For those who advocate Community EMS

[paramedicmike]

 

I am skeptical about the referral component of the idea, though. If, as has been talked about here, so many folks are incapable of understanding how to access health care specific to their needs apart from calling 911, I don't see how a visit from an ambulance crew is going to change that.

If appropriately staffed with a PA/NP level provider it'll be no different than people going to the ER for the same things they'd otherwise call 911.  If staffed simply with a paramedic or EMT crew then there could be problems.

In the ER there are more resources for referral available than what EMS providers have on the street.  Put an appropriately educated provider into these types of community programs with the resources that s/he would have available in the ER, I agree that PA/NP would be ideal for this, and not only could you decrease inappropriate access of the 911 system but also, potentially, of the ER as well.  This would likely be geographically dependent.  It would certainly be interesting to study.

Funding/billing would be difficult.  I'm way more expensive as a PA than I am as a paramedic.  To my knowledge (here in the States, anyway) CMS don't have a means to bill for these types of visits.  In other countries there may be different financial structures in place.

EMS provider education is a huge factor.  Paramedic educational programs are not geared towards, nor do they provide an adequate base for, this type of medicine.

[rock_shoes]

If appropriately staffed with a PA/NP level provider it'll be no different than people going to the ER for the same things they'd otherwise call 911.  If staffed simply with a paramedic or EMT crew then there could be problems.

In the ER there are more resources for referral available than what EMS providers have on the street.  Put an appropriately educated provider into these types of community programs with the resources that s/he would have available in the ER, I agree that PA/NP would be ideal for this, and not only could you decrease inappropriate access of the 911 system but also, potentially, of the ER as well.  This would likely be geographically dependent.  It would certainly be interesting to study.

Funding/billing would be difficult.  I'm way more expensive as a PA than I am as a paramedic.  To my knowledge (here in the States, anyway) CMS don't have a means to bill for these types of visits.  In other countries there may be different financial structures in place.

EMS provider education is a huge factor.  Paramedic educational programs are not geared towards, nor do they provide an adequate base for, this type of medicine.

This my friends is exactly what I'm getting on about with one small difference. I would advocate the development of a Paramedic Practitioner group along the lines of what has been done in the UK as opposed to a PA/NP model. It might seem far fetched state side were paramedic education varies wildly; in countries like Canada, Australia, New Zealand etc. where paramedic education involves a significant post secondary commitment, it's merely a natural progression of the profession.

Interestingly enough PA programs are just starting to come to life on the civillian side of things in Canada (currently there are two producing practitioners). Presently the overwhelming majority of accepted applicants are paramedics with a smattering of RN's and RT's tossed into the mix. I can't think of a better pool to draw from when implementing a pilot program.

[paramedicmike]

Interestingly enough I was one of two paramedics in my PA school class.  We had a few EMTs, one RT.  The traditional applicant used to be a military medic/corpsman.  That evolved into EMS providers.  Today, however, it's lots of younger folks with limited life experience.

I would love to see US EMS education mirror some of the educational programs in other countries.  PAs with a solid EMS background would be ideally suited for community EMS programs as well as more critical care based programs (e.g. ground or air critical care transport).  Unfortunately, that's not something we'll be getting anytime soon.

[Off Label]

Interestingly enough I was one of two paramedics in my PA school class.  We had a few EMTs, one RT.  The traditional applicant used to be a military medic/corpsman.  That evolved into EMS providers.  Today, however, it's lots of younger folks with limited life experience.

I would love to see US EMS education mirror some of the educational programs in other countries.  PAs with a solid EMS background would be ideally suited for community EMS programs as well as more critical care based programs (e.g. ground or air critical care transport).  Unfortunately, that's not something we'll be getting anytime soon.

A PA doing any kind of CCT would be overkill imho. Rural areas with > 1 hour transport  to a trauma center, cath lab, etc., that could make for an interesting bump in pre hospital care capability. But again, very impractical. In a big county there'd have to be a lot of PA's sitting around not doing anything if it were to make a real difference. There's a reason it doesn't happen that way now.