Community Paramedic Education

[Bieber]

Hey everyone.

We're starting to discuss community paramedicine and bringing it to my service. So in my over-eager attempt to try and become a part of one of what could be the greatest leaps in EMS since its inception, I'm working on getting enrolled in Hennepin Technical College's Community Paramedic program.

I know that the whole concept of Community Paramedicine is still pretty new, but does anyone have any experience with community paramedicine? Either as a trained CP or as a program developer within your own service/agency?

Thanks,

-Bieber

[spenac]

Used to work in a system where we did lots of treat and release. We would not transport any patient that was non emergent. If it was something we could fix we would. If they needed some type of care but not emergency we provided them with the information and even information of services available to help them get to the treatment they needed. Sadly after those of us that were competent moved on the new EMS crews adopted the you call we haul philosophy because it was easier than doing what the patient actually needed.

[chbare]

It's actually not as new as you'd think. Look up the Taos Red River Project. It was a community health programme that New Mexico developed in the early 1990's. Overall, it was a failure, but the information gained from the experience could be very helpful.

Edited December 20, 2012 by chbare

[geekymedic]

Please contact me off list if you need assistance with this. Chris Montera geekymedic@gmail.com First read www.communityparamedic.org and www.wecadems.com

[ChaseZ]

What type of degree is the Community Paramedic program? I have reservations about allowing to function as community practioner without a substantial increase in education. Can you be more specific on what the duties would actually be?

[schulz]

The concept is amazing and already exists in places like Australia. However if I read correctly, a 250 hour "badge upgrade class" for this is what will prevent it from advancing our profession in anyway. This should be a minimum undergraduate degree but hopefully masters level education.

[medicgirl05]

I am very curious about this idea. I have tried to find some information about it in Texas but there's not much available. I am waiting on an E-mail response from a service who has a Community Health Program in place.

Any of you who do get more information please bring it back to the thread.

Thanks!

[medicgirl05]

So I have done some research and have the support from my supervisor to pursue this program and try to present it to the higher-ups. I'm very excited!!!

The first step is to determine which patients could have been treated at home without an ER visit, so I'm going through all the patient contacts from 2012 to determine which patients may benefit. I may have bitten off more than I can chew but I really think this could help our community in so many ways.

We could keep our ambulances available for emergent cases, we could save money, plus we could help at the rural clinic when needed. MedStar of Texas has some great information online including the money they saved from the program. I spoke with the guy in charge of the program and he was super helpful and encouraging. He said I could come for 2 days and ride along with one of the Community Health Paramedics to get a better idea of what they do. Hopefully I can do that soon!

[nsmedic393]

Hi there, been quite a while since i posted in this forum.

Here in Nova Scotia, we have been running a community paramedicine project for almost ten years. It was started in a rural community with no physician access (actually on a island, two ferry boat rides and a hour drive from the nearest hospital). The model involves a nurse practitioner assesing and treating patients in a clinic setting with local paramedics doing home visits, follow up checks and blood draws. The paramedics perform such assesments as weight for patients being treated for CHF, fall assesment, dressing changes and suture removal. The program has had moderate success and is definatly a assett for this type of isolated community.

Along the same lines we have started a new program in the last two years called the extended care paramedic program. This program is based in a large city and i feel offers a large benifit in terms of keeping ambulances avaliable for emergencies and keeping the elderly patients out of the hospital with alternative treatment options. The short of the story is that specially trained ALS providers respond to almost all nursing home calls. They assess the patient and treat them on site in consultation the patients physician, our medical oversight physician and the nusing staff. Sometimes these calls can take 4-5 hours. The patient is transorted to the hospital only as a last resort if x-rays are needed or treatments not avaliable to the ECP. Some treatments they do provide are suturing wounds, IV antibiotics.

Here is a link with a basic overview of both programs.

http://www.gov.ns.ca/health/ehs/

[WestMetroMedic]

I completed the Hennepin Technical College program last semester and had an overall positive experience, but there is much work to be done still. Hennepin Tech's program is a 13 semester credit course which involves 4 hours of classroom once a week for 1 semester, in addition to a minimum of 200 clinical hours. I still am building my clinical experience, as I want to tailor it to the hospital that my EMS is affiliated with.

I found that much of the program was focused on changing how you think. As a traditional paramedic, our focus is on taking people to the hospital, versus the focus of this program is keeping patients out of the hospital and from ever dealing with the traditional EMS system. This will be useful to help deal more rapidly with the needs of hospitals dealing with new medicare rules involving readmission and many private insurers moving to an Accountable Care Organization (ACO) payor model.

Deployment of a program will be different in every location it is employed. In a rural setting, you will find success using the Australian model, which brings a Paramedic with primary care education and relationships and places them in communities that have poor primary care access due to a lack of providers. This also allows these rural areas to have access to an ALS provider for their 999 response, that they would not have been able to justify before.

In my system, which is a large urban center, our intention is to deploy it to deal with ACO payors, readmission issues, provide home care to clients who do not qualify for RN home care and act as an adjuct to traditional EMS by providing advanced wound care and indwelling device management at pt side versus, for example, the $3000 it costs to bring a person in from a nursing home to have a foley put back in with a coude(sp?). We also want to use mimick to successes that MedStar in Fort Worth, TX has had in dealing with high volume 911/ED users. MedStar runs an excellent program, and they don't have any selfish concerns about people copying their program, in fact, they are completely transparent and will answer any question you may have regarding how they deply their community health program. We also seen interaction with corporate health programs, public schools and homeless communities to be excellent avenues for this business arm.

The education level is a concern that I have, but until EMS provider start policing themselves and pushing the EMT-Paramedic to at least the BS education level (heck even a AAS standard is a start), we will continue to have difficulty justifying our existence. Conversely, using the John Puryear philosiphy, what is a degree beside a piece of paper saying you sat through a bunch of silly classes that are not going to make you any better of a provider. At the end of the day, this isn't for everyone, and I think in order to obtain this education, you must have proven yourself to be a model of didactic excellence that is able to integrate it with outstanding interpersonal skills.