Community Paramedics revisited

[Arovetli]

What pushback and how is it beneficial to a physician?

Paramedics will always have protocols and medical oversight. Even physicians, excepting self employed cowboys, themselves have local treatment "protocols" and guidelines and medical oversight and whatever the group or administrators dictate.

Here's why community paramedicine provided by high paid paramedics is dumb: Because. You. Can. Already. Do. It.

It's called getting an education. As a nurse or mid level or physician you can go out and do community care. All the stuff you want you can have now. You could even do house calls if you wanted. But rarely it gets done because there is no money for this, plus a host of other problems.

Instead of getting an education which already exists, or doing the job we have right for once, there exists a desire to stir special sauce into the concept of a paramedic and expecting the world to contort itself to salve the wounds of inadequacy, disrespect, and poor conditions. The irony is this is the same entitled garbage system abusing patients have: expecting something for nothing, ignoring reality, and waiting for Moses to come down off the mountain bearing salvation.

Is there a need for comprehensive community focused medicine? You bet. Could it be provided by a public health trained coordinator? You bet. Public health has already aligned itself as an academic field in this direction.

I don't need someone proficient in difficult airways and pressors and critical care getting paid big bucks to make sure Joe the diabetic is eating properly, granny is taking her meds, or Suzy gets to the local clinic instead of the ER.

In addition to the embarrassing ignorance of the science and technology being researched now and the amount of VC money flying around.

There is a much much greater chance of your iPhone being a "community paramedic" than there is a burnt out uneducated "ambulance driver" reinventing his career by being the doc of the block.

 

[pcbguy]

What pushback and how is it beneficial to a physician?

Paramedics will always have protocols and medical oversight. Even physicians, excepting self employed cowboys, themselves have local treatment "protocols" and guidelines and medical oversight and whatever the group or administrators dictate.

Here's why community paramedicine provided by high paid paramedics is dumb: Because. You. Can. Already. Do. It.

It's called getting an education. As a nurse or mid level or physician you can go out and do community care. All the stuff you want you can have now. You could even do house calls if you wanted. But rarely it gets done because there is no money for this, plus a host of other problems.

Instead of getting an education which already exists, or doing the job we have right for once, there exists a desire to stir special sauce into the concept of a paramedic and expecting the world to contort itself to salve the wounds of inadequacy, disrespect, and poor conditions. The irony is this is the same entitled garbage system abusing patients have: expecting something for nothing, ignoring reality, and waiting for Moses to come down off the mountain bearing salvation.

Is there a need for comprehensive community focused medicine? You bet. Could it be provided by a public health trained coordinator? You bet. Public health has already aligned itself as an academic field in this direction.

I don't need someone proficient in difficult airways and pressors and critical care getting paid big bucks to make sure Joe the diabetic is eating properly, granny is taking her meds, or Suzy gets to the local clinic instead of the ER.

In addition to the embarrassing ignorance of the science and technology being researched now and the amount of VC money flying around.

There is a much much greater chance of your iPhone being a "community paramedic" than there is a burnt out uneducated "ambulance driver" reinventing his career by being the doc of the block.

I read one of the recent articles from Minnesota that said, "Nursing groups were the biggest early impediment in Minnesota...."

I would imagine this is going to be a normal thing to get pushback from the nursing groups.

As for how it will benefit MDs, I think the less of the routine you have coming into the ED the more the pts you will have in the ED that actually need to be in the ED. This should free up the physicians for the pts that really need them. Also I read(here I believe) that return trips to the ED for the same problem won't be billable during the same month. I'm sure that was the short of it and there is more to the story but if an ED physician is seeing the same pt for the same thing a week later and can't bill for it, then it would have been beneficial for a CP to have seen that pt.

I know that this entire shift in the way we look at paramedicine is going to have to center around higher education. Also, even though You. Can. Already. Do. It., it's not being done and not on the level that these discussion are going toward. That's why there are these pilot programs that are trying to make advancements and improve a failing system.

There is a huge need for this and I suspect an even greater one in the near future. I don't think anyone here has insinuated that any burnt out ambulance driver should be considered or even function in the role of a community paramedic. Quite the contrary. All the discussion here has focused on the need for increased education. That will be an absolute.

There is a need for both the CP and the medic that is efficient in difficult airways and critical care and the street medic. There will be paramedics not interested in furthering their education to become a CP. Just like there re EMTBs that have not interest in becoming paramedics or paramedics that have no interest in becoming critical care paramedics. But there are a lot of us the see the need and would jump at the chance to further our education to become part of a better system of healthcare.

Hope that doesn't sound to cranky. You seem very negative toward the idea of Community Paramedics. I see you are a medic and looks like you are in med school. Don't you think that you would benefit working as a physician in the ED if you could see the pts that needed you and monetarily that you could bill for? I can't imagine the staggering number of frequent fliers that ED physicians have to see that could be handled by a CP.

This is of course all just my opinion after working at home and overseas and seeing the need for significant change in our system. I worked a service at home that ran 35,000 calls/yr with 8 full time trucks. A community with only 2 EDs that are both overrun everyday with pts that don't necessarily need to be there. I suspect that this is a common occurrence through out this country and the world or this wouldn't be such a hot topic.

 

[Arovetli]

It's not that I am opposed to community oriented care and readjusting the system, I'm just opposed to ignorance, despite how well intentioned it is.

 

[pcbguy]

It's not that I am opposed to community oriented care and readjusting the system, I'm just opposed to ignorance, despite how well intentioned it is.

Can't argue with that. Lets just hope this is all done appropriately with the emphasis being on education needed for paramedics to become CPs.

Great discussion. I hope more people get involved and would love to hear from some that are actually involved in these pilot programs. Like to hear what their take is on it.

 

[Clipper1]

Why do you need to invent another title? If you really wanted to make a difference for the PATIENT you would advance you education to obtain the title of PA, RN, Public Health RN, NP, PT, OT etc. Right now all of these areas have taken huge cuts in CMS reimbursement and really need support to get their clinics and home care services back to the patient. Instead of trying to divert funds to your own cause which essentially is nothing more than a band aid and another level of confusion, your own professional associations should be supporting the patient advocacy movements and the established professionals to keep services. All the other professional associations have banded together to support each other on the behalf of the PATIENTS in legislative issues. It seems EMS has its own agenda and what is best for the patient is not always considered. So don't expect other associations to abandon the efforts they have put forth over many years and rush to your side for a cert that is so limited. These patients need professionals who have taken the time to become experts in occupational therapy, physical therapy, diabetes, nutrition, wound care, asthma and COPD education. They need professionals who can do something for them even if it is a little personal hygiene which is "not the job" of a CP.

Usually RNs have advanced education and various specialized certs which require a least a couple years of experience working in that specialty along with up to 1000 hours of clinicals. This might include diabetes, nutrition, wound care or the Asthma or COPD educator certs. ACLS is great but the object is PREVENTITIVE medicine and not to work a code. Paramedics are trained to work emergencies. Assessing a patient and addressing their daily living needs are very different areas and a very different mindset. Just reading this forum and the many, many negative comments made toward patients who require just a little assistance or who have only the early onset of some major demonstrates the or at least this community is not ready for community health. Many have written this patients off as BS and a waste of time. You can not just change that attitude with 100 hours of additional training and a new cert.

 

[Ecgg]

Usually RNs have advanced education and various specialized certs which require a least a couple years of experience working in that specialty along with up to 1000 hours of clinicals. This might include diabetes, nutrition, wound care or the Asthma or COPD educator certs. ACLS is great but the object is PREVENTITIVE medicine and not to work a code. Paramedics are trained to work emergencies. Assessing a patient and addressing their daily living needs are very different areas and a very different mindset. Just reading this forum and the many, many negative comments made toward patients who require just a little assistance or who have only the early onset of some major demonstrates the or at least this community is not ready for community health. Many have written this patients off as BS and a waste of time. You can not just change that attitude with 100 hours of additional training and a new cert.

Please stop this charade with your superiority over medics.

Before making statements like that you need to clarify that you performed a nursing diagnosis which does not entail a medical diagnosis but adapting the medical diagnosis made by a physician to the patients limitations their condition may place on them and the nursing interventions along with nurse teachings you will perform.

You practice nursing not medicine, how many medical treatment decisions not nursing care plans but actual medications and procedures had you ordered? How many medical diagnoses have you made? You say running ACLS like it's a joke, how many codes have you ran as a nurse as the team leader?

 

[pcbguy]

Why do you need to invent another title? If you really wanted to make a difference for the PATIENT you would advance you education to obtain the title of PA, RN, Public Health RN, NP, PT, OT etc. Right now all of these areas have taken huge cuts in CMS reimbursement and really need support to get their clinics and home care services back to the patient. Instead of trying to divert funds to your own cause which essentially is nothing more than a band aid and another level of confusion, your own professional associations should be supporting the patient advocacy movements and the established professionals to keep services. All the other professional associations have banded together to support each other on the behalf of the PATIENTS in legislative issues. It seems EMS has its own agenda and what is best for the patient is not always considered. So don't expect other associations to abandon the efforts they have put forth over many years and rush to your side for a cert that is so limited. These patients need professionals who have taken the time to become experts in occupational therapy, physical therapy, diabetes, nutrition, wound care, asthma and COPD education. They need professionals who can do something for them even if it is a little personal hygiene which is "not the job" of a CP.

Usually RNs have advanced education and various specialized certs which require a least a couple years of experience working in that specialty along with up to 1000 hours of clinicals. This might include diabetes, nutrition, wound care or the Asthma or COPD educator certs. ACLS is great but the object is PREVENTITIVE medicine and not to work a code. Paramedics are trained to work emergencies. Assessing a patient and addressing their daily living needs are very different areas and a very different mindset. Just reading this forum and the many, many negative comments made toward patients who require just a little assistance or who have only the early onset of some major demonstrates the or at least this community is not ready for community health. Many have written this patients off as BS and a waste of time. You can not just change that attitude with 100 hours of additional training and a new cert.

I think this is pretty harsh. Where were the previous fields you mentioned in their infancy? They all started somewhere and non of them were designed to be community health or prehospital care. EMS and paramedicine was designed for emergencies and prehospital. I don't see anything wrong with expanding the role to help a stressed system. If those other professions want to do it that's wonderful. But if so then why haven't they? They haven't because of money. Well that's not exactly what's best for the patient either.

I don't recall anyone stating that these patients are BS. It has been said that they do not need to be at the ED as it is not an emergency. However they do need care to prevent some of their issues from becoming an emergency.

I have no problem with nurses, NPs or PAs doing community medicine but they aren't doing it. They are also needed at these EDs and clinics. Not out in the community when they are more valuable in the roles they are in. Part of the problem is the stressed workload of the EDs so what sense would it make to take the nurses and mid-levels out of the ED and into the community? Then you still have the few left in the ED to still handle the load of the ED.

Lets train and educate the people who are already working prehospital and going on these calls. Let's use them since they are already out there. There should be much more education so that they can make educated descisions on which ones can be treated at home vs. a trip to the ED vs. a trip to their pcp.

There's a place and role for everyone and there is still a gap. These programs are attempting to fill that gap. There's a lot of work to be done but these pilot programs are a step in the right direction. Maybe it's not needed in your area but I think it's safe to say that it is in most.

 

[VFlutter]

Please stop this charade with your superiority over medics.

Before making statements like that you need to clarify that you performed a nursing diagnosis which does not entail a medical diagnosis but adapting the medical diagnosis made by a physician to the patients limitations their condition may place on them and the nursing interventions along with nurse teachings you will perform.

You practice nursing not medicine, how many medical treatment decisions not nursing care plans but actual medications and procedures had you ordered? How many medical diagnoses have you made? You say running ACLS like it's a joke, how many codes have you ran as a nurse as the team leader?

First of all if Clipper is who everyone thinks she is then she is not a RN.

And by the same token you think Paramedics practice medicine? You provide treatment outside your protocols without medical approval?

By many of yout posts it is painfully apparent that you are ignorant to what nurses do.

ACLS is a joke...

RNs run codes all the time. It is not uncommon for us to get ROSC before the CCP even arrives. You act like a Medic would be team leader even if there was an MD present.

A quick example: I pull femoral arterial and venous sheaths after PCI. I have protocols and standing orders. I decide if and what to use for pain and sedation. I decide if I need to re-anesthetize with SubQ lidocaine. I do the entire procedure by myself with assistance from another nurse. If the patient vasovagals I decide what to do. I give atropine when I think it is appropriate. The only time I call a MD is if I want something not in the standing orders or something is going wrong.

How is this any different then a paramedic?

 

[Clipper1]

I think this is pretty harsh. Where were the previous fields you mentioned in their infancy? They all started somewhere and non of them were designed to be community health or prehospital care. EMS and paramedicine was designed for emergencies and prehospital. I don't see anything wrong with expanding the role to help a stressed system.

Harsh? Not at all as harsh as who some have stated here when it is suggested that RNs could work on ambulances. "No way can an RN work on an ambulance unless they go through the whole Paramedic training and get a Paramedic patch". A "PHRN" cert with a couple hundred hours of training is not good enough or so some Paramedics have stated. But, per you it is perfectly okay to do a short class of about 100 - 200 hours, get another "cert" and do what those in other professions have trained and worked for over a few years.


A lot of health care professions are still in their infancy.

Nurses also have been in emergency including prehospital medicince for over a century.

RNs, PTs, OTs and RTs are all geared for getting the patient home. They are not strengthening and educating the patient just to hang out in the hospital. OTs and PTs have all been going from the hospital to the home to evaluate the environment and order the appropriate equipment to train the patient and family on before discharge. This is what these professions train for in school. Their whole mission is to get the patient safely home and in an environment which is safe.

A large part of the nurse's training, either in school or on the job, is teaching over and over again. RNs also can take the BSN or MSN after their initial RN license and specialize in community health. They can do the clinicals along with their nursing experience to gain an insight on patient needs.

 

[Clipper1]

First of all if Clipper is who everyone thinks she is then she is not a RN.

Whatever....

I am not giving out any more personal information since it is pretty obviously this is an anonymous forum. There are also some here who claim to be Paramedics who seem to have missed a few chapters in their text and passed the test by luck if they really are Paramedics. I have identified myself to a couple of members for educational opportunities since they are here near U-Dub.

 

[Aidey]

Back on topic, now.

Clipper, if you can't post something constructive, don't post at all. That means contribute to the thread, don't talk down to anyone, and for every negative thing you say, you have to say something positive. If you can't manage that, then don't post.

 

[Ecgg]

First of all if Clipper is who everyone thinks she is then she is not a RN.

And by the same token you think Paramedics practice medicine? You provide treatment outside your protocols without medical approval?

By many of yout posts it is painfully apparent that you are ignorant to what nurses do.

ACLS is a joke...

RNs run codes all the time. It is not uncommon for us to get ROSC before the CCP even arrives. You act like a Medic would be team leader even if there was an MD present.

A quick example: I pull femoral arterial and venous sheaths after PCI. I have protocols and standing orders. I decide if and what to use for pain and sedation. I decide if I need to re-anesthetize with SubQ lidocaine. I do the entire procedure by myself with assistance from another nurse. If the patient vasovagals I decide what to do. I give atropine when I think it is appropriate. The only time I call a MD is if I want something not in the standing orders or something is going wrong.

How is this any different then a paramedic?

Let us look at nursing theory history

HISTORY

Nightingale (1860): To facilitate "the body’s reparative processes" by manipulating client’s environment
Paplau 1952: Nursing is; therapeutic interpersonal process.
Henderson 1955: The needs often called Henderson’s 14 basic needs
Abdellah 1960: This theory focus on delivering nursing care for the whole person to meet the physical, emotional, intellectual, social, and spiritual needs of the client and family.
Orlando 1962: To Ida Orlando (1960), the client is an individual; with a need; that, when met, diminishes distress, increases adequacy, or enhances well-being.
Johnson’s Theory 1968: Dorothy Johnson’s theory of nursing 1968 focuses on how the client adapts to illness and how actual or potential stress can affect the ability to adapt. The goal of nursing to reduce stress so that; the client can move more easily through recovery.
Rogers 1970: to maintain and promote health, prevent illness, and care for and rehabilitate ill and disabled client through "humanistic science of nursing"
Orem1971: This is self-care deficit theory. Nursing care becomes necessary when client is unable to fulfill biological, psychological, developmental, or social needs.
King 1971: To use communication to help client reestablish positive adaptation to environment.
Neuman 1972: Stress reduction is goal of system model of nursing practice.
Roy 1979: This adaptation model is based on the physiological, psychological, sociological and dependence-independence adaptive modes.
Watson’s Theory 1979: Watson’s philosophy of caring 1979 attempts to define the outcome of nursing activity in regard to the; humanistic aspects of life.

Please point out to me where it says your regular nurse can perform a medical diagnosis on a patient with medical problem and subsequently initiate and order treatments and direct patient care?

Additionally nursing diagnosis does not diagnose medical problems it addresses the deficits the medical diagnosis creates. This is not a derogatory statement.

http://www.staff.vu.edu.au/Nursing/Nursing/nursing_diagnosis_made_simple.htm

Through the nursing school nurses are not trained to perform medical diagnosis and prescribe medicine or perform invasive procedures upon their assessment.


Yes, Paramedics function on protocols and so do Physicians. I’ve bet your hospital ED has protocols for physicians for hypertensive crisis, sepsis, CVA, etc. Protocols are guidelines this does not absolve you as a provider from good clinical judgment at all times.

When you graduated RN school how many medical diagnoses have you made without calling a doctor? How many codes have you ran where you were a team leader and I don’t mean you are a team lead just until the code team arrives?

 

[Aidey]

What did I say about back on topic? The next person that posts about anything but community paramedicine will get my complete and undivided attention.

 

[pcbguy]

Harsh? Not at all as harsh as who some have stated here when it is suggested that RNs could work on ambulances. "No way can an RN work on an ambulance unless they go through the whole Paramedic training and get a Paramedic patch". A "PHRN" cert with a couple hundred hours of training is not good enough or so some Paramedics have stated. But, per you it is perfectly okay to do a short class of about 100 - 200 hours, get another "cert" and do what those in other professions have trained and worked for over a few years.

Can't find for the life of me where I said that it was okay t do a 100-200 hours course and do what others have done.

I actually have been saying this is a call for higher education for Paramedicine.

RNs, PTs, OTs and RTs are all geared for getting the patient home. They are not strengthening and educating the patient just to hang out in the hospital. OTs and PTs have all been going from the hospital to the home to evaluate the environment and order the appropriate equipment to train the patient and family on before discharge. This is what these professions train for in school. Their whole mission is to get the patient safely home and in an environment which is safe.

They are geared for getting the patient home. I haven't seen too many that follow the patient home. The home health care, at least in my area, is very minimal. Also if the RNs, PTs and the others were doing this then why would there be a need for these other programs popping up? Because they are not filling the gap. At least not adequately. There aren't enough RNs, PTs etc... to go around.

The point is that there is a need for this! Otherwise we wouldn't be having this discussion. More importantly the powers that be believe there is a need for this regardless of what we think. The need isn't going to go away. It's going to get worse.

A large part of the nurse's training, either in school or on the job, is teaching over and over again. RNs also can take the BSN or MSN after their initial RN license and specialize in community health. They can do the clinicals along with their nursing experience to gain an insight on patient needs.

RNs haven't been able to take the BSN or MSN for over a century. There was a need for higher education for nurses and they acted by instituting BSN, MSN and now DPN programs in response to that need.

Now there is a need for Paramedicine to evolve and the education is going to have to evolve with it. That means BSP and MSP courses should start being developed with adequate education and clinical requirements.

Saying that Paramedics cannot be trained and educated to treat or triage a patient at home and make a determination of care is just as ignorant as saying an RN doesn't have the training or is ill equipped to work on an ambulance.

 

[pcbguy]

What did I say about back on topic? The next person that posts about anything but community paramedicine will get my complete and undivided attention.

Sorry. I was typing when you posted this.

My apologies if I have offended anyone.

I have the utmost respect for RNs, OTs, PTs and everyone in the business. I will be marrying an DNP soon.

 

[Clipper1]

All of the references you mentioned also support the evolution of nursing into Public and Community Health. The things mentioned are all essential foundations in the education and training of someone who providing care for the patient and meeting their needs in many aspects and not just the life saving ones. Nursing has also grown as the technology and science has developed. Nursing must care not only for the emergencies or acute situations but also all the long term issues.

Please point out to me where it says your regular nurse can perform a medical diagnosis on a patient with medical problem and subsequently initiate and order treatments and direct patient care?

Additionally nursing diagnosis does not diagnose medical problems it addresses the deficits the medical diagnosis creates. This is not a derogatory statement.

For legal purposes to satisfy the definition of Medical Diagnosis, Physicians and Physicians Extenders such as NPs and PAs are recognized. A Paramedic can not legally code as a Physician Extender for a medical diagnosis.

NPs are nurses and they make medical diagnosis.

All licensed professionals involved in initiating treatment or therapy make some type of diagnosis to initate the treatment and plan of care. This does not have to be an emergency situation. Again, this is the difference between the way a Paramedic is trained to recognize situations and that of nurses or any of the allied health professions. It takes alot of training and experience to recognize many, many different aspects of care and anticipate needs than it does to work an emergency long enough to get to a higher level of care.

 

[Clipper1]

What did I say about back on topic? The next person that posts about anything but community paramedicine will get my complete and undivided attention.

Does this mean you are one sided and believe only Paramedics can do community health? The issue of CPs affects many other professions and care aspects. The Paramedic is NOT the sole provider of care.

Isolating other professions is exactly why this idea is not being accepted in more realms.

This must be an interdisciplinary approach for it to be successful. But, because of the way the US health care system is set up, we must make the most of what is available. Paying out for another layer of service or duplication may not be the best use of resources.

 

[Aidey]

Does this mean you are one sided and believe only Paramedics can do community health? The issue of CPs affects many other professions and care aspects. The Paramedic is NOT the sole provider of care.

Isolating other professions is exactly why this idea is not being accepted in more realms.

This must be an interdisciplinary approach for it to be successful. But, because of the way the US health care system is set up, we must make the most of what is available. Paying out for another layer of service or duplication may not be the best use of resources.

No, it means exactly what it says. Community paramedicine, or get out of the thread. If you want to discuss it from an interdisciplinary perspective, start your own thread.

 

[Clipper1]

Now there is a need for Paramedicine to evolve and the education is going to have to evolve with it. That means BSP and MSP courses should start being developed with adequate education and clinical requirements.

Saying that Paramedics cannot be trained and educated to treat or triage a patient at home and make a determination of care is just as ignorant as saying an RN doesn't have the training or is ill equipped to work on an ambulance.

Will the BSP be toward community medicine? Does this mean the 911 or emergency part will not be emphasized? Will only some Paramedics be taught intubation and ACLS while others are on more of a nursing track? Does this mean you only want to keep the title of Paramedic to avoid getting the title of RN?

 

[pcbguy]

Will the BSP be toward community medicine? Does this mean the 911 or emergency part will not be emphasized? Will only some Paramedics be taught intubation and ACLS while others are on more of a nursing track? Does this mean you only want to keep the title of Paramedic to avoid getting the title of RN?

Who knows where this will lead? The way I see it the Paramedic will remain the same and the BSP or the MSP will be more like the NP/PA. A practitioner that can practice out in the community.

They won't be taught on a nursing model at all. Just like PAs are not. They will both receive all Paramedic level education(ie., intubation, ACLS).

How about the title of Paramedic Practitioner. Like Nurse Practitioner. Still a nurse right?

Again there are so many details to be worked out and I am not the person that will be working them out(probably not anyways). Just my thoughts.