Home Health Paramedics?

[DSStudent]

I found this article and I honestly don't know what to think about this. It really doesn't fit into the job description of EMS being as the "E" stands for Emergency but if it catches on it could lead to a whole new type of "Home Health Paramedics." What do you guys think?

http://www.JEMS.com/article/news/colorado-launches-first-commun

---

Members don't see this ad.

 

[jwk]

Not sure why it's appropriate for paramedics to be doing what is essentially public health nursing.

 

[MICT]

I think it's great, and I hope the program does as well as I'm sure they do. I think this is exactly the direction EMS needs to go; that is, from EMS to Mobile Health Services.

 

[EMS5]

the article stated right at the beginning that this wasn't necessarily an EMS service but a community paramedicine aspect. in the long run I think this will increase the productivity of EMS through preventative education and care, frequent flier visits, and the ability to provide limited home healthcare to patients

 

[docB]

This would be a big shift in ideology. At this time we have a large number of firefighters who provide EMS who are already bitter that they have to do the medical stuff at all. They were forced to become medics or had to to become firefighters. That group will not be interested in taking on even more mundane medical duties.

 

[MICT]

This would be a big shift in ideology. At this time we have a large number of firefighters who provide EMS who are already bitter that they have to do the medical stuff at all. They were forced to become medics or had to to become firefighters. That group will not be interested in taking on even more mundane medical duties.

Then hopefully this will be something that draws the people who want to be paramedics and who want to increase their own education and the profession's educational standards into the field and pushes out those who are only there begrudgingly. And perhaps it will make both those firefighters and the public realize that paramedicine isn't a field for those who don't want to be in it or who only want to do it as a second part of their "main job" and that paramedics ought to be more highly educated and focused solely on the medicine.

 

[EMS5]

This would be a big shift in ideology. At this time we have a large number of firefighters who provide EMS who are already bitter that they have to do the medical stuff at all. They were forced to become medics or had to to become firefighters. That group will not be interested in taking on even more mundane medical duties.

If this whole mindset of community health and preventative care takes off, I think it will be a different skill set and scope of practice than we currently have set by NHTSA. This isn't an emergency medical service and should have different guidelines for its usage.

I'm all beat to hell and bound to start babbling incoherently about unrelated stuff, so I'm gonna catch a few hours of sleep and I'll drop my personal opinion on this new spin when I wake up. (was that a run on?)

 

[Altruist]

This would be a big shift in ideology.

And even if/when the culture changes, there will inevitably be turf wars. I heard the medical director from Albany, NY speak at a conference a few years ago, and he talked about some public health interventions he wanted to start his medics doing. He was blocked by the state board of nursing from having medics give immunizations because they argued that it was a nursing skill. I don't know to what extent he tried to fight them, but when someone asked him more about it, he shrugged and said that in the end, there was nothing he could do.

I suspect this is another of those deals that administrators would love more than your average line medic. To administration, It might be a way to expand the budget, justifying more equipment, personnel, and higher wages... To the average medic it would mean less down time. Of course, that's assuming we increase public health funding, which nobody seems too eager to do.

 

[csmmedic]

EMS has a severe identity and education crisis that both need to be solved before we expand the roles of paramedics into home health.

I pose a question then. Is a paramedic a provider of EMS only, or a more versatile allied health professional that will take on different roles in the future to fill the gaps in health care delivery?

We need to know what we want. Some of us want a 600 hour medic course so we can get on the FD and make tons of money and get a good retirement. Some of us want to have paramedic education at the A.S. level at minimum and want to do CCT and field response and do it well. Some of us don't give a crap.

 

[EMS5]

Uhh...Stephen...gotta talk about this 1st post...you essentially came into the EMS forum and told us that EMS is important. you did make me lol. but really?

The home health care paramedic will have to be trained to different standards than current paramedics. This is definitely not an "emergency" service and will hopefully be utilized and deployed separately from traditional EMS. Like docb said, it is going to be a different group of people providing these services as most of us currently involved with fire/ems don't have the patience nor interest to deal with the community health issues. If such were the case, I would have gone into nursing.

In regards to preventative medicine and follow-ups related to EMS calls, I'm all for it. However most of what they are suggesting is in the scope of an outpatient clinic - wound care, rx evaluation, d/c followups, etc...IMHO this is stuff that needs to be dealt with from the nursing standpoint and not by EMS personnel. Possibly a ploy to reduce the costs of community healthcare by replacing some RN's with community medics and reducing the usage of outpatient clinics and facilities.

Preventative and EMS follow up - Thumbs up
Community nursing - not interested, not my job, no thanks

 

[orderly]

We have a similar system in my state, albeit slightly different. Here the officers are called Extended Care Paramedics (ECPs).

To become an ECP you need to have your Bachelor of Health Sciences (Paramedic) degree, complete your 18 month internship to become a Paramedic and work as a Paramedic for 2 years before applying to become an Intensive Care Paramedic which is a further 12 months of post-grad training. ICPs can then apply to become ECPs with even more training.

The theory is for every pt that you keep out of ED you save the Government $2000. ECPs are dispatched for acute problems (they aren't used as a referral service or for chronic issues, that is for nursing staff). They are dispatched 2 ways, when someone calls for EMS and ECPs are sent when the patients complaint meets a certain criteria (eg, nursing home pt who needs a PEG replacement) or a regular Paramedic crew is first dispatched and determines that the pt can be treated on scene by ECPs rather than transport to hospital. Its a pretty cool initiative, don't know if I'd want to do it or not though!

Have a read: http://saambulance.com.au/publicweb/pdf/ECP%20FAQ%20sheet%20RACF%20gov%20colours%20-%20Nov%2009%20FINAL.pdf

 

[deleted6669]

I can't imagine ever wanting to do this as a medic. it's basically a LPN job....
maybe for a really burnt out medic who can't handle the street anymore or for someone who wants nice daytime hrs as a bridge to retirement....

 

[orderly]

I can't imagine ever wanting to do this as a medic. it's basically a LPN job....
maybe for a really burnt out medic who can't handle the street anymore or for someone who wants nice daytime hrs as a bridge to retirement....

I don't know how I'd feel about it. I mean it would be an awesome skill set to have, but the actual work would be quite mundane I would imagine. Our ECPs are used as first responders when its busy and still do normal Paramedic shifts so they don't get bored

 

[leviathan]

In the system I used to work in, I think I would welcome the addition. Too many paramedics are sitting around on pager making $2/hour doing maybe 1 call every 4 shifts. They could actually justify making a full wage if there was something to do every day, meanwhile there would be a fast response time for the community when 911 calls came in whereas now the pager response can be up to half an hour or longer.

 

[docB]

I can't imagine ever wanting to do this as a medic. it's basically a LPN job....
maybe for a really burnt out medic who can't handle the street anymore or for someone who wants nice daytime hrs as a bridge to retirement....

I see what you're saying but I can see where this could be attractive from a systems point of view. If you''re responding to nursing home patients that's a %100 insured payor mix. If you treat and street an uninsured patient you save the bad debt incurred from the transport. For these reasons it could be worth extra $$ for a system to pay these medics.

Another plus would be the medics who are always chafing about limited autonomy. This might be a way for them to operate with more leash.

In general I'm opposed to the EMS system being reconfigured to deal with primary care issues for the same reasons I don't think we should try to do it in the ED. We're too expensive. We're bad at it. And just because the primary care system is broken and we are here 24/7 doesn't mean we're the guys for the job. Fix the damn primary system first. But I can see where this could have some merit.