Paramedic-run wound care team treats pediatric patients in Fla. ER

The program gives medics an expanded role in a different health care setting, and frees up nursing staff to work with more patients


By Naseem S. Miller
Orlando Sentinel

ORLANDO, Fla. — There's a special team at the emergency department of Nemours Children's Hospital that has one main responsibility: taking care of children's boo-boos.

The Boo-Boo Care Team for the past year has been treating kids' wounds: cuts, bites, stings, ingrown nails and other small injuries that bring children to the emergency room.

What makes the team unique is that it is made up of paramedics.

The presence of paramedics in the ER isn't new. Hospitals, including Orlando Health and Florida Hospital, hire paramedics as technicians to administer IVs, triage patients, draw blood or transport patients.

But Nemours and a few other hospitals across the nation are starting to give paramedics an expanded role and more responsibility, including wound care.

With an aging population and the looming physician shortage, "we need to try and get health-care providers to work at their top ability at multiple health-care settings," said Matt Zavadsky, a member of the board of directors at the National Association of Emergency Medical Technicians.

With their advanced training, paramedics in hospitals can "help alleviate some of the nursing staff to even do more work with more patients," said Zavadsky, public-affairs director for MedStar Mobile Healthcare in Fort Worth, Texas, and a University of Central Florida alum.

Nemours already hires close to 50 paramedics to staff its state-of-the-art logistics center to monitor patients around the clock. So when Earl Fowler arrived here from a children's hospital in Ohio, he didn't hesitate for long before trying to establish a paramedic-run wound-care team in the emergency room, similar to one he had worked with before in Ohio.

He had seen that such a team not only frees up nurses and doctors but also does a better job at stitching and caring for wounds, because that's the main thing it's responsible for.

"We try to fix [the wounds] as perfect as we can so in that way the outcome is perfect, and [patients] won't have to worry about scarring," said Fowler, nurse manager for Nemours' emergency department.

The Boo-Boo Care Team at Nemours has three members, and a fourth is in training. The paramedics undergo six months of training to learn how to stitch and care for wounds in different parts of the body.

"This training bridges the gap" in what paramedics already know, said Kevin Brito, 27, who leads the team. It also helps them shift their mind-set: from fixing patients to be handed off to the emergency department to, instead, caring for them so that they can go home, he said.

When patients arrive at Nemours' emergency room, a nurse at the front desk quickly assesses the patients. If the patient needs wound care, the nurse pages a paramedic.

Brito has found that patients whose wounds are fixed by paramedics spend about an hour less in the ER compared with those who have to wait for other providers.

The team then follows physician-approved protocols to discharge the patients and, depending on their wounds, follows up with them one or two weeks after discharge. The simple phone call, Brito said, can help prevent unnecessary hospital visits.

And there are also Boo-Boo Selfies. Willing patients can take a picture of their wound before and in intervals after repair.

"The families love it because it helps them to be involved," Brito said. The photos, which are sent to the care team via email, are used for educational purposes, or what Brito calls "Stitchy Situations."

Since getting established in June 2014, the team has cared for more than 600 patients. The hospital estimates that the initiative has saved close to 500 hours of emergency-physician time.

"It helps with our flow and our efficiency," said Dr. Nazeema Khan-Assad, medical director of Nemours emergency department. "It gives us a little bit of freedom to see another critically ill patient that may be we wouldn't get to see until an hour later."

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©2015 The Orlando Sentinel (Orlando, Fla.)

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