For those who advocate Community EMS

[ERDoc]

Hey MedComRadio.  Which part of NY are you from?

 

As for the topic of community medicine, it all is going to depend on the system where you are.  Volley systems are not set up to properly handle something like that given the education requirements.

[EMT City Administrator]

Issue should be resolved.  Please let me know if it is still acting up.

[Just Plain Ruff]

Offlabel here posting as someone else. System error.

[paramedicmike]

Offlabel here posting as someone else. System error.

Then log out and log back in.  Please don't try to post under another user name.  It'll get confusing.  Let Admin know and he can continue to troubleshoot.

[rock_shoes]

No one is debating this.  We have all had experiences like this.  Sadly, people who are competent enough to follow directions and understand it are far and few between.  Although I am glad to truly help someone, a majority of our patients have no interest in helping themselves, and I will not waste my breath on them.  Get you shoes, coat, purse and lets go ma'aam.

 

What I refer to is this new approach being floating around where EMS makes appoints to go to someones house and follow up with them after a hospital discharge.  Being in a municipal service, and have no employment with a hospital or private company I frown upon being their lackey to help them retain more money for themselves in preventing readmissions.  

I am lucky though, we have 75 ambulances on the Chicago Fire Department and that isn't even enough.  So some idea like this would never work, looks like I will be spared.

Where one stands with regard to the cost part of the issue is going to vary dramatically depending on the nature of the system in which they work. I for example work in a publicly funded system whereby paramedic services, hospital services, and specialty services are all funded by the province (with a portion of federal transfer money earmarked for healthcare costs). A paramedic crew assessment and discharge costs the taxpayers a few hundred dollars. An emergency department visit costs the taxpayers several thousand dollars.

In short, the more closely paramedic services are tied to overall health services in an area, the greater the potential cost benefit to paramedic services providing non emergent care and discharge.

[Off Label]

That "health education" and pre hospital care are not mutually exclusive is nothing new. All health care providers are educators to one degree or another. That doesn't mean a mandate for a change in the composition of  public health delivery exists. And reinventing the wheel by changing definitions of existing agencies like EMS is a set up for costly failure.

Community/public health nursing exists right now, let alone home health agencies, public and private. If those entities are under utilized or over burdened, it doesn't follow that an EMS agency's role is to become their replacements.

[rock_shoes]

That "health education" and pre hospital care are not mutually exclusive is nothing new. All health care providers are educators to one degree or another. That doesn't mean a mandate for a change in the composition of  public health delivery exists. And reinventing the wheel by changing definitions of existing agencies like EMS is a set up for costly failure.

Community/public health nursing exists right now, let alone home health agencies, public and private. If those entities are under utilized or over burdened, it doesn't follow that an EMS agency's role is to become their replacements.

Whether you or I believe these people should be calling for currently existing home health services instead is becoming increasingly irrelevant. They're calling EMS wether we like it or not because few of them know how to access those services appropriately. The end goal shouldn't be for EMS to take over such services rather to redirect people into them as appropriate. Granny calls because she is weak due to poor nutrition (no longer cooking for herself). Rather than just toss the poor old girl on the bed, we should probably be leaving her home (provided she checks out medically) with a referral to a mobile meal service for seniors (and a sandwich until they show up). That isn't taking over another service. It's creating a new route to the appropriate service by marginally changing our assessment and referral pathways from the traditional "you call we haul."

EMS has become a gateway to the health system for patients who don't know how to access the most appropriate service. Further to that, we have always been an extension of the emergency department.

Little Johnny fell off his bike and needs a few stitches (no other injuries presenting). Should you as an EMS provider clean it up and toss in a few sutures with instructions to see his family physician for removal (costing the system a few hundred dollars)? Should you haul little Johnny off to the ED so a physician can provide the same service (costing the system thousands of dollars and using that physician's time for a minor task when he could be otherwise occupied with higher acuity patients)? Your total patient side time is likely going to be far less with the first option because we all know little Johnny is probably going to the back hallway to wait when you get to the ED (if you even manage to get triaged in a timely fashion).

As for the paramedics making scheduled home health visits you mention, those programs typically exist in areas that don't have any other home health programs. Those will not come to be in a place like Chicago or Vancouver where home health programs already exist. Where they will come to be is in rural areas where call volumes amount to 2-3 calls a day. In between calls they can be making these visits and if a call comes in they will either leave the current visit or reschedule any visits they miss during the emergency call. The point is they won't be replacing anyone. They'll be providing a service that wouldn't otherwise exist instead of sitting on their collective ass' watching youtube at the station.

[Off Label]

@‌ rock_shoes

You describe a combination physician assistant-EMT-public health nurse-social work case worker. Each one of those things requires both clinical and didactic training, let alone experience. It sounds good in theory, but the impracticality of it all is a non starter.

Putting people without that training into a position that they require it is at best unfair and at worse unsafe.

[rock_shoes]

@‌ rock_shoes

You describe a combination physician assistant-EMT-public health nurse-social work case worker. Each one of those things requires both clinical and didactic training, let alone experience. It sounds good in theory, but the impracticality of it all is a non starter.

Putting people without that training into a position that they require it is at best unfair and at worse unsafe.

At no point would I ever suggest putting paramedics into such a role without education/training to match the scope of the position. Paramedic education varies wildly around the world with programs ranging from 6-12 months to 3-4 years depending on the level and country. Suffice it to say the successful programs around the world have involved providers from the more educated end of the spectrum.

As I've already mentioned a large part of the role would involve directing patients toward the correct care as opposed to providing that care directly. Ie. referring the patient requiring social work directly to the social worker or referring the home care nursing patient directly to a home health assessment team. Directing patient's toward the correct care doesn't require a practitioner to be able to provide that care. It requires a practitioner to recognize when that care is required.

As far as upping the educational anti is concerned, all I can really say is it's about bloody time.

For example.

http://kssdeanery.ac.uk/sites/kssdeanery/files/Paramedic Practitioner Presentation.pdf

I'm not talking about a pack of untrained monkeys. I'm talking about educated professionals who are prepared to provide such services.

[Off Label]

At no point would I ever suggest putting paramedics into such a role without education/training to match the scope of the position. Paramedic education varies wildly around the world with programs ranging from 6-12 months to 3-4 years depending on the level and country. Suffice it to say the successful programs around the world have involved providers from the more educated end of the spectrum.

As I've already mentioned a large part of the role would involve directing patients toward the correct care as opposed to providing that care directly. Ie. referring the patient requiring social work directly to the social worker or referring the home care nursing patient directly to a home health assessment team. Directing patient's toward the correct care doesn't require a practitioner to be able to provide that care. It requires a practitioner to recognize when that care is required.

As far as upping the educational anti is concerned, all I can really say is it's about bloody time.

For example.

http://kssdeanery.ac.uk/sites/kssdeanery/files/Paramedic Practitioner Presentation.pdf

I'm not talking about a pack of untrained monkeys. I'm talking about educated professionals who are prepared to provide such services.

Interesting concept, no doubt.... but it does sound like a mobile general practice PA or NP. We've got those people now, sans wheels, already trained or in an established training pathway. Don't know if there are equivalent practitioners where you are. But perhaps putting these folks in non transport vehicles to be requested by the responding units. This at least would avoid an hour or more out of service time for suturing a laceration.

I am skeptical about the referral component of the idea, though. If, as has been talked about here, so many folks are incapable of understanding how to access health care specific to their needs apart from calling 911, I don't see how a visit from an ambulance crew is going to change that.