Paramedic Practitioner: Is this where we should be heading?

[Arctickat]

http://www.washingtonpost.com/national/health-science/nurses-can-practice-without-physician-supervision-in-many-states/2013/03/24/98b241cc-8745-11e2-999e-5f8e0410cb9d_print.html

[paramedicmike]

Hey Kat, look at the first post on page four of this discussion.

[Arctickat]

lol, shit, I thought today was the 24th and a fresh story....whoops.

[Bieber]

I said many. I did not say most.

Well without knowing what "many" is or proof that that unspecified "many" really do have EMS backgrounds...

I did a quick search to see if I could find information about PAs with and EMS background. My n=1 experience has shown that a surprising number of PAs I've met, worked with or went to school with had an EMS background. This is especially true in E-med settings. Unfortunately, I was not able to quickly find any specific numbers.

That's fair. But it also means that we can't really say PA's have any advantage to working in an EMS setting than any other health care provider.

True. But this will all be held back by the segment of EMS that wants to keep it simple. Specifically, fire departments who run EMS are the lobbying power here.

I agree. Which is all the more reason why we need EMS-based EMS. Not fire-based, not nursing-based, not PA-based. EMT's and paramedics whose only job is to provide out-of-hospital medical care. We will never be a profession as long as our job is a patch attached to some other industry's uniform.

Yes. I do. I think PAs are actually taught medicine. They're taught in a similar manner to physicians (which is entirely different from NPs and the nursing model of education). This is different from the vast majority of EMS providers who largely, even with the growth of college level programs, aren't taught much more than protocol based treatment with only a passing reference to pathophysiology.

I think that might be a bit of an overestimation (not much, but a bit). All the same, the solution you're suggesting is to eliminate EMS-based EMS and substitute it with PA-based EMS (to whatever degree), which does nothing to improve the EMT/paramedic side of the profession.

(Coincidentally, I think you and I, among some others here, tend to forget that at times because of our EMS educational foundation.)

True. Still, I'd rather see us elevate ourselves than call it quits, say we just can't do it, let's have someone better do it for us. We CAN be better, but it all starts and ends with not looking for reasons why we shouldn't elevate ourselves.

I agree in part. As we discussed, the current fee schedules and financial system as it relates to EMS barely supports the system as it exists. However, masters trained paramedic providers, depending on their local scope, could very much demand the same level of compensation as mid-levels. And they'd be foolish not to do so.

True, but they'd be foolish to lose their edge as well.

I don't know. The ability to pursue advanced education is there regardless of CMS scheduling. I managed to do it. I know a number of others who managed to do so with an EMS background. It's not necessarily the pay incentive. I think one of the biggest reasons EMS providers don't advance is that they get sucked into working more than one job to make ends meet and don't want to give that up to take out student loans to go back to school.

Really? That's sure what it sounds like with the idea of being able to refuse transport and refer to appropriate follow up care.

I would like to see EMS limited to true emergencies. I'd also argue that the patients EMS increasingly sees don't really need a whole lot of care. At least not from EMS providers.

That's true, but the point is not to take-over primary care, it's to give our patients what they need. If the greatest need for our patients was better specialist neuro care, I'd advocate us pursuing that route too; or if they truly had a greater need for emergency care.

To try and pull this back from money for a moment, I've said it before and I'll continue to say it. Education is the single biggest issue facing EMS today. Fix education and everything else will fall into place. Well, fix education and get buy in from all 50 states and fire based EMS and everything will fall into place.

I agree, though I think that fire will not buy into this as a whole.

That being said, EMS needs to focus on their introductory education before they can be focusing on advanced education. In the mean time, there already exists a provider level(s) that could appropriately fill this role of providing referrals or primary care if it's needed. And there are even models in other countries we could use as a basis for such a program in the States. Not if it's a mish-mash of inappropriate and undirected steps. That's a major cause of all the problems EMS has right now.

I also agree with that, but until we pilot these advanced educational programs and show that they are functional, useful and needed in EMS, we won't introduce them into the primary curriculum. Do you think that EMS systems are going to agree to an additional 6 months or more of education in community paramedicine or advanced practice until they see the dollar signs behind them? Much less the fire-based services.

[paramedicmike]

I'm not arguing for PA based EMS. I'm arguing that I don't think paramedics are suited for the role of a paramedic practitioner. I'm using PAs as the substitute here because they're established complete with formalized medical education. What's more, pilot programs or not, the educational foundation just isn't there for these programs to be functional in the long term.

And I hate to break it to you but EMS will ALWAYS be a patch attached to someone else's uniform. We work, and I really can't envision a US based EMS model that doesn't work, for a doc in the emergency room even to the exclusion of all other uniforms. Ideally, yes. I would love to see a system like what Carl talked about in the Netherlands or what the Aussies employ. But I just can't see that happening here in the States.

EMS is medicine. Unfortunately, there are too many other players involved who have successfully factionalized the industry. Short of scrapping the entire system and starting over it's just not going to happen.

[Bieber]

I'm not arguing for PA based EMS. I'm arguing that I don't think paramedics are suited for the role of a paramedic practitioner. I'm using PAs as the substitute here because they're established complete with formalized medical education. What's more, pilot programs or not, the educational foundation just isn't there for these programs to be functional in the long term.

Paramedics aren't suited for the role of paramedic practitioner... Hmm... Well, misnomers aside, I will agree with you that we're not there yet, but I still think that we should be the ones to do it. For the sake of our profession, if nothing else. As for the long-term future of these programs, that remains to be seen; thus far, they've been well received (at least in their current manner).

And I hate to break it to you but EMS will ALWAYS be a patch attached to someone else's uniform. We work, and I really can't envision a US based EMS model that doesn't work, for a doc in the emergency room even to the exclusion of all other uniforms. Ideally, yes. I would love to see a system like what Carl talked about in the Netherlands or what the Aussies employ. But I just can't see that happening here in the States.

EMS is medicine. Unfortunately, there are too many other players involved who have successfully factionalized the industry. Short of scrapping the entire system and starting over it's just not going to happen.

And it never will happen until we start making it happen. There are people willing to try and who are trying to unite EMS and to improve it and make it better, but what they need is for more EMT's and paramedics to join in their cause and to start supporting their growth. Things can get better, things WILL get better, but we have to make it happen. And that means pushing for EMS-based EMS, working to weaken the hold other professions have over us, and to evolve ourselves into providers worthy of all that. If you don't or can't believe in that that's fine, but I still do.

[paramedicmike]

Paramedics aren't suited for the role of paramedic practitioner... Hmm... Well, misnomers aside, I will agree with you that we're not there yet, but I still think that we should be the ones to do it. For the sake of our profession, if nothing else. As for the long-term future of these programs, that remains to be seen; thus far, they've been well received (at least in their current manner).

Nope. They aren't. And they won't be until the education system changes.

Besides, you want what's best for the patient. Does it really matter, then, who's providing the care so long as they're getting the care?

And it never will happen until we start making it happen. There are people willing to try and who are trying to unite EMS and to improve it and make it better, but what they need is for more EMT's and paramedics to join in their cause and to start supporting their growth. Things can get better, things WILL get better, but we have to make it happen. And that means pushing for EMS-based EMS, working to weaken the hold other professions have over us, and to evolve ourselves into providers worthy of all that. If you don't or can't believe in that that's fine, but I still do.

I'm curious. Who are these people? I have my own ideas. I'm interested in who you think they are.

[chbare]

I cannot fault the passion and desire to advance the profession. However, the greatest battles that are being fought revolve around minimal educational standards, pay and the formal establishment of the paramedic as an allied health professional. I cannot support taking steps to put forth a practitioner with a few hundred hours of training while neglecting the fundamental problems with EMS. This way of thinking is hurting nursing and I've seen two nursing programmes loose their NLNAC accreditation in the past year where I live due to several unresolved issues that are largely being neglected in part because of the focus on less fundamental issues. As an educator and provider who holds multiple degrees and licenses, my biggest goal is with trying to work on fundamental EMS issues. A paramedic practitioner is not on my list of issues that need to be resolved.

[runswithneedles]

Dont forget about CCEMT-P program. Though its not an additional license it is the highest level of certification aside from the National registry

[Bieber]

I cannot fault the passion and desire to advance the profession. However, the greatest battles that are being fought revolve around minimal educational standards, pay and the formal establishment of the paramedic as an allied health professional. I cannot support taking steps to put forth a practitioner with a few hundred hours of training while neglecting the fundamental problems with EMS. This way of thinking is hurting nursing and I've seen two nursing programmes loose their NLNAC accreditation in the past year where I live due to several unresolved issues that are largely being neglected in part because of the focus on less fundamental issues. As an educator and provider who holds multiple degrees and licenses, my biggest goal is with trying to work on fundamental EMS issues. A paramedic practitioner is not on my list of issues that need to be resolved.

It strikes me as odd that you see the two as mutually exclusive; that we cannot advance the profession in one way if the other battle is not yet one. Shall patients equally and ubiquitously, then, continue to suffer waiting for the whole to evolve? Should advances be withheld because of those services who refuse to advance? Don't get me wrong, I will continue to always fight for across-the-board increased in our educational levels, but I cannot accept withholding those paramedics and services that wish to advance because some would rather sit in stagnation.

Paramedic practitioners and community paramedics can and have done some real good. Look at MedStar, look at Wake County. If we wait for the whole of EMS to catch up to those places that are not content to sit idly by while patients suffer both in their health and in their bank accounts, then we will be waiting a long time. It is only when innovation surges, and when the possibility of a better future comes into view, that we realize our potential and begin to strive for greatness.

A paramedic practitioner or a community paramedic may not be on your list of issues that need to be resolved, but what about the gross misuse of ambulance and ER services for preventable conditions? Should we halt all efforts on that front because the fundamental education for EMS providers is in the shitter? Or should we let those who can, those who will, do what they can to improve conditions. It's not perfect, it never will be, and we should always work to better things, but if we refuse to fix the flat tire because the engine's not working as well as it should, all we're doing is making it harder on ourselves.

Withholding progress doesn't do a thing to establish ourselves as health professionals, and even if a bandage won't fix the entire problem, it's a step in the right direction. These are things which will be vital to the future of EMS and EMS education if we're to become a cost-effective, evidence-based and beneficial service.

Nope. They aren't. And they won't be until the education system changes.

Besides, you want what's best for the patient. Does it really matter, then, who's providing the care so long as they're getting the care?

I'm curious. Who are these people? I have my own ideas. I'm interested in who you think they are.

You're right, I do want what's best for the patient. And yes, it does matter who's providing the care. After all, PA's only came about because physicians were too few and too costly to fill all the gaps. Were that to change tomorrow, you would want to find a way to stay in business, wouldn't you?

As for the people I speak of, it's everyone who has a stake in bettering EMS, and everyone who has made efforts to try and improve EMS. The folks who have been pushing for community paramedicine, increasing our professionalism, degree requirements and opportunities, guidelines instead of protocols, evidence-based medicine--all of those things that are slowly but surely dragging us out of the dark ages and bringing us evermore closer toward being a true discipline and profession.