Fat Albert Posted November 21, 2012 Share Posted November 21, 2012 I'm sure that it's state-specific, but does anybody know if there is a state that allows this? Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted November 21, 2012 Moderator Share Posted November 21, 2012 i BELIEVE VIRGINIA DOES. CALIFORNIA AS WELL. I THINK YOU HAVE TO DEMONSTRATE THAT YOU HAVE AT LEAST AN EMT-BASIC CARD TO DO THIS. THERE IS A 2 WEEK INTENSIVE COURSE AT CREIGHTON IN NEBRASKA OPEN TO PA'S WITH AN EMT-B TO BECOME MEDICS. Link to comment Share on other sites More sharing options...
FfIghter23 Posted November 21, 2012 Share Posted November 21, 2012 Short answer: yes in most states, but there are a lot of hoops you have to jump through. The best thing to do is to just contact your state EMS office and get information from them. Check this link, it probably has the best information available about all the states (From2008): http://www.nasemso.org/NewsAndPublications/News/documents/NASEMSOsurvey051208.pdf Link to comment Share on other sites More sharing options...
Randito Posted November 21, 2012 Share Posted November 21, 2012 I'm wondering what advantages there are to this? Are there wilderness or other paid/volunteer opportunities in which being a PA/paramedic is an advantage due to no SP? Link to comment Share on other sites More sharing options...
Will352ns Posted November 21, 2012 Share Posted November 21, 2012 I wouldn't go into a paramedic test cold; it isn't easy. It's not that the information is hard, it is the way the NREMT and many States write the test. It's a tricky bugger. I know a Doc and a nurse that took the NREMT exam cold and failed it. When I went through P school I didn't find the information that earth-shattering as I was already a military medic, but the exam was b%%l-buster. Link to comment Share on other sites More sharing options...
beano Posted November 21, 2012 Share Posted November 21, 2012 in MA I believe a PA is exempt from the training but must still pass written and practical exams, as well as hold an EMT-B card. Link to comment Share on other sites More sharing options...
MedicinePower Posted November 21, 2012 Share Posted November 21, 2012 As an EMT-Intermediate (certified by the NREMT) and an EMT-B instructor I can tell you that knowledge≠passing the exam. The NREMT has a very particular way they want their questions to be answered. In addition there are questions about EMS laws, ambulance operations, etc that one needs to be familiar with. I would be very cautious about allowing any PA, NP, MD/DO from being able to challenge the NREMT-P exam simply as prehospital medicine is a completely different world from office and hospital-based medicine. In order to be allowed to take the NREMT exam we have to have gone to accredited training facilities which include a certain number of internship hours in the ambulance and ER. PA/NP/MD/DOs simply don't have this training and thus aren't prepared for pre-hospital medicine. I am strongly in favor of a 3 months program to bridge the two and provide for this experience and internship. Link to comment Share on other sites More sharing options...
aquafresh11 Posted November 21, 2012 Share Posted November 21, 2012 In Pennsylvania they have a pre-hospital PA certification. Link to comment Share on other sites More sharing options...
MedicinePower Posted November 21, 2012 Share Posted November 21, 2012 In Pennsylvania they have a pre-hospital PA certification. That's cool! Do you know who runs it? Link to comment Share on other sites More sharing options...
aquafresh11 Posted November 21, 2012 Share Posted November 21, 2012 It's not a class, it is a certification level that PA's can get to run pre-hospital in Pennsylvania without being an EMT. You just have to be a PA and pass a written and skills exam. I believe the official title is PHPE (pre-hospital physician extender). Link to comment Share on other sites More sharing options...
MedicinePower Posted November 21, 2012 Share Posted November 21, 2012 It's not a class, it is a certification level that PA's can get to run pre-hospital in Pennsylvania without being an EMT. You just have to be a PA and pass a written and skills exam. I believe the official title is PHPE (pre-hospital physician extender). Here's the statute from PA. Really cool. http://law.justia.com/codes/pennsylvania/2010/title-35/chapter-81/8119/ Link to comment Share on other sites More sharing options...
Moderator True Anomaly Posted November 22, 2012 Moderator Share Posted November 22, 2012 It's not a class, it is a certification level that PA's can get to run pre-hospital in Pennsylvania without being an EMT. You just have to be a PA and pass a written and skills exam. I believe the official title is PHPE (pre-hospital physician extender). While this does exist legally, the state has done NOTHING with it since it was passed. The state has to create an exam and recertification process to actually put this thing into effect, which hasn't happened, and there is no known reason as to why this hasn't happened. As someone who was aiming to be one of the first in Pennsylvania with this certification, I was really let down when we ran into many road blocks in trying to secure it. Hopefully in the near future things turn around and it actually gets put into effect, but by that time I may be leaving Pennsylvania. Link to comment Share on other sites More sharing options...
Just Steve Posted November 22, 2012 Share Posted November 22, 2012 A PA will over think paramedicine and delay transport. Link to comment Share on other sites More sharing options...
MediMike Posted November 22, 2012 Share Posted November 22, 2012 I'm in the process of contacting Washington's EMS credentialing office about it, I'll get back to ya'll about it! Link to comment Share on other sites More sharing options...
MedicinePower Posted November 22, 2012 Share Posted November 22, 2012 A PA will over think paramedicine and delay transport. That's not really true and I doubt it would be a bad thing. If the PA is trained in prehospital medicine then they will know when to discharge on scene, when to stay and play, and when to transport. The first two greatly expands the abilities of EMS from the current scenario, which is "you call, we haul". It reduces unnecessary ER visits and provides EMS with additional tools not previous available. Link to comment Share on other sites More sharing options...
EHOLDENPA-C Posted November 22, 2012 Share Posted November 22, 2012 FOR YOUR CONSIDERATION RE: PA'S IN THE FIELD. SOMETHING I WROTE FOR JAAPA A FEW YRS AGO(2005): http://www.jaapa.com/fast-track-in-the-field-another-option-to-ease-ed-overcrowding/article/124609/ Link to comment Share on other sites More sharing options...
SocialMedicine Posted November 22, 2012 Share Posted November 22, 2012 if you have the knowledge of a PA I am not too worried about stay and play mentality .... I would hope not anyway ..... Not sure I like the PA prehospital cert because of liability ... I will have to look into that more Link to comment Share on other sites More sharing options...
PM2PA Posted November 22, 2012 Share Posted November 22, 2012 As a medic about to enter PA school myself, this whole idea of PAs in the field looks good on paper but would probably fail IRL. For example, a lot of times simple calls that come out sounding as pure BS end up becoming a lot worse after an ER evaluation (headache turns out to be brain cancer). The solution to EMS overcrowding the ER lies within how the specific EMS/FD system operates itself (which is a lost cause to begin with). And to reply to the OP, the only real application I can think of for a PA to obtain his medic is to fly. In Florida I know RNs can challenge the medic test but first must sit in an EMT-B class for a full semester just like a first timer. After they pass the class and the subsequent state test, they can challenge the medic test. But without a real understanding of how EMS/paramedicine works, you're pretty much a "paper medic". I would assume this process holds true for everyone else. Link to comment Share on other sites More sharing options...
Just Steve Posted November 22, 2012 Share Posted November 22, 2012 There are several systems across the nation that use a split BLS/ALS system which in theory, preserves the medic for "true emergencies" and let the BLS crew handle the lower acuity calls. I worked for one...the triage system at the 911 operator station fails horribly. It is a rare time that a minute or so phone conversation can accurately triage a patient. Even with EMD que cards. The efficacy would not pan out to keep a significant amount of patients from the ER. PAs would find themselves on calls that require a more comprehensive work up than what can be performed in the field too many times. It may divert 8-10 patients from the ER, but for the same money and in a more comprehensive care center, that PA can see 7 times that many patients at a lower legal risk to the provider. As for a PA discharging the patient in the field...that means that the "paramedic PA" is conflating the two roles. In order to do so, the PA would need a SP to sign off on that practice. Do you know enough docs nationwide who would agree to be the SP for a PA to discharge a patient in the field after evaluating them in a poorly lit, trash filled, overcrowded living room at 2 a.m.? I am a strong advocate for making stand alone acute care clinics that are accessible only via EMS referral. Advanced trained paramedics triage the pt in the home/at the call site. When they decide that their issue is sub acute, that medic calls the clinic, makes an appointment for said patient, then calls a cab for that patient to take them to that clinic at their appointment time. This leaves more expensive and crowded ERs, with their access to OR, advance labs, CT/MRI, ICU with more open beds to treat the true emergent patient. Link to comment Share on other sites More sharing options...
Administrator rev ronin Posted November 22, 2012 Administrator Share Posted November 22, 2012 My BLS/ALS system usually works well--about 90% of the times, BLS calls are BLS or lower, and about 60% of the time, ALS calls result in ALS transport. Mind you, I'm an EMT-B/PA-C, so I about the only things I can use from PA school in the field are my knowledge and physical exam skills. I'm theoretically supposed to have a paramedic on scene looking over my shoulder before I use a glucometer, but most of the paramedics I run with know who I am. But at any rate, I think the best role for field/EMS PAs is for ED follow-up for poorly-managed patients, especially homebound ones. Not entirely sure how this would be funded, but stopping by and collecting follow-up labs, doing repeat evals, and chatting with patients with CHF, DM II, would cut down on both EMS calls and ED visits while decreasing morbidity and mortality. Lots of that could be done by other health professionals, but if you want someone who can actually adjust meds, you need an NP or PA... Link to comment Share on other sites More sharing options...
MedicinePower Posted November 22, 2012 Share Posted November 22, 2012 As for a PA discharging the patient in the field...that means that the "paramedic PA" is conflating the two roles. In order to do so, the PA would need a SP to sign off on that practice. Do you know enough docs nationwide who would agree to be the SP for a PA to discharge a patient in the field after evaluating them in a poorly lit, trash filled, overcrowded living room at 2 a.m.? Yes, in fact. The entire purpose of the PA is to evaluate, diagnose, and treat. If a PA is appropriately trained as a pre-hospital PA and working in such a capacity then the SP (or medical director, most likely) would be entirely fine with the PA doing this. It is the whole point of the PA profession, afterall. Link to comment Share on other sites More sharing options...
Just Steve Posted November 23, 2012 Share Posted November 23, 2012 Yes, in fact. The entire purpose of the PA is to evaluate, diagnose, and treat. If a PA is appropriately trained as a pre-hospital PA and working in such a capacity then the SP (or medical director, most likely) would be entirely fine with the PA doing this. It is the whole point of the PA profession, afterall. i do believe I have a pretty decent grasp on the role of a PA, but thanks for the clarification. We have different opinions on the situation and I look forward to reading your studies/results demonstrating the deployment, efficacy, and overall success of this endeavor. Please keep us posted. Link to comment Share on other sites More sharing options...
MedicinePower Posted November 23, 2012 Share Posted November 23, 2012 i do believe I have a pretty decent grasp on the role of a PA, but thanks for the clarification. We have different opinions on the situation and I look forward to reading your studies/results demonstrating the deployment, efficacy, and overall success of this endeavor. Please keep us posted. I, too, look forward to this but it does not appear to be moving in this direction. PAs are needed in primary care and tertiary care positions more than prehospital. As an EMT-Intermediate for the past many years I think it should be natural for paramedics to become PAs and transition from "you call, we haul" to actually treating and discharging on-scene, when warranted. Link to comment Share on other sites More sharing options...
Medic207 Posted November 23, 2012 Share Posted November 23, 2012 The fire department in my town recently announced an initiative to hire a PA in conjunction with the ED. The purpose is to see if better prehospital screening could avoid unnecessary transports/ED visits. It's still in the early planning stages. Link to comment Share on other sites More sharing options...
A1CAMERON Posted November 23, 2012 Share Posted November 23, 2012 PAs are utilized in the field (in very few locations) in conjunction with EMS to provide in-home care where appropriate i.e. suturing, minor Rx dispensing, etc. At this time, I believe they are on some type of on-call basis. My previous agency has asked if I would come back to perform that type of work; they claim that Medicare and some insurance services will reimburse better for in-home service vs. ambulance transport, at times. As for PAs in the field, if they obtain ACLS, PHTLS, PALS, BLS, and emergency services training such as the ICS system, HAZMAT Ops/Awareness training, and agency specific operations training- then by all means, hit the field. In Oregon, where I have practiced for 17 years, that has been the standard and statute for a non-EMT type to operate as a 1st or 2nd crew member on a 911 ambulance. Presumably, it would apply to a PA as well. Link to comment Share on other sites More sharing options...
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