newguy Posted October 24, 2013 Share Posted October 24, 2013 1. Fire Departments nationwide are beginning to push "community paramedicine". Most are beginning to understand they need PAs/NPs - not medics. 2. IN PARTNERSHIP not competition with local hospitals and primary are providers - ultimate flex tool - prevent readmit, after hours urgent care, primary care 3. Would expand billing opportunities for fire to include Medicare A(? I know nothing about billing) 4. Here's the rub - Cailifornia Professional firefighters newsletter just came out saying they are leaning toward working with nurses union on this - HEADS UP AAPA and PAFT. PAs are decision makers and are made for this role. 5. Fire away. Just wanted to increase awareness. And this seems like it might be the equivalent of adding medics to fire back in the day - it makes sense It adds revenue to fire. It increases efficiency of medical delivery. Link to comment Share on other sites More sharing options...
MedicalRN Posted October 24, 2013 Share Posted October 24, 2013 Very interesting, I would love to see how that plays out, but it does make sense. I believe both PAs and NPs could handle this role. There are many NPs out there with years of RN experience working in Burn/Trauma or ED, then years of experience in the same field as an NP. They would be "made" for that role too and are also quite capable of making decisions. I agree though that PAs would be capable of the position and it should be open to both PAs and NPs rather than just NPs. Link to comment Share on other sites More sharing options...
UGoLong Posted October 24, 2013 Share Posted October 24, 2013 There is an effort underway to train the existing paramedics to be "community paramedics." A bridge class is in the works from what I hear (I still ride with my EMS unit a few times a month). I suspect this is more likely than having a PA or NP sit in the station and wait for calls. Link to comment Share on other sites More sharing options...
newguy Posted October 24, 2013 Author Share Posted October 24, 2013 1. Open to NPs absolutely - wary of union cooperation leaving non-union out ie PAs 2. Not waiting for calls. Proactively community dictated scheduling with hospitals and primary, as well as some urgent response 3. One year trial has been conducted saved local hospital decent $$$$ Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted October 24, 2013 Moderator Share Posted October 24, 2013 this idea has been around for years: http://journals.lww.com/jaapa/Fulltext/2005/06000/Fast_track_in_the_field__Another_option_to_ease_ED.10.aspx Link to comment Share on other sites More sharing options...
Will352ns Posted October 24, 2013 Share Posted October 24, 2013 This isn't the first time I have read about this either. Maybe this time it will get off the ground, but it always ends up in failure to launch. Could be a pretty cool gig for a PA with EMS experience, but I really see this as a local thing. EMS laws vary state to state, sometimes county to county. Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted October 24, 2013 Moderator Share Posted October 24, 2013 I am hoping that someday I will end up as an asst. ems medical director at a rural facility and do ride alongs with medics on a regular basis. Link to comment Share on other sites More sharing options...
Moderator ventana Posted October 24, 2013 Moderator Share Posted October 24, 2013 ugh.... midlevels..... we must only provide "mid level" care with doctors really providing the really good care..... Can we call ourselves "advanced practice clinicians", health care providers, or anything that does not conjure up thoughts of mediocrity? (very sarcastic tone.....) Link to comment Share on other sites More sharing options...
MedicalRN Posted October 24, 2013 Share Posted October 24, 2013 ugh.... midlevels..... we must only provide "mid level" care with doctors really providing the really good care..... Can we call ourselves "advanced practice clinicians", health care providers, or anything that does not conjure up thoughts of mediocrity? (very sarcastic tone.....) I think everyone caught that, but decided to let it slide since it wasn't the main point of the conversation. But yes, "midlevel" is sort of deragatory and disregards the fact that both NPs and PAs are careers in their own right, not lower level versions of physicians. Link to comment Share on other sites More sharing options...
PM2PA Posted October 24, 2013 Share Posted October 24, 2013 I would totally jump on this if it became main stream. But this seems like it would be big city only or very rich communities. Link to comment Share on other sites More sharing options...
Gordon, PA-C Posted October 25, 2013 Share Posted October 25, 2013 Nice idea in theory.... never going to work in practice unless PA/NPs agree to volunteer their services or take a huge salary cut. Think about it -- firefighters/EMS get paid peanuts. The calls you respond to are a bunch of Medicaid and uninsured people, so even if you could bill those insurances for your services you wouldnt get paid jack squat. PAs/NPs aint touching any kind of decent income unless they are supervising multiple fire/EMS crews from a central location. No way could you make anywhere close to a PA salary by hanging out at a fire station and responding to calls directly. Supervising EMS crews from a central location is already done -- usually by MDs so they aint movin out of the way so a PA could take their job. Dont get me wrong -- I think its a great idea. You just wont get paid for what you do there. Link to comment Share on other sites More sharing options...
beano Posted October 25, 2013 Share Posted October 25, 2013 Nice idea in theory.... never going to work in practice unless PA/NPs agree to volunteer their services or take a huge salary cut. Think about it -- firefighters/EMS get paid peanuts. The calls you respond to are a bunch of Medicaid and uninsured people, so even if you could bill those insurances for your services you wouldnt get paid jack squat. PAs/NPs aint touching any kind of decent income unless they are supervising multiple fire/EMS crews from a central location. No way could you make anywhere close to a PA salary by hanging out at a fire station and responding to calls directly. Supervising EMS crews from a central location is already done -- usually by MDs so they aint movin out of the way so a PA could take their job. Dont get me wrong -- I think its a great idea. You just wont get paid for what you do there. I don't think the idea is for the PA to respond to 911 calls. Community Medicine is more like scheduled visits for frequent flyers and recent discharges. The idea is to PREVENT the 911 call because the Pt needs a refill or they dont have a glucometer at home. I think the majority of funding would come from the hospital, 'm trading the cost of the visit for the cost of a readmission. It could probably save money, however, I don't see it being a lucrative business for the provider. Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted October 25, 2013 Moderator Share Posted October 25, 2013 I don't think the idea is for the PA to respond to 911 calls. Community Medicine is more like scheduled visits for frequent flyers and recent discharges. The idea is to PREVENT the 911 call because the Pt needs a refill or they dont have a glucometer at home. I think the majority of funding would come from the hospital, 'm trading the cost of the visit for the cost of a readmission. It could probably save money, however, I don't see it being a lucrative business for the provider. agree with your summary. this is mostly about saving the er for true emergencies and freeing up medic crews for real ems calls. Link to comment Share on other sites More sharing options...
Medic207 Posted October 25, 2013 Share Posted October 25, 2013 Correct me if I am wrong...I thought The community paramedicine concept is to train paramedics to function as a provider, more so than moving providers to the field. The experiments with PAs is to see if the model works. Link to comment Share on other sites More sharing options...
newguy Posted October 25, 2013 Author Share Posted October 25, 2013 That is the intent in many areas. Other areas are starting to realize that a higher level is needed to actually affect change in delivery, hence California Professional Firefighters indicating in a newsletter that they are working with the nursing union. Europe hasn't found much success with medics as providers, although one trial in New Zealand showed promise. Link to comment Share on other sites More sharing options...
dannydude57 Posted October 25, 2013 Share Posted October 25, 2013 Nice idea in theory.... never going to work in practice unless PA/NPs agree to volunteer their services or take a huge salary cut. Think about it -- firefighters/EMS get paid peanuts. The calls you respond to are a bunch of Medicaid and uninsured people, so even if you could bill those insurances for your services you wouldnt get paid jack squat. PAs/NPs aint touching any kind of decent income unless they are supervising multiple fire/EMS crews from a central location. No way could you make anywhere close to a PA salary by hanging out at a fire station and responding to calls directly. Supervising EMS crews from a central location is already done -- usually by MDs so they aint movin out of the way so a PA could take their job. Dont get me wrong -- I think its a great idea. You just wont get paid for what you do there. Good point, luckily my PA program is in the city that is piloting this program for the nation. They have set it up so that some of the students can do ride alongs. If I get the chance, I will ask this very question and post it here if I can. From what I understand, EMT/fire/911 is called to the scene. They evaluate the patient's condition. If they deems the patient needs to be transported to an ED, they do that. If the complaint is non-critical, they call the PA/NP response unit (sorry, I forgot what it is called at this time). They come and act as a mobile clinic, treating the patient at their home. From what I understand, these providers are employee's of the city. Link to comment Share on other sites More sharing options...
Moderator True Anomaly Posted October 26, 2013 Moderator Share Posted October 26, 2013 Good point, luckily my PA program is in the city that is piloting this program for the nation. They have set it up so that some of the students can do ride alongs. If I get the chance, I will ask this very question and post it here if I can. From what I understand, EMT/fire/911 is called to the scene. They evaluate the patient's condition. If they deems the patient needs to be transported to an ED, they do that. If the complaint is non-critical, they call the PA/NP response unit (sorry, I forgot what it is called at this time). They come and act as a mobile clinic, treating the patient at their home. From what I understand, these providers are employee's of the city. This is the kind of setup needed to do a trial run of PA's in a situation like this. It sounds very similar to what Arizona was doing during flu season a few years ago (can't remember if it was Tucson or Phoenix) where they would use PA's for house calls to prevent ED's from becoming overrun. I believe they worked for the city. DC Fire was also doing a trial run of PA's getting hand-off's from medics at ED's- the PA's worked for DC Fire, not the hospitals- would just continue care so that the ambulances could immediately turn around onto the street for more calls. People who have been around here for a long time know I attempted a sort of "EMS Fellowship" after I finished my residency, but ultimately it didn't work out like I was hoping, and now I'm not involved in EMS at any level. Medic25 is the most involved PA in EMS I've met yet, and his set up is pretty sweet. I agree with Gordon- the real crux of it all is who will pay for the PA and take on the liability. Ideally, preventing an ER visit/ambulance ride and the costs associated with it (if the patient was going to pay anything anyway) would justify the expense, but there's still several pratfalls for that to be translated well to a nation-wide adoption policy. Link to comment Share on other sites More sharing options...
FBIDoc Posted October 30, 2013 Share Posted October 30, 2013 http://www.examiner.com/article/hospital-partners-with-mesa-fire-dept-to-respond-to-911-calls http://www.usfa.fema.gov/pdf/efop/efo44936.pdf Link to comment Share on other sites More sharing options...
medic25 Posted October 30, 2013 Share Posted October 30, 2013 People who have been around here for a long time know I attempted a sort of "EMS Fellowship" after I finished my residency, but ultimately it didn't work out like I was hoping, and now I'm not involved in EMS at any level. Medic25 is the most involved PA in EMS I've met yet, and his set up is pretty sweet. If you ever decide to move north, I'm sure we could make a spot here for you! Link to comment Share on other sites More sharing options...
Moderator True Anomaly Posted October 30, 2013 Moderator Share Posted October 30, 2013 If you ever decide to move north, I'm sure we could make a spot here for you! You know I appreciate that, but right now Texas is too big of a draw :) Link to comment Share on other sites More sharing options...
HLReed Posted November 1, 2013 Share Posted November 1, 2013 ugh.... midlevels..... we must only provide "mid level" care with doctors really providing the really good care..... Can we call ourselves "advanced practice clinicians", health care providers, or anything that does not conjure up thoughts of mediocrity? (very sarcastic tone.....) ugh.... midlevels..... we must only provide "mid level" care with doctors really providing the really good care..... Can we call ourselves "advanced practice clinicians", health care providers, or anything that does not conjure up thoughts of mediocrity? (very sarcastic tone.....) Not sure what we are in the "middle" of. Still trying to find the Lowlevel clinicians that we are above. Those guys must have it rough. Link to comment Share on other sites More sharing options...
Doc Savage Posted November 1, 2013 Share Posted November 1, 2013 When I was in the Military when we suspected there would be a high casualty rate for certain missions, or missions that were remote and far from the echelon of care, the PA would go along on these missions. The combat medics were great and well equipped, but they had their limits. Im sure that with good surveys of what areas are furthest from care, and a excellent traige person knowing which calls would be most beneficial to have a advanced practice provider you could definately warrant a pilot program. With 20-30 million new insured customers and 8 hour ED wait times... some entrepreneur should start something. Link to comment Share on other sites More sharing options...
Recommended Posts
Archived
This topic is now archived and is closed to further replies.