For as long as I could remember, I wanted to be in EMS. My decision to become a nurse was exclusive to the pride I felt when I attained the level of “paramedic” in my EMS training.
While many of my colleagues jest about being “a paramedic with a nursing license,” I see the advantages in each of these distinct disciplines. It was not perceived upward mobility that I sought; rather the need for specialized training and education that both licenses provide. As I and a number of my EMS colleagues look to “what’s next,” I keep this same thought in mind.
Whether or not we realize it, the current state of healthcare will provide us with unique opportunities. As EMS providers, we have answered the call and altered the manner in which we have delivered healthcare based upon the needs of those we serve. Today the job is no different. Given the current state of the American healthcare system, we have an unprecedented chance to foster change and care for those who need us the most.
Imagine a practitioner in the community, mobile and limitless in scope and depth of practice. Mid-level “physician extenders” such as physician assistants already provide excellent healthcare in almost every area, such as hospital emergency rooms, urgent care centers, schools, free-standing and extended care facilities and intensive care units.
Nurse practitioners, midwives and nurse anesthetists also provide superb care in many of these areas. A larger community presence of such a practitioner could relieve the burden on doctors offices and emergency rooms, free up ambulances to provide the care for which they were designed: emergencies; and provide cost-saving measures that would ensure more individuals have access to quality healthcare.
What is an ‘advanced practice paramedic’?
An advanced scope of practice, a clinical advancement ladder, and opportunities to provide expanded services to those that need it most are all valid reasons to promote this type of care. While not universally recognized, this idea has blossomed in small pockets of North America and been formulated into a valuable advanced specialty of EMS in Great Britain and Australia. A few challenges preventing this idea from becoming a widespread reality: there currently is no national regulating body, no standardized curriculum and not much of a perceived need for this type of practitioner. Regardless, the design is taking shape and “advanced practice paramedics” are providing care.
Utilization of available resources, advanced training and “streamlining” access to quality healthcare are common themes behind the idea of a “community-based” paramedic, capable of providing “in-home” care for minor ailments, healthcare education, health-promotion services and advanced, state-of-the-art emergency care that communities have grown accustomed to. This idea has the potential of saving valuable healthcare dollars while relieving a strained emergency care system and potentially overburdened community emergency department.
A story that piqued the interest of many EMS1 readers (including this one) as I was preparing to write this piece was posted in November called “Colo. County considers new prehospital care model”. In cooperation with Colorado’s Western Eagle County Ambulance District, Eagle County Public Health and the Colorado Rural Health Center, a new five-year prehospital care delivery model is being considered. With 200 hours of advanced training, these paramedics will be able to perform vital community-based care. The one line in that story that perfectly describes the vision is “Paramedics are, by job description, emergency medical providers. But what if they became involved in patient care before the accident happens?” (1)
In Winnipeg, Canada, the Winnipeg Fire Paramedic Service is utilizing specially trained paramedics to answer increased community needs for healthcare. Responding in a specially equipped sedan, these paramedics can respond quickly to minor and urgent emergencies as well as life-threatening emergencies. Utilizing a comprehensive triage checklist, similar to those used in an emergency department, these paramedics are trained to place priority of transport and care, treat minor ailments and arrange for the best mode of transport to the most appropriate facility should the need for transport arise(2).
Wake County EMS in North Carolina began an advanced practice paramedic program (APP) in January 2009. This program is designed to augment and improve the already high quality EMS delivery system. The program uses 5 specially equipped and designed response units. These paramedics operate independently and possess the ability to assist ambulance crews should the need arise. The program in Wake County has specific objectives based on the needs of the community.
The goal
One objective is to mitigate crisis situations for patients in the community with specific medical conditions (e.g., diabetes, pediatric asthma, congestive heart failure). By providing close monitoring, at-home care and education to patients and families, healthcare dollars are saved. In addition, overall patient well-being is enhanced and the need for ambulance response is reduced.
Another objective of the Wake EMS APP is to assist with the care of individuals in the community suffering from mental illness or substance abuse crises. These individuals often benefit from care that would utilize resources other than those offered in an already overburdened emergency room.
An APP and responding ambulance crew can evaluate a patient and decide the most appropriate treatment, which may include free-standing mental health facilities, out patient substance abuse treatment centers, or the local emergency department. Based upon needs, the APP will determine the most appropriate treatment option and arrange for the patient’s transportation and admission.
Additionally, an APP may respond alongside an ambulance crew for the most critical patient care situations. In addition to the primary care training received, a Wake EMS APP is experienced and skilled in emergency and critical care situations in order to supplement care being provided by responding ambulance crews. An APP is required to complete an intense 225-hour academy that will prepare them for their new, expanded role within the community(3).
Taking this model to the ‘next level’
A masters degree prepared EMS provider trained to be a “physician extender” is exactly this next level. With the current shortage in general care practitioners and increased need for healthcare, this seems to be a logical step for EMS to take. This is a bold initiative that has already seen some success in Great Britain. Intriguing? While likely not a chosen career path for all EMS providers, this certainly would provide the profession with something it has been long overdue for: a clinical ladder. If at all interested, readers are encouraged to visit the American Society for the Advancement of Paramedicine’s (ASAP) Web site to see what is being done to accomplish this goal.
References
1. EMS1.com News. Colo. County considers new prehospital care model. http://www.ems1.com/ems-management/articles/607051-Colo-county-considers-new-prehospital-care-model/. 25Nov2009. Accessed January 8, 2010.
2. Welch MA. Sedans may Replace Ambulances: Move Mulled to Free up ER’s. Winnipeg Free Press On-Line http://www.winnipegfreepress.com/breakingnews/sedans-may-replace-ambulances-64477607.html. 10Oct2009. Accessed February 4, 2010.
3. Wake County EMS. Advanced Practice Paramedic (APP). http://www.wakegov.com/ems/staff/app.htm. Accessed February 4, 2010.
