How community paramedics use point-of-care devices
Handheld, portable blood analyzers used by community paramedics to assess heart failure patients and make prehospital care decisions
SALT LAKE CITY — Point-of-care testing is a tool for community paramedic patient assessments in the out-of-hospital setting that is convenient for the patient and providers, easy to use, leads to a more prompt field diagnosis and results in more timely treatment. Desiree Partain, clinical program manager with MedStar Mobile Health, introduced how community paramedics are using handheld, portable blood analyzers in a presentation at EMS Today.
Partain discussed the benefits and drawbacks to consider, as well as the regulatory hurdles, involved in implementing point-of-care testing. Much of the presentation was based on the lessons Partain and MedStar has learned through implementing its point-of-care testing program
Memorable quotes on point-of-care testing by community paramedics
Partain repeatedly emphasized the importance of first defining the department's goals for a community paramedicine program. The program goals, along with the target patient population, should drive the decision to purchase a handheld blood analyzer. Here are three memorable quotes from Partain's presentation.
"The important thing is identifying the needs of your specific (community paramedic) program. Truly define what is important to your agency. What patient populations are you going to be treating?"
"Get the right equipment to meet the needs of your program and the patients you are trying to serve."
"If we are giving paramedics point-of-care devices, we need to give them information on how to use the data."
Top takeaways of point-of-care testing
Partain's presentation was a helpful introduction to point-of-care testing and how it has been implemented by MedStar mobile integrated health care personnel. Here are the top three takeaways:
1. Benefits of point-of-care testing
The benefits of point-of-care testing include speed, portability, convenience, connectivity and quality assurance. A portable blood analyzer allows community paramedics to provide more information to physicians than they could do with vital signs and a physical exam.
2. Understand regularity requirements
EMS clinical managers need to review and understand the Clinical Laboratory Improvement Amendment (CLIA) waiver requirements. A CLIA waiver is most likely to be granted when there is low risk for incorrect results, such as blood glucose testing or a CHEM 8 which is chemistry, electrolytes, hematology and blood glasses.
3. Treatment goals come first
Partain described a post-discharge heart failure patient and how a field diagnosis with point-of-care testing led to earlier intervention for the patient. The treatment, provided in the patient's home, was quicker and more convenient for the patient than transport and treatment at the hospital.
A point-of-care testing program needs to driven by goals for specific patient populations. The testing needs to be articulated in specific patient protocols, such as a heart failure protocol. The MedStar protocol directs both the use of an iSTAT device and what to do with the data the iSTAT returns.
Learn more about point-of-care testing
Partain discussed the importance of initial and ongoing education. Here are several articles about prehospital conditions which might benefit from handheld, blood analyzer data.
- A salty tale: What EMS personnel need to know about electrolyte disorders
- 6 useful sepsis assessment and treatment tips
- 4 things paramedics need to know about capnography and heart failure
- 4 steps to prepare for prehospital antibiotic administration
- Drunk versus diabetes: How can you tell?
- Remember 2 Things: How to avoid common glucometer mistakes
- Remember 2 Things: How to best obtain a glucometer blood sample
- How to get an accurate glucose reading for diabetic patients
- Blood glucose test for altered mental status