Preventative Paramedicine

[paramedicmike]

I saw this in today's New York Times. It's in interesting article. I don't think it necessarily offers any solutions to anything. But it touches on what's starting to happen in some communities and even touches on cost savings involved.

If memory serves we've had at least one discussion on this before. I figured it couldn't hurt to touch on some of these ideas again.

What do you think? Does preventative paramedicine have a role? Is this something we'll be seeing more of in the future? What about educational preparation for people undertaking these roles?

[flamingemt2011]

We should learn from the Fire Monkeys. Getting people to stop calling 911 is bad for our futures, just like fire education has basically made all Fire Departments an EMS Department, as true fires have almost been eliminated through education and better building codes. Be careful what you wish for on this one.

[ERDoc]

Until we cure death, get rid of alcohol and eliminate stupidity and testosterone, there will always be a need for EMS.

[DwayneEMTP]

Remote paramedics deal constantly with preventative medicine...As it should be on the streets, right? Don't you council your elderly patients on staying compliant with their meds, eliminating throw rugs in the house, making sure their phone is within reach of their bed? If you don't, you should.

I rarely have a black patient when I work remote that I don't take a B/P, (often finding undiagnosed hypertension), council them on the risks of vascular/heart disease/diabetes in the black population, etc. Council the kids on their drinking and smoking habits...quiz the muscleheads on their supplement use. Now that I think of it, the same stuff I did on the streets as well.

Good article, and I absolutely see a need for it. But I also see the best medics I know teaching these things, call to call, every day.

Thanks for posting.

Dwayne

[ERDoc]

I rarely have a black patient when I work remote that I don't take a B/P, (often finding undiagnosed hypertension), council them on the risks of vascular/heart disease/diabetes in the black population, etc.

There you go, singling out the black people. You are such a racist cracker.

Seriously though, are paramedics, with the current state of education, er, training, really the best people to be doing this?

[flamingemt2011]

NO they are not, it is the Physicians and Pharmacist who should be doing this "education"

[Just Plain Ruff]

There you go, singling out the black people. You are such a racist cracker.

Seriously though, are paramedics, with the current state of education, er, training, really the best people to be doing this?

I don't know if the answer is yes but I think that we are the best that many can get. Often we are their first route and often their only route to the healthcare system and it's incumbent on us to be their advocates and like Dwayne says, we should be doing the type of stuff that he mentioned on every call. How much more time does it take to look around the house and say "you know, I noticed you have a bunch of throwrugs on the floor. Those are fall hazards and you should get rid of them" and then help them remove the rugs. Who knows, your actions may save some elderly person from falling and breaking a hip.

I always look in their kitchen, and bathroom if I can and that tells me a lot about how they are eating or what goes on in the bathroom. Lots of meds nilly willy inthe medicine chest, I'll write their dosage and times to take out on a piece of paper I designed and give it to them. Saves me the trouble of writing the stuff down in the future and gives the person a list of their meds when they go to the hospital.

I look at their kitchen and if it looks like they haven't eaten today I'll offer to make em a sandwich or I'll put a bug in the ear of our social workers to put them on the list of who needs help or to help set up a social worker visit.

That's just me though.

[crotchitymedic1986]

You search their kitchen and bathrooms ? I think you are doing that to serve your reasons, not theirs.

[chbare]

There exist many important aspects of home care that could in theory be addressed by pre-hospital providers:

1) Safety issues as mentioned

2) Education about diseases and health issues

3) Education about medications and compliance

4) Community health projects

5) Health clinics and fairs

6) Education and assessment of special modalities:

-Invasive catheters

-Wound Care

-Rehabilitative Issues

-Ostomy Care

Specific issues that come to my mind would be teaching people how to use their respiratory equipment properly at home to decrease ER visits and hospital admission. This clearly may save money but can also prevent exacerbations or enable patients/family/support networks to recognise when exacerbations cannot be controlled without additional help. Unfortunately, as already stated, education of pre-hospital providers remains a significant limiting factor:

-How many people know about asthma action plans?

-How many people know about peak flow measurements and how to use devices and what indicates what?

-How many people know the correct way to take aerosol medications, what breathing techniques to teach, how to clean equipment and what to monitor for or to do after certain medications are given?

-How many people know about respiratory care home equipment, how to troubleshoot, how to clean and how to properly use and store backup systems?

These are just a few specific questions regarding one of many concepts that a provider would potentially deal with in school. Are there a significant number of paramedic programmes that even cover home health in class and have home health clinical rotations with competencies and identified student learning experiences, goals and outcomes?

[DwayneEMTP]

...There you go, singling out the black people. You are such a racist cracker...

Heh..Yeah, I hear ya Doc.

...Seriously though, are paramedics, with the current state of education, er, training, really the best people to be doing this?

First, I get your point, though unfortunately there's currently no state of education for paramedics. When you can spend from 4 months to 3 years becoming a medic we can't ever really compare apples to apples.

But as Chris and Mike said, I do believe that there is a lot we could do. Most of the education that folks need at home is Basic level stuff. Anyone that's ever childproofed their home has a decent idea of many of the needs of the infirm elderly.

And I too, when I have reason to believe that someone is at unusual risk take a look in the bedroom, bathroom, and kitchen for clues to how they are living. Often times it's simply a matter of reminding them that their meds are important that gets them to become compliant again. I've used the phrase, "Do you have anyone that cares about you? Anyone at all that cares if you live or die?" To which the answer is almost always, though not always, "Yeah...my son, daughter, grandkids, etc.." "Then you have no right to treat yourself like this, right? If they were here would you feel ok telling them, 'kids, I'm sorry, but I've chosen to be sick/die because being with you isn't worth the bother of taking a couple of pills every day."

The upside is that I've seen significant change in a few patients following this simple intervention (Of course I can't verify that I had anything to do with it, but there appeared to be a connection). The down side is getting a call from a patients doc saying, "Bob said that you told him he would die if he missed a dose of his medicine...What's wrong with you?!?!" "Ummmm....that's not exactly what I said..."

Should cops be teaching kids how to stay off of drugs? Probably not. Should priests be conducting marriage counseling? Almost certainly not. Should medics spend their spare time teaching the elderly and infirm how to live safer and healthier lives? God no....

But sometimes making really inefficient use of the resources we've got may be better than doing nothing at all. And most of the medics that I know are not putting their down time to any kind of good use...so maybe this is one of those times? (Assuming an acceptable scope of education and proper oversight of course.) (No, I know that sounds like I'm kidding, but I'm trying to be serious.) (Yeah, on second though, if proper oversight needs be a requirement then it's simply not worth the risk.)

(Why did I write that last part in ()s? I'm not exactly sure...)

Dwayne