# UK unveils "super paramedic"



## ExpatMedic0 (Mar 17, 2010)

http://www.ems1.com/trauma/articles/772225-UK-unveils-new-breed-of-super-paramedics/

UK unveils new breed of 'super paramedics'
By Sara Thomas
Daily Post

WREXHAM, Wales — A new breed of 'super' paramedics — the first of their kind in the UK — are taking to the roads of North Wales.

The Welsh Ambulance Service is setting up a network of highly-skilled and equipped specialist practitioners across the region ready not just to respond to emergencies but also to make decisions about aftercare.

They will undergo specialised training to graduate and postgraduate level to equip them for their new role.

Read more


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## mct601 (Mar 17, 2010)

Interesting... I was wondering when something like this would happen somewhere...


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## EMSLaw (Mar 18, 2010)

It can happen here if we can ever manage to move Paramedicine into the realm of college degrees.  But it does mean that Paramedics need to become experts in more than the very narrow area they specialize in now and need to become more generalists - at least in the still specific area of acute emergency care.


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## ExpatMedic0 (Mar 18, 2010)

The UK paramedics use to have less training than ours even into the mid 90's from what I understand. There degree requirement and extended training is not very old.

Anyway you look at it though, they got a jump on us now for sure


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## bstone (Mar 18, 2010)

For a country with socialized medicine, they are blazing the trail as to how things ought to be done.

I applaud them. And I am heavily in favor of socialized medicine if this is the sort of advancement and excellent patient care it delivers.


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## medicdan (Mar 18, 2010)

I'm interested in the changes are in scope of practice, but more importantly, what aftercare options are made. What differs this rank from that of "Paramedic Team Leader", ie Mark Glencourse (Medic99.fireemsblogs.com)?


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## Melclin (Mar 18, 2010)

The article was a bit vague about terminology but I think what they were getting at was the extended care practitioner program which is not terribly new. It does seem to be a standard media ploy in health matters to "unveil" these programs after they have been running for a while though. 

The extended care model is of great interest to me. In two states here (Queensland and South Australia), the model has been trialled and found to be quite successful. Here in Victoria there has been a little talk of it but it is certainly in its infancy. 

There is a lot of talk about the best role for these paramedics. Here the program has involved literally taking the simple commonly used parts of the ED to the pt (which strikes me as being somewhat inefficient) for quite serious cases. Suturing, and an i-Stat machine for blood chemistry and troponin are the biggest additions to standard ALS practice in terms of "skills" that I know of. The more important component here though is the education and experience to be able to meaningfully apply these skills.

The UK models, however, tend to focus on the encouraging out of hospital management of less severe issues such as asthma cases that would previously be admitted. This means spending more time on the "dunny jobs" as many would put it, and I can't see it being that popular with paramedics. It may end up being (or being perceived to be) not overly dissimilar to watered down GP practice - something few paramedics, especially the bright ones who extend themselves with the kinds of post grad education that this requires, want to do. 

I'm writing an essay about future models of extended care for one of my subjects this semester... so lets get a good conversation going


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## Scott33 (Mar 18, 2010)

Contrary to what the article says, these types of paramedics are not the first of their kind in the UK (perhaps in Wales though). They are ECPs with another name, and ECPs have been around for about 7 years.

The idea is to have a clinician with more extended training and education, who can handle the lesser (for want of a better word) jobs, which do not need to be treated in a hospital. As well as being able to treat-and-release at their own discretion, they can also order follow up tests to be done in primary care facilities other than the ER - including x-rays etc (without the need to "ask" a Doctor). 

Treatments such as dressing changes, suturing, Foley cath changes, neb treatments, and prescriptions for URIs / UTIs etc (yes they have limited Rx rights like NPs) can all be handled in the home. This is the bread and butter of the ECP. 

For something like this to work, it needs a change in the mindset of both the public and the ambulance service. People who call 911 / 999 are calling for medical attention, *not* necessarily for a ride to a hospital. The ECP can usually take care of those non-critical patients, who would normally be sat in fast track in the ED, thus freeing up its resources for the more acute / critical cases. 

A very specialized role but I agree it is not a job for a lot of paramedics, due to the isolation of the role, and less acute patient load.

Wiki ECP 
http://en.wikipedia.org/wiki/Emergency_Care_Practitioner

An old report from 2004  
http://www.dh.gov.uk/prod_consum_dh...@dh/@en/documents/digitalasset/dh_4093088.pdf

Oh, and an old BBC report from half a decade ago...knew I had read about _"Super Paramedics"_ before. http://news.bbc.co.uk/2/hi/health/4634569.stm


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## Scott33 (Mar 18, 2010)

emt.dan said:


> What differs this rank from that of "Paramedic Team Leader", ie Mark Glencourse (Medic99.fireemsblogs.com)?



An ECP isn't a rank, it is a clinical speciality. A team leader is a leader of a team - of paramedics (and techs), involved in administrative stuff such as the running of a shift. This on top of the usual role required of a paramedic. 

Think _Dwight Schrute_ more than _Clark Kent_ ^_^


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## Melclin (Mar 18, 2010)

Scott33 said:


> Contrary to what the article says, these types of paramedics are not the first of their kind in the UK (perhaps in Wales though). They are ECPs with another name, and ECPs have been around for about 7 years.
> 
> The idea is to have a clinician with more extended training and education, who can handle the lesser (for want of a better word) jobs, which do not need to be treated in a hospital. As well as being able to treat-and-release at their own discretion, they can also order follow up tests to be done in primary care facilities other than the ER - including x-rays etc (without the need to "ask" a Doctor).
> 
> ...



Indeed. Very nice post. Do you think you would have trouble getting paramedics to spend they days dealing _specifically_ with low acuity cases when the culture in EMS tends to value cases by how sick a person is? 

I can see there being medics suited to these roles. I think many paramedics here want to extend themselves clinically but don't necessarily want the stress of working on an MICA truck. So I can see there being people signing up for these masters degrees, but I wonder how many. 

The South Australian ECP program that I mentioned appears to be focused less on low acuity pt and more on a mobile ED, although I haven't anything more than a few short reports to base that on.

There is a report called "An exploration of expanded paramedic healthcare
roles for Queensland" that briefly discusses most of the models around the world. I can't for life of me think where I got it. If anyone is interested I can email it to them but I can't seem to find it on the web for free anymore.


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## Foxbat (Mar 18, 2010)

bstone said:


> For a country with socialized medicine, they are blazing the trail as to how things ought to be done.
> 
> I applaud them. And I am heavily in favor of socialized medicine if this is the sort of advancement and excellent patient care it delivers.


Yep. Another country with socialized medicine, USSR, used to have a PHPA, an emergency physician (with a relevant specialty - there were cardiac MICUs, pediatric MICUs, toxicological MICUs, etc), and a professional driver with EMT-like training on every ambulance (Russia still has physicians and professional drivers on most trucks, even though under capitalism it's severely underfunded and slowly falls apart; it's not uncommon to see trucks with only a driver and a PHPA, and they are currently discussing getting rid of the drivers and making PHPAs drive trucks instead, like paramedics in the US).


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## NWParamedic (Mar 18, 2010)

Interesting topic. Interesting approach by the UK. Of course in America, under our current for profit system, paramedics will never be elevated to the level outlined in the UK article and subsequent posts have indicated. Ambulance transportation is the only way ambulance services make money and therefore survive. Even the not-for profit services like fire departments rely on revenues generated by transporting the patient. This model encourages quick, fast, efficient transportation, so the ambulance is freed up to run another quick, fast efficient transport. Our model here in the US would require a significant change that was not tied to ambulance transport re-imbursement. In many ways this system does encourage quick definitive care as the patient ultimately does see a doctor. Although I do see advantages to a "super-paramedic" that sounds like a physician assistant by the type of treatment modalities that were described in some of the earlier posts. Any paramedic that has worked any length of time would agree that not having to transport some of the less emergent patients would be an efficient use of ambulance resources.


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## enjoynz (Mar 18, 2010)

I remember in the chatroom once, Ridryder911 talking to us about something along the same lines (or close to it),
that they were looking at doing in the States.
Guess the Brit's beat you to it.

Enjoynz


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## NWParamedic (Mar 18, 2010)

enjoynz said:


> I remember in the chatroom once, Ridryder911 talking to us about something along the same lines (or close to it),
> that they were looking at doing in the States.
> Guess the Brit's beat you to it.
> 
> Enjoynz


Nope. Will never happen here in the states. Our greedy little system of capitalism would never allow true health care to prevail


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## Scott33 (Mar 18, 2010)

NWParamedic said:


> Nope. Will never happen here in the states. Our greedy little system of capitalism would never allow true health care to prevail



I agree it will never happen. As has been mentioned before in other threads, the US system would need to be completely rebuilt from scratch for something like that to work.


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## FLEMTP (Mar 18, 2010)

I love how certain people here use this as a "kudos" on socialized health care. Socialized health care will RUIN our healthcare system in the US. If you don't believe that, go to canada, where after having a heart attack, you must be put on a waiting list to get your "emergency" angioplasty and stent placement. 

Oh.. and on top of that.. you think we make low salaries now? Wait til the government takes 40% of your paycheck instead of the 15-25% they take now and gives you a lower quality of healthcare. 

Besides, how long do you think it will be before the federal government "mandates" the salaries of healthcare providers in order to "control costs"? 

55% of americans are opposed to universal health care/obamacare/socialized medicine.. which ever term you prefer.

There is a reason for this!

Oh, and there will come a time when states begin to implement an advanced practice paramedic program like this. It will take time, and it wont be appropriate in every locality in the US either. By keeping the attitude that it would never work, and it wont ever be allowed to happen here.. is whats keeping it from happening here.


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## ExpatMedic0 (Mar 18, 2010)

It sounds like this could available anywhere to anyone with PA who does house calls


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## NWParamedic (Mar 18, 2010)

FLEMTP said:


> I love how certain people here use this as a "kudos" on socialized health care. Socialized health care will RUIN our healthcare system in the US. If you don't believe that, go to canada, where after having a heart attack, you must be put on a waiting list to get your "emergency" angioplasty and stent placement.
> 
> Oh.. and on top of that.. you think we make low salaries now? Wait til the government takes 40% of your paycheck instead of the 15-25% they take now and gives you a lower quality of healthcare.
> 
> ...


FLEMTP,

Thank you for your counter argument. The only problem with it is you are simply re-stating the old republican playbook.

First of all canadians are very happy with their healthcare system. This standard statement of pointing to the canadian system as an example of how bad "socialized medicine" is bogus. See the article below:

http://new-canadian.blogspot.com/2009/07/shocking-poll-canadians-happy-with.html

Secondly, you indicate that salaries will be reduced. This is pure speculation on your part. You have no idea what will happen with salaries. You are simply stating your opinion as a fear tactic. Lets again look at some factual information. Here are what paramedics are making in the UK.

http://www.prospects.ac.uk/p/types_of_job/paramedic_salary.jsp

Roughly they are making 30-50 thousand per year with better benefits than us. So certainly not 40% less than what we are making now.

Your third ascertion is that 55% oppose Obamacare. This statistic may actually be correct. Because if you listen to either side of the argument through the media you are inclined to just vote party lines. Which the country is politically split right down the middle right now. Secondly, many who originally were in favor of the early proposals were for the bill and after changes have decided to now oppose it. Unfortunately the bill has been so compromised many have just decided to vote against it.

And finally you believe that the advanced practice paramedic will still evolve in our system of healthcare. Well I have to tell you. When I first became a paramedic back in 1990, we would frequently talk about this subject and we would often point to the future when PA's would be riding the ambulances so that we could make emergency ambulance efficient so we could run real emergencies. Well that day is still coming. Again this day will never come in our current system of transport re-imbursement.


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## bstone (Mar 18, 2010)

NWParamedic said:


> FLEMTP,
> 
> Thank you for your counter argument. The only problem with it is you are simply re-stating the old republican playbook.
> 
> ...



^_^
And that, friends, was extremely well said.


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## bstone (Mar 18, 2010)

This is a handy resource for those who go strictly by the Republican playbook.

http://www.afscmeblog.org/2010/03/18/afscme-gop-first-aid-kit/


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## boingo (Mar 19, 2010)

Never mind the Republican playbook, just look at what it costs the state of Massachusetts for its "universal healthcare". (4.2 Billion since its inception) Without huge subsidies of Federal money, the state would be bankrupt already, and we don't have the numbers of uninsured like California or Texas.  If you extrapolate the cost from Massachusetts and apply it nationally, you'll quickly realize that the cost will quickly spiral out of control, unless of course we tax at 45-50%, not something I look forward to.


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## EMSLaw (Mar 19, 2010)

FLEMTP said:


> Oh.. and on top of that.. you think we make low salaries now? Wait til the government takes 40% of your paycheck instead of the 15-25% they take now and gives you a lower quality of healthcare.



I don't know how it works for you, but the government already takes about 40% of my paycheck.


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## MrBrown (Mar 19, 2010)

EMSLaw said:


> I don't know how it works for you, but the government already takes about 40% of my paycheck.



Then you're not putting that 8 years in school to good enough use and making use of the creative tax loopholes my friend!


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## jrm818 (Mar 19, 2010)

boingo said:


> Never mind the Republican playbook, just look at what it costs the state of Massachusetts for its "universal healthcare". (4.2 Billion since its inception) Without huge subsidies of Federal money, the state would be bankrupt already, and we don't have the numbers of uninsured like California or Texas.  If you extrapolate the cost from Massachusetts and apply it nationally, you'll quickly realize that the cost will quickly spiral out of control, unless of course we tax at 45-50%, not something I look forward to.



X2...couldn't ask for a better case study.

As for the "need transportation for money" argument:

There is an alternative solution to socialism that would allow for some sort of expanded treat-on-scene medic role: change reimbursement rules to allow for payment for care rendered on scene.  I believe the model of "paying for care rather than transport" works just fine for every patient ever seen inside a hospital.  As I recall, doctors who make house calls get paid as well....

Shocking, I know, but we don't need to go all USSR simply remove the financial incentive to transport a patient.

The issue of socialized medicine is separate (very separate..I have a hard time seeing how advanced care medics and socialized medicine are related at all), but in brief:

the problem in the US is largely thanks to the advent of managed care/HMO's, who take huge profit margins off of routine care that shouldn't involve insurance.  Every routine physical, minor visit, etc. today is more expensive than it should be because HMO's take a bit of the pie and because physicians have to deal with an insane billing/regulatory environment which costs them time and money.  Side note: the advent of managed care has a lot to do with government (our holy savior) encouragement via tax policy.

Manged care causes

-increased overhead for providers
-no incentive to patients to reduce their healthcare costs
-incentive for providers and hospitals to run as many tests and perform as many procedures as possible
-lack of access for the uninsured, made worse by the fact that the costs of care are higher for people not accessing care via an HMO (which often negotiate lower rates than available to the public)
-less availability of care/greater financial burden to people with chronic/pre-existing conditions
-less autonomy for physicians and erosion of the doctor/patient relationship when determining appropriate care

Socialized medicine doesn't fix the problems of managed care: it makes them worse.  Oh, and for those of us in the U.S., there's one other biggie

It's unconstitutional!  I know the Constitution is sort of an ignored irritant these days, but I feel obligated to at least mention that teeny problem...


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## bstone (Mar 19, 2010)

boingo said:


> Never mind the Republican playbook, just look at what it costs the state of Massachusetts for its "universal healthcare". (4.2 Billion since its inception) Without huge subsidies of Federal money, the state would be bankrupt already, and we don't have the numbers of uninsured like California or Texas.  If you extrapolate the cost from Massachusetts and apply it nationally, you'll quickly realize that the cost will quickly spiral out of control, unless of course we tax at 45-50%, not something I look forward to.



As a resident of MA and someone who is keenly interested in it's healthcare system, I am calling you out on this. Your figure of $4.2 billion is a wild exaggeration, if not a downright lie. To prove this I will quote from the nonpartisan Massachusetts Taxpayers Foundation,





> The Foundation report concludes that state spending on the reform has increased by $350 million between fiscal 2006, the last year before reform, and fiscal 2010 - an average annual increase of only $88 million. Source: http://www.masstaxpayers.org/public...s_health_reform_the_myth_uncontrollable_costs


and as well from the NY Times





> Massachusetts’s experiment in near universal health care coverage has become a favorite whipping boy for opponents of health care reform. They claim the program is a fiscal disaster and that the whole country will be plunged into a similar disaster if President Obama and Congress’s Democratic leaders have their way. That is an egregious misreading of what is happening in Massachusetts.



The MA plan costs only $350 million, *not $4.2 billion*. Where in the world did you think up of such numbers? Additionally, MA plan is NOT state-run health care. Everyone who signed up for health insurance did so through a private health insurance company- like Blue Cross, Network Health, etc. Their revenues in MA have gone through the roof and they are very happy to be doing business here.

So, anything more from the Republican playbook that we can easily debunk?


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## NWParamedic (Mar 19, 2010)

bstone said:


> As a resident of MA and someone who is keenly interested in it's healthcare system, I am calling you out on this. Your figure of $4.2 billion is a wild exaggeration, if not a downright lie. To prove this I will quote from the nonpartisan Massachusetts Taxpayers Foundation,
> and as well from the NY Times
> 
> The MA plan costs only $350 million, *not $4.2 billion*. Where in the world did you think up of such numbers? Additionally, MA plan is NOT state-run health care. Everyone who signed up for health insurance did so through a private health insurance company- like Blue Cross, Network Health, etc. Their revenues in MA have gone through the roof and they are very happy to be doing business here.
> ...


Extremely well said. I love putting forth the facts when the old republican playbook opens up. The truth will set you free.


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## boingo (Mar 19, 2010)

That was the cost to Mass, doesn't include the federal part.  Tim Cahill, the state treasurer, the guy who keeps the books came up with the figure.  You can check his references, I don't have time to cut and paste right now.


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## bstone (Mar 19, 2010)

boingo said:


> That was the cost to Mass, doesn't include the federal part.



If you read the report then you will have a much better appreciation for it and further realize that *your $4.2 billion figure does not exist in reality*. 

*Massachusetts HealthReform: The Myth of Uncontrolled Costs* Source: http://www.masstaxpayers.org/files/Health care-NT.pdf



> Based on actual and projected spending data for the first four years of health care reform, the Foundation concludes that state budget spending on health reform has grown from a base of $1.041 billion in fiscal 2006 to a projected $1.748 billion in fiscal 2010. *That is an increase of $707 million, half of which is supported by federal reimbursements.* The $353 million state share translates into an average yearly increase of only $88 million (see Table 2, p.6).



Half of $707 million is $353.5 million. This is the total amount that the federal government has contributed to the MA plan. Again, not $4.2 billion. Not even close.


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## ExpatMedic0 (Mar 19, 2010)

Like Patrick, Baker cited a report issued last year by the Massachusetts Taxpayers Foundation, a business-backed watchdog group, that found the cost of the law to state taxpayers is about $88 million a year, less than four-tenths of 1 percent of the $27 billion state budget.
Just to play devils advocate though,
Here is a link to guy speaking on how it could wipe out the economy. http://www.boston.com/news/local/ma...report_mass_hospital_costs_on_the_rise_again/
Anyway...

anymore feedback on the UK super paramedic? Sounds like a PA doing house calls to me with a different title


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## Scott33 (Mar 19, 2010)

schulz said:


> anymore feedback on the UK super paramedic? Sounds like a PA doing house calls to me with a different title



Difference being that a PA works under a physician's license.


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## NWParamedic (Mar 19, 2010)

This super medic sounds pretty cool though. Think about it what a great career builder. Start your career as an EMT, then paramedic, then super paramedic. I have to tell you if you love medicine and have been doing EMS more than say 10-15 years this kind of upgrade sounds really cool. Again this kind of position is needed in a system that does not need to transport everyone.


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## EMSLaw (Mar 19, 2010)

Scott33 said:


> Difference being that a PA works under a physician's license.



And in most states, PAs have wide ranging prescriptive authority.  Sounds like this is more limited.


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## ExpatMedic0 (Mar 19, 2010)

Scott33 said:


> Difference being that a PA works under a physician's license.


So does a Paramedic...


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## Scott33 (Mar 19, 2010)

Not in the UK

http://en.wikipedia.org/wiki/Paramedics_in_the_United_Kingdom


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## FLEMTP (Mar 19, 2010)

NWParamedic said:


> FLEMTP,
> 
> Thank you for your counter argument. The only problem with it is you are simply re-stating the old republican playbook.
> 
> ...



ok.. I used to work in detroit.. which shares a very large and very active border with Windsor, Ontario. If the canadian healthcare system is so great.. then why are people in Canada having STEMI's, then signing out AMA from the ER's in canada, and driving across the border into detroit, and calling 911 to get treatment? Oh.. wait.. its because they dont have immediate access to the same type of emergency treatments we do here. They have literally been told by their doctors that they will be put on a waiting list for their "emergency" angioplasty.

Cancer patients come to the US in droves because they know they'll die before they get the treatment they need in Canada, if at all.

I mean even the former Quebec Premier Robert Bourassa avoided his country's own "free" health care and sought treatment in Cleavland for his cancer! 

If a small minority of people want socialized medicine here so bad.. why not pack up and move to Canada, or England or one of the other countries that offer it? I mean, even you admitted that over half of americans are opposed to Obamacare, why are democrats willing to ignore what people want to further their own socialist agenda?

As far as the salaries being government controlled, it IS only a matter of time if this bill is passed. One of the BIG points of Obamacare is cost control. They have already started by decreasing medicare and medicaid payouts... Hell Walgreens wont even take new medicaid patients because of the reduced payouts. If a prescription costs 100 dollars, and medicaid will only give you 75 dollars, and not let you bill the patient for the remaining 25 bucks, then WHY would you want to continue to lose money and accept those patients? Decreasing reimbursement is the FIRST step.. controlling the cost of medical supplies is the second.. and then when costs are still sky high, the governement WILL start mandating how much people in medical professions are "allowed" to make. They may not do it with a flat out mandate, but if they decide that a paramedic is not supposed to make more than 40k a year, they will just impose ungodly high income taxes on incomes over 40k a year, calling it a "salary adjustment" tax. It IS a matter of time before that happens, and that is NOT speculation, it is looking at what democrats do on a historical basis and applying it in this situation!
Plain and simple, our government cannot even run the post office efficiently.... let alone health care. You want the perfect example? Talk to anyone that's a veteran and relies on the VA health system for medical care. Red tape, many treatments denied, and people not getting the healthcare they need. 

Yeah, thats exactly what I want.

Folks, this has nothing to do with a "republican playbook" it has to do with what the majority of the American people want... and it has to do with a select few people with an overwhelming sense of entitlement want to take from those who worked hard.

Oh and btw.. You gave me a story that tells how happy Canadians are with their health care? 
Well here is one with the exact opposite view.
Socialized Medicine Leaves a Bad Taste in Patients' Mouths

Im sorry, but if you want health insurance, you are not entitled to it just by living here. You must get off your butt, and work hard like everyone else here. If an immigrant can come here with nothing, and work hard for what they have, so can you. If I can work hard for everything I have, so can you.

America is no longer the "land of opportunity" its quickly becoming the land of " come here, and complain because you dont have anything. Your government will take it from those who earned it and give it to those who didn't"  

Social security and welfare and free health care is NOT what the founding fathers wanted for this country. It says NO WHERE in the constitution that it is the government's job to give you money when you have none. It IS the governments job to protect our nation from all enemies, foreign and domestic, not to play Robin Hood.


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## ExpatMedic0 (Mar 19, 2010)

FLEMTP said:


> It IS the governments job to protect our nation from all enemies, foreign and domestic, not to play Robin Hood.



One could argue it IS the governments job to protect its citizens period. But even if you are specific to enemies...
 Do you consider obesity a domestic enemy? Because the government (Surgeon General) does

I am mixed on the issue and can see both sides.


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## Hal9000 (Mar 19, 2010)

This started off as an interesting topic, but it seems that it is turning into some catchphrase-ridden morass of sophistic, partisan conclusions based almost solely around certain users' political and psychological ingroupings.  That is certainly not a competent style of communication.

Regarding this topic, it's interesting, but I wonder how effective/efficient it is?  It would seem at first hand to require travel time on the part of the provider, instead of the other way around, which reduces overall availability.  Does this increase the provider's unit downtime?  

It seems odd to me to send them on "field" calls instead of simply placing them in a static location.  Can it be that it is only efficient when it reduces the ER admittance rate?  

Anyway, it still strikes me as less efficient than a centralized location would otherwise provide.


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## FLEMTP (Mar 19, 2010)

schulz said:


> One could argue it IS the governments job to protect its citizens period. But even if you are specific to enemies...
> Do you consider obesity a domestic enemy? Because the government (Surgeon General) does
> 
> I am mixed on the issue and can see both sides.




The government considers obesity to be an "enemy" so it can make a power grab and tell you what you are and are not allowed to eat... this country is turning into a nanny state. It is my god given right to eat until im obese if i so choose.

And just in case you were curious.. obesity is a medical condition, or a disease, brought on by unhealthy choices, not an "enemy" of the people.

And btw.. what the government is supposed to do is not open to arguement or debate.. its in black and white in the US constitution.. you should actually READ it sometime.. its interesting.


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## LucidResq (Mar 19, 2010)

Hal9000 said:


> Anyway, it still strikes me as less efficient than a centralized location would otherwise provide.



People are still calling 911 despite the wide availability of low-cost urgent care centers. There are several populations of patients who would benefit from at-home care, such as the elderly, disabled, and children. 

I would be interested to see if such a model of care also decreases the rate of nosocomial infections in a community.


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## Hal9000 (Mar 19, 2010)

LucidResq said:


> People are still calling 911 despite the wide availability of low-cost urgent care centers. There are several populations of patients who would benefit from at-home care, such as the elderly, disabled, and children.
> 
> I would be interested to see if such a model of care also decreases the rate of nosocomial infections in a community.





That's why I posited that it must be solely based upon ER admittance rate post-911 call.  I suppose that the only in a perfect world would such a "perfectly efficient" be truly so.  

Ah, and I forgot that this does reduce the number of patient-provider contacts.


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## rescue99 (Mar 19, 2010)

enjoynz said:


> I remember in the chatroom once, Ridryder911 talking to us about something along the same lines (or close to it),
> that they were looking at doing in the States.
> Guess the Brit's beat you to it.
> 
> Enjoynz



Been talking about something for years in the US. It'll happen eventually.


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## Sasha (Mar 20, 2010)

> Im sorry, but if you want health insurance, you are not entitled to it just by living here. You must get off your butt, and work hard like everyone else here. If an immigrant can come here with nothing, and work hard for what they have, so can you. If I can work hard for everything I have, so can you.



I'm wondering, does your job offer health care? If not, do you provide your own? Do you have a pre-exsisting condition such as obesity (By BMI standards, which can take a well muscled healthy person and call them obese), diabetes, hypertension, history of stroke, heart attack, HIV/AIDS, an STD? Have you looked at the health insurance premiums for people who do? It's outrageous! With my history, I am paying outrageously high premiums for health insurance. I can pay it, however, working parents in a family of four may not be able to.

When the economy is struggling where people are LUCKY to have a job much less one that provides health insurance, people shouldn't have to choose between paying their rent or paying health insurance. 

Is social health care the answer? Probably not, but we are in serious need of health care reform to make health care affordable and attainable to all. 



> Social security and welfare and free health care is NOT what the founding fathers wanted for this country. It says NO WHERE in the constitution that it is the government's job to give you money when you have none. It IS the governments job to protect our nation from all enemies, foreign and domestic, not to play Robin Hood.



I'm sure when you are old and find out that your retirement fund is simply not enough, you will be thankful for medicare and social security so you don't have to work as a bagger at Albertson's well into your 90s to make ends meet. What do you propose we do about all the seniors on social security? Cut them off and throw them into the street where they will languish and die? As a health care provider, I would hope you have more compassion for people than that.

I consider illness and poverty domestic enemies.


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## FLEMTP (Mar 20, 2010)

> Sasha said:
> 
> 
> > I'm wondering, does your job offer health care? If not, do you provide your own? Do you have a pre-exsisting condition such as obesity (By BMI standards, which can take a well muscled healthy person and call them obese), diabetes, hypertension, history of stroke, heart attack, HIV/AIDS, an STD? Have you looked at the health insurance premiums for people who do? It's outrageous! With my history, I am paying outrageously high premiums for health insurance. I can pay it, however, working parents in a family of four may not be able to.
> ...


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## EMSLaw (Mar 20, 2010)

rescue99 said:


> Been talking about something for years in the US. It'll happen eventually.



It would be the sort of thing that might help our overburdened emergency rooms, especially if people continue to refuse to see, or be unable to afford, a GP/PCP and regular visits.  

The problem also is that only persons holding a medical license are supposed to "diagnose" (we won't start this argument again about what it is that we do before we do what we do. )  Sure, you, me, and everyone in the room may know that in all likelihood, the patient has a standard URI.  We may know that the conservative treatment for that is a Z-Pack.  But we can't practice medicine to put two and two together.

I agree that eventually, circumstances will push us in the direction of more allied health providers handling urgent care needs, especially as the number of physicians in family practice continue to dwindle in favor of higher-paid and more prestigious specialties.  But that might take a while.


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## firetender (Mar 20, 2010)

*SuperParamedics and the Big Picture*

Throughout these posts medics ask, "Why aren't we respected by other agencies, our companies, services or, even, sometimes, ourselves?" It has been a theme I've been looking at for years. Here, somebody's broadening the view. It prompted me to go back to a few threads here I was involved in one way or another and come up with a position; A New Paradigm for EMS

Enjoy!


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## NWParamedic (Mar 21, 2010)

firetender said:


> Throughout these posts medics ask, "Why aren't we respected by other agencies, our companies, services or, even, sometimes, ourselves?" It has been a theme I've been looking at for years. Here, somebody's broadening the view. It prompted me to go back to a few threads here I was involved in one way or another and come up with a position; A New Paradigm for EMS
> 
> Enjoy!


Very Nice Post Firetender! Wisdom packed and right on the mark. I agree our salvation (EMS as a profession), needs to come from within. Within ourselves and within our own professional discipline. 

Folks, you all need to check out the new thread by Firetender.


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