Paramedic Practitioner: Is this where we should be heading?

[paramedicmike]

Welcome, MrNinjaDrBrian.

I see an awful lot of "...if only we could do what <insert provider level> could do..." and "...I want to be able to do <insert skill/procedure> just like <insert provider level>..." in what you've posted. I can't help but think that if you want to function just like a PA/NP/MD/DO then you need to go to the appropriate educational center to earn the PA/NP/MD/DO designation.

Have you read through the full text of this particular discussion? I think ERDoc's comments on the first page of this discussion will be helpful to you.

Anyway, welcome to the Forums.

[Just Plain Ruff]

Mr Ninja, what level of education do you see the paramedic practitioner having? In my understanding, PA"s or NP's do not have the qualifications to do advanced surgical techniques so why should a PP(paramedic Practitioner) have that especially if you are not advocating education of at least the PA or NP.

I'm very very very very skeptical of what you are wanting to do especially the surgical procedures because it sure sounds like you are wanting the doctor part but not wanting to do the schooling part.

Guys, here's my thoughts on the paramedic practitioner - Be careful what you wish for because you might just get it. You might just get a bunch of PP(paramedic practitioner) mills just like medic mills and we all know many of those on this sites opinions of medic mills.

This just reeks of the zero to PP hero if we allow it. What I advocate is making sure that we have our ducks in a row with the paramedic level education requirements and then work on getting an Advance practice paramedic. There is the CCEMTP program out there but you really get what you pay for and even though you go to one program another program is better or more thorough.

So while we all are wishing we could do more, let's make sure our house is in order before we do that. I'm sure that there are many medics that everyone of us knows that should NOT be medics because they are piss poor medics or they just SUCK.. Would you want those medics to attend a course to become a PP? to do advanced surgical procedures like Mr Ninja advocates?

I think that our profession has a long way to go before we EVEN THINK about letting paramedics do advanced surgical interventions on the way to the hospital. It's already hard enough to find space for the equipment we have on the ambulance but now if we allow advanced surgical procedures by PP's, where do you put the equipment to do those procedures?

And just what procedures do we allow them to do.

More questions rather than answers.

[ERDoc]

I don't think you will see paramedics doing this any time soon. The NP gestapo has already started sinking their claws into it and you know how they protect their territory.

[paramedicmike]

How do you mean, Doc? Home care type visits? Or something else?

[ERDoc]

Home visits, even for "emergencies." I can't find the article now, but I read about an NP service that wanted you to call them before you called 911 unless it was a "real" emergency. They said they would respond in a certain amount of time and then send you to the hospital if needed. I believe it was directed at the elderly (read: insured) so that they did not need to leave their house unless absolutely necessary. I believe they even did simple suturing.

[Just Plain Ruff]

Home visits, even for "emergencies." I can't find the article now, but I read about an NP service that wanted you to call them before you called 911 unless it was a "real" emergency. They said they would respond in a certain amount of time and then send you to the hospital if needed. I believe it was directed at the elderly (read: insured) so that they did not need to leave their house unless absolutely necessary. I believe they even did simple suturing.

These types of services are what I'm talking about. You have a person who may be sick, but they are contracted to that NP service to call them first and then they will determine if it's an emergency, if they deem it not to be an emergency, they will make it to your house in a "reasonable" amount of time and then decide if you need to go to the hospital.

Does anyone else have an issue with that? I can't see why the ENA(NP Gestapo I think that's what is referred to here) is upset about this type of service.

[ERDoc]

Because they don't want the paramedics pushing them out of a niche they are trying to take over. I think the idea of a home service is a great idea if run properly (I don't know how to do that, it is for much smarter people than me to figure out). Anything that will cut down on unnecessary ER visits is a good idea in my book.

[scubanurse]

It sounds like you are wanting to take what most insurance companies have and advertise as the nurse advice line, a step further and have a nurse on call to visit the home if deemed necessary. As a future nurse I support working with paramedics since it is a different scope of practice for these situations. Have the nurses line dispatch paramedics if it is an emergency and if it is non-urgant send a NP or PA. Seems like this would work from the insurance companies standpoint since they have the deep pockets to cover liability.

It takes EMS in a totally new direction though. If insurance companies are dispatching them or going through the dispatching center, does insurance then cover the bill 100%? I know with my current policy, it will pay EMS trips at 80% unless it is interfacility transport or air medical. Will this change?

I like the idea of advancing the scope in EMS, but where will the education come from? I personally only know of really 1 BS EMT-P degree program, although I am sure there are more, in the country. If we advance the scope, the education will have to advance with it. Then EMS might face the challenge that nursing has and not have enough educators because it would be a pay cut for most to leave the streets to teach.

ETA: sorry for the somewhat disjointed ramble of a post, I'm studying for NCLEX and finals so my brain hurts.

Edited March 24, 2013 by Kate_826

[paramatt_]

Also wouldn't it be nice to tell the patient who is calling you for a stubbed toe and demands to be treated to go to the pharmacy and get a prescription of Ibuprofen filled!!!!! ;P

Don't you have the ability to refer patients to other providers? Am I wrong to be under the impression that all paramedics are able to give basic advice to patients that may not need transport or can be managed by some other means?

At any rate, the service I work for is currently running a community paramedic trial...not sure what the exact title is, but they're basically functioning like a community nurse. The focus is to do basic hospital based interventions such as changing catheters, basic wound care, and can book patients in to other services, order x-rays, and prescribe some ab's, etc, etc.

I think it’s great to have this sort of service available, but to echo chbare, it shouldn’t take away from other healthcare providers who already have a degree or post-grad education. Granted, coming from someone working in a country with an already high level of paramedic education, this is already looking like the next step forward. Community based paramedicine master degrees have begun to pop up around these parts. Not sure what resistance the nurses’ union have, though in my opinion, it will play out like the way PAs/NPs function in the states….similar level of education, with a different background, serving in different settings, thus different titles.

[scubanurse]

Paramedics are prescribing antibiotics? How much pharmacology training do they have to know which ones to prescribe? Or how about checking against current meds? I'm sincerely curious as to what training they're getting before being allowed to go out and be a community paramedic.