Solving the problem of rural EMS

[Eydawn]

Bump! I'd hate to see this die. Anyone have any fresh ideas?

--Wendy

[rock_shoes]

Ah hah! So we need to create a new health care provider. Basically what many of you are saying is don't pigeonhole into a PA or NP, but create a Paramedic Practitioner instead... so that they are already familiar with the environment, but then educated to the level of a physician extender and therefore much better suited for a hybrid clinic/pre-hospital role.

I think I need to eat breakfast, read over things, and come back and take another look.

More to come.

Wendy

CO EMT-B

That’s my take on it. Only degree paramedics would be suitable for education to a physician extender level. Paramedics from “monkey see, medic do” type programs will not have the background knowledge or, I suspect in most cases, critical thinking skills needed to function at such a level. Rural healthcare is an intriguing challenge that most fail to give the credit it is due. Rural practitioners have to be able to function in a “tag you’re it” type of environment where the next person available to tag could literally be hours away. Personally, I love the challenge. I would rather have one long call where I really had to think and apply every resource available to me than 10 short transport calls where you barely have time to take a set of vitals, never mind formulate an evidence based treatment plan. Unfortunately, the way things are currently running in my home province, the more I increase my education level the less likely I am to be able to work in a rural setting (ALS (Advanced Care Paramedic) providers are only in certain designated cities with most rural areas being served by either ILS (Primary Care Paramedic) or BLS (Emergency Medical Responder) providers). Maybe I’m biased because I’m from a rural area, but I believe that rural people deserve to have this level of care available to them.

The fact that we are already working in the clinical setting shows a strong progression towards a Clinical Care paramedic or Paramedic Practitioner. The classic paramedic of the past has to adapt and evolve to the needs of today's health care. There is no reason a Paramedic couldn't be doing primary home care rather than a poorly trained aide who can hardly recognise a medical emergency. With patents being sent home from hospitals to recuperate there it's not a far stretch for the medics to make daily rounds within their zones to change dressings, conduct followup care, or do simple welfare checks. It's just not glamorous enough for those in EMS because they can't use their lights and sirens. A progressive EMS manager will make changes like these, the rest will be lost to attrition.

Some might turn up their noses at such programs. I’m not one of them. These programs are brilliant concepts that now need to be followed by careful, evidence based, implementation. I find developing care plans for critically ill or injured patients to be fascinating. I also enjoy interacting with patients in a way that betters their lives. A well developed Paramedic Practitioner program will teach its students to do both. The prospect of say, touring through the local nursing homes providing vaccinations, then leaving to provide for a critically ill or injured patient when needed is one I find very exciting. You can interact with the community on a daily basis and then step up into a more involving role whenever needed. This type of role is about best serving a rural community not feeding your own ego at all times.

Ed

[armymedic571]

Rock shoes.... I have to agree with you that paramedics from poor producing programs will not be suitable for such a program as an Advanced paramedic practicioner. However, that level of pre-hospital provider is exactly what is needed. Part of the issue is that we need to get our educational standards down as a nation and not by state.. But that is a different thread altogether.

I actually find that the PA's skill set to be more towards the paramedics than a NP. NO offense to our nurses. But once again we have to talk dollars. You can pay a NP or PA the going rate, or a Paramedic their salary with some extra benies and save money. This will actually help to keep taxes under control, and provide the revenue for more positions.

i think this goes back to the discussion that WE as providers (EMT-B to Paramedic) need to raise our standards not lower them. To bad we don't have as strong a lobby like the nurses do.....

By the way. One of the services out in Pitt tried to put a flight crew (Nurse and Paramedic ) in a chase truck to do such things. Help Paramedics in trouble, do house calls for minor things. All the skills and knowledge of a flight crew in a truck, maybe even have the flight Doc on certain days. But no.. The State medical director put the Kybosh on it....

I hate backwards thinking, risk adverse morons.......but that is just my opinion.

Cheers

Edited October 30, 2009 by armymedic571

[46Young]

Add paramedic fly cars (chase cars, QRV's, whatever you want to call it) during business hours, when vollie participation is at it's least.

The North Shore LIJ Health System CEMS is currently providing medic fly cars to several communities in Suffolk Co LI at no cost to the public. This was negotiated with the County, as NSLIJ bought a number of hospitals in the area, giving the health system considerable market share in the area. The fly car program was a give back to the area. The contract is set to expire, though, to the liking of the health system.

The town of Rockville Centre contracted out EMS coverage to NSLIJ. The CEMS is a combo NYC 911/IFT agency. The CEMS provides 24/7 ALS coverage with an EMT/medic crew. The CEMS provides all equipment including the bus. The town guarantees a certain amount of revenue for the year. I think it's around $500,000 or so. The town keeps any additional revenue from billing. Worth mentioning, this is an area with a high cost of living and tax rate, with a proportionally high number of privtely insures residents, and few uncompensated cases.

Perhaps the vollies in your area can put out some paid fly cars during the day. Perhaps an area hospital can provide a staffed txp unit for a certain amount of guaranteed compensation. To get the hosp to agree to a lower rate of compensation, perhaps the community could persuade local NH's, clinics, urgent care's and hospitals to let any IFT contracts with the privates expire, and let the hospital have exclusive rights to the IFT business in the area. The community gets professional coverage, and the hospital gets the IFT windfall. Win-win.

Edited October 30, 2009 by 46Young