Is There a Need for the Advanced Practice Paramedic?

[UMSTUDENT]

When voting in this poll please only vote if you can contribute with a response. I want serious answers as to why or why not.

A recent post sparked my interest in this thread. Apparently there are several jurisdictions across the United States that are toying with this idea, including several states that are seeking approval from their relevant State Medical Boards to begin implementing paramedics with expanded "critical" and "primary" care roles. I find this interesting after the idea was so quickly shot down in the first round of discussions regarding the new National Scope of Practice Model.

I personally, as some of the regulars here know, believe this is the future of our profession. I thought it was at least 5-10 years away, but apparently there are some progressive jurisdictions who are starting to seriously consider the concept even earlier. For those who are not familiar, our British cousins have already developed such a program in the form of their Emergency Care Practitioner.

References:

http://www.gatheringofeagles.us/Presentati...20EaglesAPP.pdf

http://www.wakeems.com/blog/?p=57

[Dustdevil]

Well, you said not to vote unless we post, but is it okay to post without voting?

I'm not quite ready to vote, because I don't think that "Advanced Practice Paramedic" is well defined yet. The Wake County definition differs significantly from others I have heard proposed. When I think of the APP, I generally picture the "Poor Man's PA" that many propose, not just a super field medic.

Generally, I am not a proponent of either role. Every paramedic should be educated to the level that Wake County proposes. And we have no business involving EMS in home health functions like oxygen delivery, medical and social referrals, and vaccinations. Apparently, the idiot who designed the Wake County model forgot to take his own advice, which is to not dilute the paramedic's role and experience, because that is exactly what he is proposing. If we start trying to be all things to all people, we dilute our core strength. Do one thing and do it well. If it is not an emergency, then it is none of our business. Without E, there is no EMS.

I feel the same way about the clinical model of the APP, which many propose to be the "Poor Man's PA", to do PA type work. I am against it. There is are already two career paths that address that need. There is no need to re-invent the wheel. And if we start moving in on the turf of other professions, we will only increase the hostility we already encounter from those groups, which is not a positive thing for EMS.

I do feel there is a potential for advanced paramedic scopes in some rural systems. However, it would not be anything like what Wake County proposes. And Wake County and Houston are far from rural. There is really nothing "advanced" about the practice that Wake County proposes. Every medic should be educated to that level. So what they are doing is not creating advanced paramedics. They are simply dumbing down and restricting all the other medics to make the selected few medics appear "advanced". And anytime people start using that kind of smoke and mirrors in their plan, it becomes immediately suspect and dubious.

[chbare]

Just read through the links and agree with Dustdevil. From what I gather, they want to have "APP's" perform risky modalities? They are assigned to an area and respond to calls where such modalities may be utilized? However, from what I can gather, they do not appear to have any more of an advanced scope of practice than many other systems.

I fail to see how such a system could work. I suspect this could create confusion and potentially increase the amount of time it takes to deliver a patient to definitive care. We have to either wait around or meet up with this advanced paramedic if our patient may require a specific intervention?

I too initially thought this was another debate on paramedics transitioning into a mid level provider role. Before we can seriously discuss this concept we have to talk about education. Midlevel providers typically have masters level education and I find a push for PHd level education for current or future providers. Clearly, this is a concept that EMS in our country simply should not be considering. We still have six month shake and bake medic mills and we want to talk about having a mid level provider medic? Once we establish a core level of paramedic education, perhaps we can discuss the pros and cons of paramedics moving into primary care. We already have APN's and PA's filling this role and taking on many challenges. EMS would have to change significantly before it could even consider moving into this area of medicine.

Take care,

chbare.

[UMSTUDENT]

Well, you said not to vote unless we post, but is it okay to post without voting?

I'm not quite ready to vote, because I don't think that "Advanced Practice Paramedic" is well defined yet. The Wake County definition differs significantly from others I have heard proposed. When I think of the APP, I generally picture the "Poor Man's PA" that many propose, not just a super field medic.

Generally, I am not a proponent of either role. Every paramedic should be educated to the level that Wake County proposes. And we have no business involving EMS in home health functions like oxygen delivery, medical and social referrals, and vaccinations. Apparently, the idiot who designed the Wake County model forgot to take his own advice, which is to not dilute the paramedic's role and experience, because that is exactly what he is proposing. If we start trying to be all things to all people, we dilute our core strength. Do one thing and do it well. If it is not an emergency, then it is none of our business. Without E, there is no EMS.

I feel the same way about the clinical model of the APP, which many propose to be the "Poor Man's PA", to do PA type work. I am against it. There is are already two career paths that address that need. There is no need to re-invent the wheel. And if we start moving in on the turf of other professions, we will only increase the hostility we already encounter from those groups, which is not a positive thing for EMS.

I do feel there is a potential for advanced paramedic scopes in some rural systems. However, it would not be anything like what Wake County proposes. And Wake County and Houston are far from rural. There is really nothing "advanced" about the practice that Wake County proposes. Every medic should be educated to that level. So what they are doing is not creating advanced paramedics. They are simply dumbing down and restricting all the other medics to make the selected few medics appear "advanced". And anytime people start using that kind of smoke and mirrors in their plan, it becomes immediately suspect and dubious.

While I generally agree with much of what you say, I do disagree with the narrow focus of "sticking to one thing and going it well." Unfortunately I think as more and more research becomes available there will be data coming out suggesting that much of what we do and respond for is of little benefit to some patients. More importantly that the conventional interventions we engage in today really, in most cases, does not significantly decrease the morbidity and mortality of many diseases. I think what we'll find in the coming years is that most disease processes are best fought with time honored prevention and maintenance of disease. This is where the paramedic, where the profession, has the opportunity to progress and advance.

From what I've gathered about Wake, they're going to have more than just the gambit of skills that paramedics should be educated to do. Trust me, I understand that things like DAI (RSI) and prevention issues should be found in current paramedic programs, but I've also heard that Wake and other jurisdictions are attempting to pass through refusal of services, home medication maintenance, basic scripts (heard third-hand), and diagnostic referrals. What I'm worried about is the idea of simply giving current paramedics, who may or may not have the education in physiology to back these skills, the capability with just a couple months of "extra" training.

The idea for the APP works. The Brits have implemented it with initial success. Financially is where it shows the most promise. As I've said, and they are now discovering, keeping people from costly hospitals for basic illnesses is simply the best fiscal decision and the best option for the patient and family.

I'm totally in your camp. I'd prefer the program to require a Master's Degree. For that matter I wouldn't be against it being a PA program with a speciality in prehospital medicine. I just simply think there is a place for this.

I appreciate the response though. This is the stuff I want to hear.

[Dustdevil]

More importantly that the conventional interventions we engage in today really, in most cases, does not significantly decrease the morbidity and mortality of many diseases. I think what we'll find in the coming years is that most disease processes are best fought with time honored prevention and maintenance of disease. This is where the paramedic, where the profession, has the opportunity to progress and advance.

Moving EMS outside the realm of EMERGENCY is not progress. It's just change. In fact, it is change in the exact same category as giving EMS to the fire service simply because they're already on the clock and need more to do in order to justify their cost. We are already doing a horrible job of making the case for those services we currently render. Attempting to take on more jobs before we have done that is FAIL.

If it's not an emergency, it has no business in EMS.

[Niftymedi911]

UM, when you stated that EMS or the paramedic cirriculum has the opportunity to progress or advance. If given the current situation with educational shortfalls, why focusing on advancing, when the most focus should be placed on standardizing the current system nation wide and fixing the broken wheel that EMS has become.

Essentially, the roles you are describing UM are the Physcian's Assistant cirriculum. I don't agree with a more advanced Paramedic, simply because, lets face it, if we're having trouble promoting higher educational standards for all (In the EMS world), what makes you think that this new cert or educational standard won't end up falling suseptable to the rest of the EMS cirriculums down falls?

However, I completely agree with a PA specializing in EMS, to perform the minor variety of calls (and major too) the currently help offset the downfall EMS has become. Simple sutures, simple scripts, simple tx's that can be performed in the field and won't require transport are the immediate benefits. Long term..... financially, for less medical malpractice suits, a higher EMS satisfactory rating with the public, and overall better public education on the risks and benefits of EMS. I also if this was implemented would like to see the new smaller sized (portable) lab machine be utilized with this feature. That way the patient wont even need to step inside a hospital to obtain simple and lipid blood draws. Thus providing a very wide spectrum of not only life or death treatments, but also providing those non-emergent services, where an ambulance would normally be tied to a non-emergent transport, thus decreasing unit availability, increase in response times, and increase in practioner skill degradation and complacency.

I really think before we start to try and advance our cirriculum now, we need to fix it. There are too many problems associated with the lack of education in this field. Creating a new more "advanced" cirriculum would be like putting a band-aid on a close proximity shotgun wound. As Dust said, We don't need to re-invent the wheel

[SANDMEDIC]

I think the Paramedic Programs need to get back to the foundation of EMS. I have seen 4 new medics graduate from their program with basic knowledge of Paramedicine.

Basically they know when to push the drug, but fail to recognize why they are pushing the drug.

I say this realizing that not all Paramedic programs are created equal, but with more and more training programs popping up all over the country, it seems a lot are teaching what the student needs just to pass the National Registry test.

Caveate to that is ACLS, PALS, and all the other alphabet soup courses need to toughen up a bit and make the course like it used to be, Pass or Fail, not just remediate the test if the student does not make the cut.

When it comes to the mega-code scenario.. Hammer the student.

Make it a challenge.

Begin to graduate quality, highly trained paramedics and then we can talk about advanced care paramedics.

For the those that are currently paramedics it should be an option to extend their education with CCEMT-P or FP-C. although it should be limited to those with a minimum of 3 years in the field, to grasp the foundation of being a skilled paramedic.

***Note: Not all paramedic program are created equal. The statements made are not aimed at those programs with proven education and training techniques.**

[UMSTUDENT]

UM, when you stated that EMS or the paramedic cirriculum has the opportunity to progress or advance. If given the current situation with educational shortfalls, why focusing on advancing, when the most focus should be placed on standardizing the current system nation wide and fixing the broken wheel that EMS has become.

Because not all of us have shortfalls. I think I'm more than capable of doing my job to a high standard-on a daily basis. There are plenty of paramedics out there who are at levels of profeciency.

Essentially, the roles you are describing UM are the Physcian's Assistant cirriculum. I don't agree with a more advanced Paramedic, simply because, lets face it, if we're having trouble promoting higher educational standards for all (In the EMS world), what makes you think that this new cert or educational standard won't end up falling suseptable to the rest of the EMS cirriculums down falls?

Yep, I said that. I agree with it. Like I said, I'm not opposed to them simply being prehospital physician assistants. If it makes you feel better, take the word "paramedic" out of the entire equation. I think this is a big downfall for a lot of people. The whole idea of having to get a Master's Degree is just petrifying. At least if it got boring you could move into a hospital.

[SANDMEDIC]

Yep, I said that. I agree with it. Like I said, I'm not opposed to them simply being prehospital physician assistants. If it makes you feel better, take the word "paramedic" out of the entire equation. I think this is a big downfall for a lot of people. The whole idea of having to get a Master's Degree is just petrifying. At least if it got boring you could move into a hospital.

[Arizonaffcep]

Yep' date=' I said that. I agree with it. Like I said, I'm not opposed to them simply being prehospital physician assistants. If it makes you feel better, take the word "paramedic" out of the entire equation. I think this is a big downfall for a lot of people. The whole idea of having to get a Master's Degree is just petrifying. At least if it got boring you could move into a hospital.[/quote']

I am unsure if the rest of the country has them, but all over the Phoenix Metro area there are little Urgent Care facilities. It seems you cannot go a few miles without stumbling upon one.

These "urgent care" facilities are actually a great idea.

Usually staffed with a P.A., N.P, Paramedic, RN, and an LPN. I will say I always seen a Paramedic there when we would respond for a patient requiring a higher level of care or directly to the catherization lab.

They are capable of doing labs, X-ray, sutures and some even have a CT scanner, all while taking some of the load off local emergency rooms and EMS.

After moving to the midwest, I have only noticed a hand full.

This in my eyes would be more resourceful than putting a P.A. in an ambulance.

After doing some basic research. I located 49+ urgent cares all throughout the Phoenix Metro area.

Just some food for thought.

Urgent cares also pay Paramedics pretty well. $22-25 per hour.

I know several years ago, Phoenix Fire put one of their personnel through PA School on their dime, under the thought that they would be able to use them prehospital. Unfortunately, the process didn't get past DHS.