Advanced Practice Paramedic

[chappy]

In Wake county, NC, they are running a pilot program for what they are calling an Advanced Practice Paramedic. Here is a link to the program. What do you think?

[Dustdevil]

I think it's a joke, as is the joker who runs it.

There is nothing advanced about it, so I really don't see where the name came from. Guess they thought it would attract more applicants if they gave it a fancy name. Might as well call them supersonic tactical flight officers.

[mobey]

Laughable.

It is basically a rover unit (PRU, whatever you wanna call it) that is staffed with a single medic with 300hrs of in-house training.....

So.... basically just another paramedic to respond to an already als crew, and some community proactive stuff thrown in for good measure.

Seems pretty fractured to me.

Why not just have dual medic units, and have them do community outreach between calls?

[Just Plain Ruff]

Ensure that an additional experienced paramedic is available on critical level calls by responding alongside paramedic ambulances. While some EMS systems use a “paramedic chase car” to provide the lone paramedic responding to assist a basic ambulance, our approach brings APPs to provide a supplemental paramedic with a high frequency of critical patient care encounters to augment the care being provided by our outstanding ambulance-based EMS providers and fire service first responders

My response is this - I have worked in several systems where there are supervisors which respond to all major medical/trauma calls. That puts an additional medic on scene. This APP piece seems like what 4 of the EMS agencies I've worked at are already doing!

Every critical medical call and trauma call gets the supervisor and most often there are paramedics on the fire trucks and sometimes even dual medics on the ambulance.

How is the above piece different than what I've described?

"Number 1 in the web site - Reduce the occurrence of, or minimize, medical crises for persons with specific medical conditions known to benefit from close medical monitoring. Increasing the overall well-being of the patient can prevent the need for EMS response and decrease the time and money spent by patients and other taxpayers for emergency room visits and hospital stays.

Studies show that diabetics, high blood pressure patients with congestive heart failure, those with increased risk of falls (such as people over 65 years of age), some substance abusers, and children with asthma may all significantly benefit by home visits from medical care providers such as our Advanced Practice Paramedics."

When did this become the purview of EMS? Aren't home health nurses more equipped to handle these types of patients?

How is Wake county being reimbursed for the above services? I'm more than sure that EMS is unable to bill for these services which have traditionally been the arena of hospital home health departments.

I think that if done right this is a good idea.

Edited May 26, 2011 by Ruffems

[Dustdevil]

I think that if done right this is a good idea.

But, if done right, it wouldn't involve EMS.

[Just Plain Ruff]

But, if done right, it wouldn't involve EMS.

I'll give you that Dust, EMS should not be doing home health level visits. Let's get real.

[mobey]

I'll give you that Dust, EMS should not be doing home health level visits. Let's get real.

Care to expand?

[Dustdevil]

Care to expand?

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.

Edited May 26, 2011 by Dustdevil

[Just Plain Ruff]

Care to expand?

Yes, EMS should not be expanding out to home health visits as that is not the best use of resources for EMS to do.

With resources being stretched so thin anyway, wouldn't a better use of these APP's be spent getting them to the calls rather than being stuck doing a home health visit for someone and not be able to get away from that visit in a timely manner.

If there is one or two of the APP's on duty that their specific job function is to provide during their shift those types of visits then that's a different story, BUT if they are expected to respond to calls while doing these visits then that is just a waste of resources.

I mean if we are going to branch out in EMS to do home health, why not branch out into traditionally fire based roles such as fire safety and fire prevention. I mean if Fire can provide medical coverage then EMS should be ok to provide fire roles.

I didn't get into EMS to be a home health aide!!! I don't think that this is the role of EMS.

[tniuqs]

Crap the link ate my home work !

Attempt #2.

A topic near and dear to my heart .. I believe we must in so called "EMS" advance to provide improved health care to rural and remote communities, there is a huge gap in these communities with loss of the the Family Practice MDs.

Think "Pre Hospital Care" should no longer be the dogmatic EMS title. Community Outreach it is the proven wave of the future in Nova Scotia, Queensland OZ, Alaska, and UK is more of a future for our profession than swallowed up by Fire Departments in attempt to improve their budgets. EMS should IMHO be pragmatic and be adapt to the real needs, that said the USA and Canada are very different demographics in the population density.

http://www.ruralcenter.org/sites/default/files/2%20G%20Wingrove%20CP%20M1%20L1%20PP1%20-%20Community%20Paramedic.pdf

This Wake County is just capitalizing on a concept that already has been successful although I remain very sceptical its just a money grab and PR ONLY ... no wheels on this wagon !

1- Fly cars "can" be an excuse to implement a tiered response BLS/ALS and just a stop gap (Alberta now being a perfect example) that said on a serious call extra hands are not a bad idea, but getting the fly car back in service is always problematic, maybe call STARS to drive it to the local ER eh mobey ? .

The link and stated program above IMHO does not go far enough, it should increase scope of practice with education and with an associate's degree it is laughable a bachelor’s degree should be the minimum standard and increase "skill set" is not going to cut it. Increasing Scope of Practice to Antibiotic therapy and the intermediated pain killers as I have Ibuprofen/Tylenol/ASA then M/S (a must do soon in my practice for ugly abscessed teeth! Then also CXRAY interpretation at the ACP level here, is no where near competent. Handing out a puffer or 2 not a bad idea (along with asthma education) for yet another I forgot to get my "puffer" and do I need to expound on that ? Prenatal care sure would avoid a quite a few medivacs as well, or possibly save an in utero life. Suturing is a big seller in the NS outreach program (clearly limited, no pretend plastic surgeons please) that said without bug juice to cover SA, a recipe for a problem. FB EYES another top of my hit parade in remote. And another big seller is assisting in mass inoculations .. what a huge disaster in delivery model we observed with the last AB H1N1 fiasco, ps stab them in small groups don't gather the entire high risk community in a school gymnasium, how stupid from an infectious disease perspective (although it works very well to stop a war) re: WW1 Spanish flu

What we should NOT do (as in BC) is get used in nursing homes as muscle and routine bath care moreover as "emergent" IMHO We also need Medical Directors that have not only ER experience but with Community Health, Alberta Health Services and ACoP gets a big phat FAIL in those areas, the 3 wize men concept is all baddness.

nuff said fer now.

cheers

ps I am awaiting a Alphabet course that is entitled ECP ... that's the EXTREME CARE PARAMEDIC

Edited May 26, 2011 by tniuqs