medical provider can do outreach and referral with a minimum amount of training. We recently had a thread on education and studying in our down time back at the dorms, and although self improvement is respectable, I got into this gig to help people and if I don't get to read up on the latest new England journal of medicine on this shift because I was out consulting brittle diabetic Mrs. Smith on her need to followup with her endocrineologist and diatition and setting those appointments for her, I will be happy catching up on that article on my next shift, rather than giving her her eighth amp of d50 this month.

Fireman1037

[rock_shoes]

If it's not an EMERGENCY, then it is not EMERGENCY MEDICAL SERVICE.

This is almost (but not quite) as bad an idea as sending firemonkey first responders to EMS runs. An unjustifiable deviation from the primary function that creates more problems than it even addresses.

It's more a deviation away from solely providing EMERGENCY MEDICAL SERVICES towards providing pre or out of hospital care. While I 100% agree that a program measured in hours (let alone a mere 300 hours) will be woefully inadequate, the concept of bringing back the house-call isn't necessarily bad.

The education required to do it successfully will drastically exceed current paramedic educational requirements. 300 hour patch jobs like this thing in Wake County could kill the concept before it has any chance of success.

[NYCEMS9115]

The APP appears to be similar to VNS (Visiting Nurse Services)...

[NYCEMS9115]

http://vnaa.org/vnaa/g/?h=HTML/AboutVNAA2

http://www.vnsny.org/

[chappy]

If we look at the role of a Paramedic strictly as Prehospital Emergency care, then the APP is stepping outside of the defined role. However, if the Paramedic is viewed as a skilled medical provider and a valuable resource in the chain of medical care, then there are plenty of roles for the Paramedic.

Essentially, the Paramedic operates under the direction of medical control or indirectly with standing orders, right?

With that in mind, what is wrong with a paradigm shift in the role of the Paramedic? Such a shift would allow the Paramedic, under the direction of medical control, to provide a vast and diverse service to the community. How many of us know (or, in my case, remember) regulars who, if there were some in-home followup, would not be regular users of EMS?

If it's not an EMERGENCY, then it is not EMERGENCY MEDICAL SERVICE.

So, are you saying that inter-hospital transports, convalescent transports, etc., are not EMS?

Don't misunderstand what I am saying. I am not recommending that line EMS units be scheduled to do home-health calls. However, why couldn't a licensed Paramedic, operating outside of the EMS system - perhaps as an extension of the local health department or county hospital, be allowed to make these types of calls? There are those who claim there is a shortage of nursing professionals. If so, using Paramedics in this role would provide more skilled providers, right?

[paramedicmike]

With that in mind, what is wrong with a paradigm shift in the role of the Paramedic? Such a shift would allow the Paramedic, under the direction of medical control, to provide a vast and diverse service to the community. How many of us know (or, in my case, remember) regulars who, if there were some in-home followup, would not be regular users of EMS?

In a word, education. Paramedics aren't adequately educated to do the job they do now much less the job of an "expanded role provider". Now, if you were to argue for a complete and total revamping of the paramedic educational process then perhaps you might be on to something.

Essentially, what I see you arguing for here could be handled by nurses.

So, are you saying that inter-hospital transports, convalescent transports, etc., are not EMS?

I can't speak for Dust but I believe he would answer this question with a resounding yes. At the very least, he has answered the same question previously with a resounding yes.

I agree with him, too. What you're describing in your question is NOT emergency medical services. It's transport medicine. They're not the same.

Don't misunderstand what I am saying. I am not recommending that line EMS units be scheduled to do home-health calls. However, why couldn't a licensed Paramedic, operating outside of the EMS system - perhaps as an extension of the local health department or county hospital, be allowed to make these types of calls? There are those who claim there is a shortage of nursing professionals. If so, using Paramedics in this role would provide more skilled providers, right?

You're mistaking paramedics for skilled providers. Sure, paramedics may think they have some skills. However, there are increasing studies that show that the skills many paramedics pride themselves on are not performed at nearly the level they should be. So if paramedics can't even do the fundamental skills for they job they're expected to do, they cannot reasonably be expected to do skills for which they haven't received education.

Which takes me, again, back to education. Fix paramedic education and everything else will fall into place. But if you're looking for home health care follow up then I think that would be better handled by nurses.

[tniuqs]

With that in mind, what is wrong with a paradigm shift in the role of the Paramedic? Such a shift would allow the Paramedic, under the direction of medical control, to provide a vast and diverse service to the community. How many of us know (or, in my case, remember) regulars who, if there were some in-home followup, would not be regular users of EMS?

What about a paradigm shift without direct medical control ?

[NYCEMS9115]

Don't misunderstand what I am saying. I am not recommending that line EMS units be scheduled to do home-health calls. However, why couldn't a licensed Paramedic, operating outside of the EMS system - perhaps as an extension of the local health department or county hospital, be allowed to make these types of calls? There are those who claim there is a shortage of nursing professionals. If so, using Paramedics in this role would provide more skilled providers, right?

In 2000, Lenox Hill used Paramedics in the ER as Triage. This Pilot Program didn't work well. The RN made a big issue and the Paramedics were no longer doing Triage after a year long project.

That is the problem with expanding the Role of the Paramedic. Other Healthcare Providers will intervene in this progression if it steps on their toes. Why aren't the Paramedics protesting Nurses on our "Rigs" and "Birds"? EMS is not Medicine or Healthcare in the eyes of laypersons and many Practitioners. It is our (EMS as a whole) fault. We do not petition, advocate, or educate our existence to people who are unaware we exist. This APP may not work in areas where VNA and VNS are relevant. EMS folks crack fun at Nurses but look how far they've progress and look how far we've gotten. Nurses has this voice that demands to be heard. They will wreck havoc if they are not heard. EMS must mirror the Progressions of Nursing... Of course these are my feelings and having others agree is not reason for the post...

[chappy]

I agree with him, too. What you're describing in your question is NOT emergency medical services. It's transport medicine. They're not the same.

I don't know that I could effectively argue with that point, nor do I want to. However, transport medicine is a valuable tool in the medical system.

You're mistaking paramedics for skilled providers. Sure, paramedics may think they have some skills. However, there are increasing studies that show that the skills many paramedics pride themselves on are not performed at nearly the level they should be. So if paramedics can't even do the fundamental skills for they job they're expected to do, they cannot reasonably be expected to do skills for which they haven't received education.

Supposedly, everyone wearing that NREMT-P patch has the same basic set of skills (or, at least they did at one point). But, we all know that any given skill will decay with lack of use. I think it is sad, almost comical, to see a low-volume unit pull on to a serious scene. Sure, the senior person on the truck has run the rescue squad for the last fifteen years. So, he is a seasoned medic, right? Nope. In all of his fifteen years, he's only seen one call like this one, and this one is it. Don't get me wrong, I am certainly not discounting the rural EMS units. They are extremely valuable. But, here is my point. Mike, you are exactly right in one point: there are many paramedics who have a patch and a card in their wallet which says they met some minimum core competency at some point in the past. That card and patch does not make a good paramedic. Perhaps a change in paradigm would offer some a chance to exercise their skills on a more frequent basis.

Edited May 31, 2011 by chappy

[paramedicmike]

I don't know that I could effectively argue with that point, nor do I want to. However, transport medicine is a valuable tool in the medical system.

Supposedly, everyone wearing that NREMT-P patch has the same basic set of skills (or, at least they did at one point). But, we all know that any given skill will decay with lack of use. I think it is sad, almost comical, to see a low-volume unit pull on to a serious scene. Sure, the senior person on the truck has run the rescue squad for the last fifteen years. So, he is a seasoned medic, right? Nope. In all of his fifteen years, he's only seen one call like this one, and this one is it. Don't get me wrong, I am certainly not discounting the rural EMS units. They are extremely valuable. But, here is my point. Mike, you are exactly right in one point: there are many paramedics who have a patch and a card in their wallet which says they met some minimum core competency at some point in the past. That card and patch does not make a good paramedic. Perhaps a change in paradigm would offer some a chance to exercise their skills on a more frequent basis.

Ok. Perhaps I didn't explain myself clearly enough.

It's not about skills. Skills have nothing to do with it.

It is education that's what important. Education is what is lacking from this entire thought process.