Paramedics Providing Care?

[NewtonsApple]

I read this article in one of the AAPA newsletters sent out yesterday. I like this idea for various reasons. First, I think anyone that can be utilized to provide health care should be utilized. Further, to me (as a PA-S), it seems that the care provided is well within the scope of what a EMT-P can provide. The 2 links are to the AAPA article and the more in depth NPR news article.

 

http://www.aapa.org/advocacy-and-practice-resources/state-advocacy/2881-minnesota-bill-authorizes-practice-of-community-paramedics

 

http://minnesota.publicradio.org/display/web/2011/06/20/ground-level-rural-health-care-midlevel-practitioners-telemedicine/

 

"First law in the country to formally recognize community paramedics. The legislation allows specially-trained paramedics expanded responsibilities as long as they are supervised by a physician.

 

According to law, a certified community paramedic may "provide services as directed by a patient care plan if the plan has been developed by the patient's primary physician, an advanced practice registered nurse, or a physician assistant, in conjunction with the ambulance service medical director and relevant local health care providers." The bill also provides for reimbursement under the state Medicaid program for services that community paramedics provide.

 

 

A community paramedic is trained to address a patient's immediate medical issues without requiring a trip to the emergency department, including suturing lacerations, helping a patient adjust blood sugar levels, or talking through a mental health issue."

[Just Steve]

http://www.physicianassistantforum.com/forums/showthread.php/25974-To-PAs-in-pre-hospital-EMS

 

here is a link within the EM forum that compliments your thoughts

 

The concept of non college trained providers taking care of others under the direction of a physician has been around for a century or so...some people call it military medicine...Personally, when I was doing it as a Navy Corpsman, I called it "practicing medicine without a license". As a current paramedic, I do believe there is a niche for it out there. You just have to find the right medics to do it. It's a mind set as much as it is a skill set.

[Jambi]

This is how I see EMS evolving in the future, as a more completely integrated part of the healthcare system with changing focus from only EMS to more emphasis placed on pre/out of hospital care. While there are many hurdles that need to be faced, change is inevitable.

I won’t go off on too far of a tangent, but to make any change meaningful and lasting, the paramedic profession must go through an educational evolution similar to what Canadian, New Zealand, the UK, and Australia have in place. Without education behind the profession EMS will remain occupational technical training with a handful of merit badges similar to fire fighting but without the strong national organizations telling everyone that will listen we’re important.

I could a million different directions with this, but I am seriously considering forgoing PA school for the MHSc/DHSc degree program at Nova to take up the cause.

[ohiovolffemtp]

It's interesting to me that the comments from the Minnesota Nursing Assn about paramedics are very similar to those from the ANA about NP's being the same as physicians - that nursing education and experience is somehow unique. Paramedics learn algorithms just like RN's do - as part of overall patient assessment and care. Paramedics are very much educated to assess and treat patients. Many of us have long term relationships with patients, especially those with chronic health problems - because we see them so often. The real key is the mindset, experience, and knowledge of the individuals. I'm sure each of us can cite experiences ranging from excellent to horrible with physicians, nurses, paramedics, and the whole gamut of other health care workers.

[SocialMedicine]

who are the physicians providing this supervision training .... DEPT OF HEALTH? Fire Dept Medical Director? and why would a Medical Doctor or PA want to take on this responsibility?

[acozadd]

Who is calling a paramedic for a simple laceration? or blood sugar control?

[EMEDPA]

Who is calling a paramedic for a simple laceration? or blood sugar control?

lots of folks. when I was an l.a. county medic we used to get 911 calls for splinters and constipation. seriously.

that's 1 reason so many medics get burned out; bogus calls. if everyone who called 911 really needed to I would still be a medic today. probably only 10% of 911 calls are legitimate emergencies. many are just taxi cab rides or abuse of the system.

one of my partners used to have a license plate frame:

UNLESS YOU ARE DYING TAKE 2 ASPIRIN AND LET A PARAMEDIC SLEEP.

[Just Steve]

Who is calling a paramedic for a simple laceration? or blood sugar control?

 

common chief complaints:

I'm drunk

My friend/lover/family member is drunk

I'm high

My friend/lover family member is high

I was in a car wreck last week and my ankle is starting to ache

I can't sleep

I think that guy over there is dead

I am thinking about hurting myself

I cut myself with this paper clip

I think I might be getting one of my regular migraines. I need dilaudid to deal with it

I get seen by a doctor faster if I go by ambulance

I can't get an appointment to see my regular doctor for my follow up appointment

I got bit by spiders while up in the woods 10 days ago, the bumps won't go away

 

I could fill volumes of actual material just like this.

 

Our medical director, in an attempt to minimize their risk, had strict orders "they call, we haul, that's all". Meaning, medics did not have the option to treat and street. Everyone got a ride if they wanted one.

[EMEDPA]

common chief complaints:

I'm drunk

My friend/lover/family member is drunk

I'm high

My friend/lover family member is high

I was in a car wreck last week and my ankle is starting to ache

I can't sleep

I think that guy over there is dead

I am thinking about hurting myself

I cut myself with this paper clip

I think I might be getting one of my regular migraines. I need dilaudid to deal with it

I get seen by a doctor faster if I go by ambulance

I can't get an appointment to see my regular doctor for my follow up appointment

I got bit by spiders while up in the woods 10 days ago, the bumps won't go away

 

.

 

my favorite bar is near the hospital and I can't afford a taxi ride.

I think there is a screwdriver in my butt and I don't know how it got there

I'm scared because my boss hates me

I've got bumps on my junk

how long does it take valium to get out of your piss? can you give me something to speed that up?

etc, etc, etc

welcome to the life of a metro medic

[Contrarian]

Yeah... yeah... yeah... BTDT.

 

Still...

 

There are tooooooo many things that can be overlooked and/or go wrong that the EMT-P just isn't trained to recognize... let alone even look for.

 

If I was the AAPA head... Like the nurses, I'd fight this ill-formulated Idea also.

 

As a former medic, its very clear to me that this is a "muscle in" ... encroach on OUR (PA/NP/MD/DOs) territory.... and yeah, yeah... I'm sure I'm gonna get the idealistic well-meaning speech about just making sure everyone has access, and that it shouldn't be about professional "turf/territory"... but the reality of the situation is that the individual scope of practice of each profession is there for a reason.

 

Hell... we already got folks like psychologist who didn't take any/many science/biology/chemistry/biochem classes prescribe in some states. Whats next...???

Will these EMT-Ps begin working in Acute/Urgent Care and Family Practice clinics as a cheap alternative to PAs/NPs...??

 

Yeah... I can forsee a situation where a huge portiions of PAs/NPs can only find work in the inner city and are otherwise underemployed ... and trying to figure out why they paid $80-$100k to become PAs since a rural EMT-P has the same scope of practice but is favored because they are cheaper.

 

Kinda reminds me of when the hospitals were trying to lay off RNs and replace them with PCTs to cut costs. Thing was... I was a PCT III (EMT-P) working in the ED while attending Nursing school when this was going down. It got really ugly.

 

Want to practice medicine... get the training, credentials, and license to do so, versus simply lobbying to lower the standards.

 

The Solution to the precieved problem is: If you want this level of care out there on the door steps and curbsides of the public... then hire PA-Cs/NPs to do it.

DO not "lower the standards" of care by pretending like inadequately trained folks (EMT-Ps) can do the jobs of trained and experienced PAs.

 

My $0.02

 

YMMV

 

Contrarian

[Just Steve]

I fixed your reply there for you

Still...

 

There are tooooooo many things that can be overlooked and/or go wrong that the PA just isn't trained to recognize... let alone even look for.

 

If I was the AMA head... Like the nurses, I'd fight this ill-formulated Idea also.

 

As a former medic, its very clear to me that this is a "muscle in" ... encroach on OUR (MD/DOs) territory.... and yeah, yeah... I'm sure I'm gonna get the idealistic well-meaning speech about just making sure everyone has access, and that it shouldn't be about professional "turf/territory"... but the reality of the situation is that the individual scope of practice of each profession is there for a reason.

 

Hell... we already go folks like psychologist who didn't take any/many med school quality classes prescribe in some states. Whats next...???

Will these PAs begin working in Acute/Urgent Care and Family Practice clinics as a cheap alternative to MDs...??

 

Want to practice medicine... get the training, credentials, and license to do so, versus simply lobbying to lower the standards.

 

The Solution to the precieved problem is: If you want this level of care out there on the door steps and curbsides of the public... then hire MDs to do it.

DO not "lower the standards" of care by pretending like inadequately trained folks PAs can do the jobs of trained and experienced MDs.

 

My $0.02

 

YMMV

 

 

In all seriousness, I hear your point and I agree to a point. However, I don't think paramedics who have the right training and right mindset are incapable of determining the need of immediate need verses sub acute need. There are about 2 gazillion things out there that need medical attention in a sub acute manner than can be handled remotely or at the least, outside an ER. At least a paramedic with a few years of experience have some HCE, which is a far cry from what is rapidly becoming the vast majority contrast to the PAs being graduated from PA-C programs.

 

the quote paraphrase was partially in jest but I could defiantly see that speech being given by a member of the AMA about PAs. Wouldn't surprise me to find out it was given 40 years ago.

[Contrarian]

If it was a "quote redo"... then its NOT a quote.

So now YOU are asserting that I wrote things that i did not...

 

You need to rectify that.

[Just Steve]

paraphrase a better term?

[Contrarian]

paraphrase a better term?

 

 

you are missing the point.... 'quote-paraphrase' is a oxymoron

 

I under/overstand your intent and get what you were doing/saying, its the form that's improper...

 

YOU HAVE CHANGED MY WORDS AND YOU ARE CALLING the CHANGE you made A "QUOTE."

 

You either need to include my ORIGINAL unaltered post in the blue quoted section (as it starts with "originally posted by contrarian") and make your comments/insertions/assertions in red there or remove the "originally posted by contrarian" from the begining of that section and carry on, because I didn't "originally post" anything about the AMA or MDs or med school quality...

 

Capice...???

 

In all seriousness, I hear your point and I agree to a point. However, I don't think paramedics who have the right training and right mindset are incapable of determining the need of immediate need verses sub acute need. [i agree... I just think that "the right training and right mindset" comes from PA/NP/MD/DO school.] There are about 2 gazillion things out there that need medical attention in a sub acute manner than can be handled remotely or at the least, outside an ER. [Correct... and it takes the "the right training and right mindset" to recognize and treat them to reach a favorable and adequate disposition. This "right training and right mindset" usually comes from a program that teaches the practice of medicine. These programs currently exist as PA/MD/DO programs.] At least a paramedic with a few years of experience have some HCE, which is a far cry from what is rapidly becoming the vast majority contrast to the PAs being graduated from PA-C programs. [How/why is this "strawman" relevent...??? What is the value in comparing a Medic " with a few years of experience" to a new grad without "a few years of experience"..?? One has experience and one doesn't so I really don't get your point with this comparison. Now if you wanna compare a "paramedic with a few years of experience" to a PA-C with a few years of experience (who may or may not also be a paramedic) thats a whole nother conversation. Anywho... FyI... most PA programs require and/or select from applicants with about as much experience as is required to sign up for a EMT-I course. Also, consider that a EMT-B doing "C" car SNF--> Dr.s Appointments--> SNF transports all day, every day can sign up for a EMT-P course after 6 months "experience." This same person can complete this course, get his/her NREMTP and then NEVER handle a #7 et tube again except in training/testing.

 

the quote paraphrase was partially in jest but I could defiantly see that speech being given by a member of the AMA about PAs. Wouldn't surprise me to find out it was given 40 years ago.

 

IMNSHO... the correct way to go about this would be to actively recruit PA-Cs who are/were EMT-Is/Ps.

They could also send medics to PA School and/or send PAs to accelerated EMT-P programs.

 

YMMV

 

Contrarian

 

P.S... notice that I didn't actually change anything YOU wrote. Your "quote" is still intact and unadulturated.

[EMEDPA]

C- I removed your name from his quote alteration.

he doe s have a point though...not that I am in favor of extended scope medics...sure, let them decide that care doesn't need to happen in a hospital but letting them do lac repair, etc could be bad...suturing in fb's, missing fxs, etc

it was bad enough when they tried to train er nurses to do it. lots of complications as above so we scrapped the project in about 3 months.

[Contrarian]

Thanks for correcting that.

 

Yes he does have a point...

I too think medics should have a extended scope, I just don't know that this should be it. Medics aren't PAs.

Based upon my experience it can ALL go bad.

 

Still today, my nurses (RNs with decades of experience) have to literally argue and get into 'pissing matches' with medics when they call for transport from facilities to the EDs.

 

I can't count the number of time medics have been called to transport a patient from a facility that I have worked at as either a nurse, or a PA assistant medical director... and arrived with a "ParaGod" demeanor and attitude with the staff as if they were being "bothered."

 

The silliest thing about this behavior to me is that in my former work as a medic... I wanted as much info as I could get from the folks that had the most recent experience with the patient. If/when I was called to a facility where trained caregivers were concerned about the status of a patient... then I ASSumed that there MUST be something wrong with the patient. Hell... I only get to see the patient for a few minutes... that caregiver (usually licensed/registered nurse) KNOWS this patient and has spent considerable time recognizing normal versus abnormal in this patient. I always felt that if they were concerned... then I damn well better heed and be concerned cause I really don't know this patient like they do.

 

Most recent examples include:

 

Called to transport a longterm patient with decreased LOC. Medics argued that patient was "faking" because ECG was WNL and Vitals and FSBG was only 300.

Patient was T2DM and actually had NKHS, was bone dry and hypotensive.

 

Called to transport a newly admitted patient with rapid (12hr) decreased LOC. Different Medics argued that patient was "faking" because there was no indication of anything wrong (Vitals WNL) and we are in a psych facility. Patient found to be suffering from NMS (CPK-7k, Cogwheeling, Myoglobinuria, etc)

 

Called to involuntary "Inpatient Psych Facility" to transport a elderly psychotic patient after unexplained LOC... with PMH of CHF, S/P MI x 3, T2DM, HypoThyroidism, ... took patient out to bus... brought patient back and stated that the patient didn't want to go to the hospital... AND that in their professiional opinion, didn't need to go...!!!!

 

I lost my $hit on this one..!!! Eventuall had a talk with Med-Control. Patient found to have a evolving CVA...

[Jambi]

Like it or not, this will eventually happen. Not in the nightmare way that Contraian is suggesting, though it is amusing that it's the same fear and argument that every other profession makes about any other profession that expands and evolves. Just saying…

The problem is that everyone sees this as equipping paramedics, who are already really undereducated for what there are doing, tossing a 100 hr merit badge class at them, and allowing them to have a vastly expanded scope. This not going to happen. First, the firefighting organizations don’t want anything to do with this. Ironically, they’re also the reasons EMS education is not really education but technical training.

Ideally, the PA would be what is needed in this role, and while there are EMS-PA’s out there (North Carolina comes to mind), but that’s also not going to happen unless there is a major change in the way healthcare is delivered. The paramedic level of licensure, regardless of its evolution in the future to something more like the Canadian or New Zealand system, or even expanded beyond, should not, nor would not be at the same level of what PA is. Rather, what would be more appropriate is something more intermediate between what paramedic is today and a PA. I believe the Independent Duty Corpsman model may be useful here as it is very much a hybrid and similar to what I’m speaking about.

I am not an advocate of medics ever doing too much. Lac repair, really, not a good idea IMO. There a many things that should remain the purview in the in-hospital/facility setting. I do not have a problem with more in home healthcare, patient education

[Jambi]

Thanks for correcting that.

 

Yes he does have a point...

I too think medics should have a extended scope, I just don't know that this should be it. Medics aren't PAs.

Based upon my experience it can ALL go bad.

 

Still today, my nurses (RNs with decades of experience) have to literally argue and get into 'pissing matches' with medics when they call for transport from facilities to the EDs.

 

I can't count the number of time medics have been called to transport a patient from a facility that I have worked at as either a nurse, or a PA assistant medical director... and arrived with a "ParaGod" demeanor and attitude with the staff as if they were being "bothered."

 

The silliest thing about this behavior to me is that in my former work as a medic... I wanted as much info as I could get from the folks that had the most recent experience with the patient. If/when I was called to a facility where trained caregivers were concerned about the status of a patient... then I ASSumed that there MUST be something wrong with the patient. Hell... I only get to see the patient for a few minutes... that caregiver (usually licensed/registered nurse) KNOWS this patient and has spent considerable time recognizing normal versus abnormal in this patient. I always felt that if they were concerned... then I damn well better heed and be concerned cause I really don't know this patient like they do.

 

Most recent examples include:

 

Called to transport a longterm patient with decreased LOC. Medics argued that patient was "faking" because ECG was WNL and Vitals and FSBG was only 300.

Patient was T2DM and actually had NKHS, was bone dry and hypotensive.

 

Called to transport a newly admitted patient with rapid (12hr) decreased LOC. Different Medics argued that patient was "faking" because there was no indication of anything wrong (Vitals WNL) and we are in a psych facility. Patient found to be suffering from NMS (CPK-7k, Cogwheeling, Myoglobinuria, etc)

 

Called to involuntary "Inpatient Psych Facility" to transport a elderly psychotic patient after unexplained LOC... with PMH of CHF, S/P MI x 3, T2DM, HypoThyroidism, ... took patient out to bus... brought patient back and stated that the patient didn't want to go to the hospital... AND that in their professiional opinion, didn't need to go...!!!!

 

I lost my $hit on this one..!!! Eventuall had a talk with Med-Control. Patient found to have a evolving CVA...

 

All this sums up my thoughts as well. Why there are EMS professionals out there, I hesitate to refer to EMS as a profession. In its current state it’s a vocation with no central professional identity. I think many of the problems with the implementation of education that's heavily based on sciences associated with national professional licensure (PANCE). A statement often read here is, "you don't know what you don't know." Education and closer association and integration with other medical professionals like PA's and physicians will help create professional respect and breed the right kinds of attitude and demeanor that is needed to move forward. Sometimes I swear that arrogance is a required skill in class these days...

[Just Steve]

You make a valid point with the pre requisite for Paramedic school is even less than the pre requisite for PA school. I do see the issue with a brand new paramedic being given a wider scope of practice directly out of school where they have no real clinical seasoning. The point I was striving to make though was that a paramedic with a few years on the job will have enough experience to take their scope of practice up a notch to allow for a bit more discretion in how/where the patient is treated. If we can take PAs with limited to no previous HCE and let them go to work treating patients under the guidance of a mentor/sp, then I don't see the stretch to expanding the SOPs of seasoned medics under the supervision of a medical director. How far to expand their SOPs and who will be granted this extra skill is the crux of the discussion.

 

Flight medics are along similar lines. Of the flight programs I know of, there isn't one of them that will take a medic without 4-5 years of experience in a busy service before putting them in the air. These folks have to demonstrate that the know which end is up before getting that career jump.

 

In the immediate future I see this discussion as a exercise in typing skills but not much more. I saw the writing on the wall for me and have managed to get myself into school. With a bit of work I hope to at least mentor some of my former partners in finding the ejection handle from the cab of the ambulance in the future. I don't see their scope expanding much further without some radical changes.

[Just Steve]

You make a valid point with the pre requisite for Paramedic school is even less than the pre requisite for PA school. I do see the issue with a brand new paramedic being given a wider scope of practice directly out of school where they have no real clinical seasoning. The point I was striving to make though was that a paramedic with a few years on the job will have enough experience to take their scope of practice up a notch to allow for a bit more discretion in how/where the patient is treated. If we can take PAs with limited to no previous HCE and let them go to work treating patients under the guidance of a mentor/sp, then I don't see the stretch to expanding the SOPs of seasoned medics under the supervision of a medical director. How far to expand their SOPs and who will be granted this extra skill is the crux of the discussion.

 

Flight medics are along similar lines. Of the flight programs I know of, there isn't one of them that will take a medic without 4-5 years of experience in a busy service before putting them in the air. These folks have to demonstrate that the know which end is up before getting that career jump.

 

In the immediate future I see this discussion as a exercise in typing skills but not much more. I saw the writing on the wall for me and have managed to get myself into school. With a bit of work I hope to at least mentor some of my former partners in finding the ejection handle from the cab of the ambulance in the future. I don't see their scope expanding much further without some radical changes.

[Jambi]

The model is not about taking a paramedic and tossing extra scope into his or her "bag." It is about evolving the paramedic into something more than what it is today. And as Just Steve said about nothing happening without drastic change in today's educational models, he's right. Paramedics and EMS in general is not trained or educated to the extend needed to fall into any kind of extended role, hell, paramedics are barely qualified to provided the care they do when comparing models of education and training with other professions.

Further, the idea of roving ambulances visiting people's homes in an attempt to provide a, "mobile ed," is a gross mischaracterization of what is likely to come about with less emphasis placed on evolving the ALS/911 aspect of EMS (while still preserving it) and instead evolving the pre/out of hospital aspect with the intention of extending the reach of the healthcare system to avoid the misuse of the current ED system.

There is no current system or support structure in place to support such initiatives, but the fact that such pilot programs are cropping up in different places should be seen as an indicator that it’s a service that is needs and can usefully impact current utilization of our healthcare systems. There is a system in North Carolina (I believe) that has taken seasoned paramedics and put them through additional training that focuses more on community health and long-term care. The paramedic is then assigned to a “flight car” where he or she then visits frequent flies and other at-risk individuals. In this role the paramedic provides patient education, assistance with medication, compliance, and devices, and helps establish them as patients with local medical practices and clinics. Each interaction is then documented and discussed with the appropriate healthcare providers, i.e. the patient’s PCP receives information about the visit, what was covered during the visit, problems with compliance, and any concerns the paramedic may have with the patient. I suppose that this is similar as the visiting nurse concept but on a more community-wide scale.

[Jambi]

The model is not about taking a paramedic and tossing extra scope into his or her "bag." It is about evolving the paramedic into something more than what it is today. And as Just Steve said about nothing happening without drastic change in today's educational models, he's right. Paramedics and EMS in general is not trained or educated to the extend needed to fall into any kind of extended role, hell, paramedics are barely qualified to provided the care they do when comparing models of education and training with other professions.

Further, the idea of roving ambulances visiting people's homes in an attempt to provide a, "mobile ed," is a gross mischaracterization of what is likely to come about with less emphasis placed on evolving the ALS/911 aspect of EMS (while still preserving it) and instead evolving the pre/out of hospital aspect with the intention of extending the reach of the healthcare system to avoid the misuse of the current ED system.

There is no current system or support structure in place to support such initiatives, but the fact that such pilot programs are cropping up in different places should be seen as an indicator that it’s a service that is needs and can usefully impact current utilization of our healthcare systems. There is a system in North Carolina (I believe) that has taken seasoned paramedics and put them through additional training that focuses more on community health and long-term care. The paramedic is then assigned to a “flight car” where he or she then visits frequent flies and other at-risk individuals. In this role the paramedic provides patient education, assistance with medication, compliance, and devices, and helps establish them as patients with local medical practices and clinics. Each interaction is then documented and discussed with the appropriate healthcare providers, i.e. the patient’s PCP receives information about the visit, what was covered during the visit, problems with compliance, and any concerns the paramedic may have with the patient. I suppose that this is similar as the visiting nurse concept but on a more community-wide scale.

[Contrarian]

... [brevity edit]... If we can take PAs with limited to no previous HCE and let them go to work treating patients under the guidance of a mentor/sp, then I don't see the stretch to expanding the SOPs of seasoned medics under the supervision of a medical director. How far to expand their SOPs and who will be granted this extra skill is the crux of the discussion.

 

Apples and oranges...

 

1.) New Grad PA-Cs... generally are NOT allowed to roam the country-side seeing patients independently. For the most part, many/most/all(?) states require close supervision of new grads by doing things like requiring chart review AND cosignature and restricting the use of new grads at "remote-sites." So functionally speaking, most new-grads spend a significant portion of their time practicing under the same roof, elbow to elbow with their SPs. So what we have is a person with the extensive training of a PA practicing medicine under the close supervision of a MD/DO in a controlled environment.

 

2.) Seasoned and Un-seasoned Medics... are generally allowed to roam the country-side seeing patients de-facto independently. Med control is but a radio/phone call away, but really doesn't serve as a "supervisory" force unless invited into the equation. They may be "seasoned" but they are not "seasoned with the right spice. They were taught but a fraction of what the highly "supervised" new-grad PA knows... but will be expected to make "treat then street" decisions that require the knowledge and skill set of this same new grad PA-C without the benefit of the same training and/or same close supervision.

 

So as "PAMAC" pointed out... all of these "Medics" are still medics. Therefore, by definition, they aren't really trained to the level required to make 'primary care' triage decisions and the MINIMUM level/amount of training needed to get them safely there will essentially make them PAs.

 

Again... IMO... It simply makes more sense to hire and deploy PAs for this system to work.

It wouldn't require a PA for every ambulance either.

Maybe a PA every 12hrs daily.

More PAs or less PAs based upon a population density and call volume study/equation.

 

Just thoughts

[Contrarian]

... [brevity edit]... If we can take PAs with limited to no previous HCE and let them go to work treating patients under the guidance of a mentor/sp, then I don't see the stretch to expanding the SOPs of seasoned medics under the supervision of a medical director. How far to expand their SOPs and who will be granted this extra skill is the crux of the discussion.

 

Apples and oranges...

 

1.) New Grad PA-Cs... generally are NOT allowed to roam the country-side seeing patients independently. For the most part, many/most/all(?) states require close supervision of new grads by doing things like requiring chart review AND cosignature and restricting the use of new grads at "remote-sites." So functionally speaking, most new-grads spend a significant portion of their time practicing under the same roof, elbow to elbow with their SPs. So what we have is a person with the extensive training of a PA practicing medicine under the close supervision of a MD/DO in a controlled environment.

 

2.) Seasoned and Un-seasoned Medics... are generally allowed to roam the country-side seeing patients de-facto independently. Med control is but a radio/phone call away, but really doesn't serve as a "supervisory" force unless invited into the equation. They may be "seasoned" but they are not "seasoned with the right spice. They were taught but a fraction of what the highly "supervised" new-grad PA knows... but will be expected to make "treat then street" decisions that require the knowledge and skill set of this same new grad PA-C without the benefit of the same training and/or same close supervision.

 

So as "PAMAC" pointed out... all of these "Medics" are still medics. Therefore, by definition, they aren't really trained to the level required to make 'primary care' triage decisions and the MINIMUM level/amount of training needed to get them safely there will essentially make them PAs.

 

Again... IMO... It simply makes more sense to hire and deploy PAs for this system to work.

It wouldn't require a PA for every ambulance either.

Maybe a PA every 12hrs daily.

More PAs or less PAs based upon a population density and call volume study/equation.

 

Just thoughts

[ohiovolffemtp]

Most of the arguments about expanding the scope of care provided by paramedics seem to be falling into two categories:

1. I had this bad experience where a paramedic mis-handled a situation and this bad thing happened.

2. Paramedic training is just "trade-school" classes and not true medical education.

 

Neither provide the validity needed to preclude paramedics doing more than 911 type emergent responses or interfacility transports.

 

Each of us can cite many examples of excellent care provided by physicians, mid-levels, nurses, paramedics, and other providers. Each of us can also cite many examples of poor care provided by the same list of providers, and supplement it with how other providers, whether at higher or lower levels of training, caught those mistakes. None of this makes it possible to generalize from these specific cases to all providers of that level.

 

I've taught at both a university based paramedic program and an in-house paramedic program run by a large career fire department. Neither was "trade-school" education. We covered anatomy & physiology, pathophysiology, pharmacology, etc. This was the underlayment to the patient assessment and treatment education. It must have worked. Pass rates on the National Registry exam - the national exam most states use for paramedic certification - for both programs was above 95%. The paramedics must have learned well - they perform well in the field and continue to learn. Their knowledge must be pretty solid within their areas of expertise - the local university hospital uses them to train their nurses, residents, and staff physicians in ACLS, airway management, etc.

 

Expanding the scope of paramedics to do routine screenings, wound management, etc can work. You have to choose the proper persons and give them the right training. Just as not all RN's have what it takes to be good NP's, not all medics will have what it takes to do well in the expanded roles. Whether it's attractive for an area to do this will depend on local circumstances. An urban area with a stressed 911 system and plenty of hospitals might not get much value from it. A rural area with very limited hospital availability and long travel times might benefit from it greatly.