# Paramedic & Nurse Practitioner ambulance in OC



## zzyzx (Jul 17, 2015)

http://behindthebadgeoc.com/cities/...urse-practitioner-board#.Vab0UuO21hg.facebook


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## SandpitMedic (Jul 17, 2015)

The way of the future?
How about a PA?


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## Carlos Danger (Jul 17, 2015)

Pretty cool. I've long thought using NP's and PA's in this capacity made good sense. In fact I wonder why it hasn't caught on sooner.


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## Jim37F (Jul 17, 2015)

Sounds pretty interesting. While we're not doing Urgent Care on wheels, we're starting a pilot program where we can transport certain patients directly to an Urgent Care Center instead if the ED. That's with just the normal paramedic and BLS ambulance response, if the BLS patient meets the criteria of course. 

Otherwise our Community Paramedic program is going to be doing CHF follow ups to try and reduce hospital re-admits, but it'll be single specially trained department medic working a 40 hour week in a department vehicle that won't be emergency response capable (i.e. no lights or sirens, won't be available in dispatch's system, but still monitoring the radio and can call in for assistance or whatever, kinda like the the Fire Prevention Bureau Inspectors)


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## Gurby (Jul 17, 2015)

Sounds awesome, but I wonder how the financial aspect of it works out?  A NP would command a much higher salary than a paramedic.  I could see hospital-based EMS programs doing this, but it seems like it wouldn't make sense financially for private EMS.


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## johnrsemt (Jul 17, 2015)

If the county or city (or hospitals) would reimburse the Private Service for this it would make total sense for them to do it


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## Summit (Jul 17, 2015)

Gurby said:


> Sounds awesome, but I wonder how the financial aspect of it works out?  A NP would command a much higher salary than a paramedic.  I could see hospital-based EMS programs doing this, but it seems like it wouldn't make sense financially for private EMS.


Sure it would make financial sense as a NP/PA would command much higher reimbursement.


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## DesertMedic66 (Jul 17, 2015)

Gurby said:


> Sounds awesome, but I wonder how the financial aspect of it works out?  A NP would command a much higher salary than a paramedic.  I could see hospital-based EMS programs doing this, but it seems like it wouldn't make sense financially for private EMS.


It sounds like the NP is employeed with a hospital.


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## Carlos Danger (Jul 17, 2015)

The real value of this for the hospitals is likely in uninsured patients who can't (or won't) pay their bills. This is because unreimbursed ED visits are far more expensive than a house visit from an NP or PA. So just by avoiding what would otherwise be an ambulance transport and ED visit, the health system saves themselves money.

I would imagine that avoiding unnecessary ED visits alone would probably pay for this program......anything they can bill for is just gravy.


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## Akulahawk (Jul 17, 2015)

SandpitMedic said:


> The way of the future?
> How about a PA?


Generally speaking, I don't see why not. Since neither practitioner (NP or PA) is a physician replacement and usually can be interchangeably used, just hire the most qualified persons to go do those certain calls. Physician oversight is something that's likely easily dealt with, in the grand scheme of things. Getting an EMS system (in general) to buy into this as an early adopter may not be easy.


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## zzyzx (Jul 18, 2015)

It's certainly interesting, but I do wonder about how valuable an NP or PA is on an ambulance. Even if there was an MD on board, what can they really do without labs, chest xray, imaging, etc. Let's consider the most typical call--abdominal pain. They need labs and often they need imaging, so they still need to go to an ER.


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## Carlos Danger (Jul 18, 2015)

zzyzx said:


> It's certainly interesting, but I do wonder about how valuable an NP or PA is on an ambulance. Even if there was an MD on board, what can they really do without labs, chest xray, imaging, etc. Let's consider the most typical call--abdominal pain. They need labs and often they need imaging, so they still need to go to an ER.



Obviously they are limited, but there is a lot they can do to avoid ED admissions. Look at the Minute Clinic at CVS.


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## zzyzx (Jul 18, 2015)

the patients who call 911 are gonna have different complaints than people who seek out a Minute Clinic. Yes we do have people who call for a stubbed toe, but really this is a small percentage of 911   Also, stuff that could be treated, like say a minor lac that needs no xray and only needs suturing, is going to put the ambulance out of service for a long time. 
More importantly, we should not be catering to these idiots who call 911 for Fastrack complaints.


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## MMiz (Jul 18, 2015)

zzyzx said:


> It's certainly interesting, but I do wonder about how valuable an NP or PA is on an ambulance. Even if there was an MD on board, what can they really do without labs, chest xray, imaging, etc. Let's consider the most typical call--abdominal pain. They need labs and often they need imaging, so they still need to go to an ER.



In a true medical emergency I'm not sure there is much added value in having a NP or PA on board, but I see huge value in a NP responding to diabetic emergencies/management calls, sick/general malaise, etc.  Especially in an urban area, this seems to be a viable solution to the overcrowded ER situation.

As a side story, I was short on time but really needed to see a doctor.  I couldn't wait for urgent care.  I stopped by a Target Clinic, walked right in, and was seen by a qualified Nurse Practitioner.  I was out in only minutes.  This has to be the wave of the future.


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## zzyzx (Jul 18, 2015)

"As a side story, I was short on time but really needed to see a doctor. I couldn't wait for urgent care. I stopped by a Target Clinic, walked right in, and was seen by a qualified Nurse Practitioner. I was out in only minutes. This has to be the wave of the future."

That's great, but people shouldn't be using 911 for stuff that should be seen at a clinic. 
Diabetic emergencies and sick/general malaise calls, as you mention, require a lot more than what an NP can provide on an ambulance. 
An important concept for us EMT's and medics to understand is that the "little stuff" can be a lot more complicated than you think, and can also be potentially very debilitating for the patient if they don't get prompt and fully qualified treatment.


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## Carlos Danger (Jul 18, 2015)

zzyzx said:


> That's great, but people shouldn't be using 911 for stuff that should be seen at a clinic.



They shouldn't, but they DO....that's the whole point here.



zzyzx said:


> Diabetic emergencies and sick/general malaise calls, as you mention, require a lot more than what an NP can provide on an ambulance.



Of course they can deal with those things. What do you think they do at an urgent care?


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## MMiz (Jul 18, 2015)

zzyzx said:


> "As a side story, I was short on time but really needed to see a doctor. I couldn't wait for urgent care. I stopped by a Target Clinic, walked right in, and was seen by a qualified Nurse Practitioner. I was out in only minutes. This has to be the wave of the future."
> 
> That's great, but people shouldn't be using 911 for stuff that should be seen at a clinic.
> Diabetic emergencies and sick/general malaise calls, as you mention, require a lot more than what an NP can provide on an ambulance.
> An important concept for us EMT's and medics to understand is that the "little stuff" can be a lot more complicated than you think, and can also be potentially very debilitating for the patient if they don't get prompt and fully qualified treatment.



Diabetics, CHF patients, patients with breathing problems, and even those in an emotional crisis can absolutely benefit from an advanced level of care.  The ER is not always the best immediate solution.

This seems like a natural progression from the Advanced Practice Paramedic programs around the nation.

In many urban areas the E.R. is _the_ primary healthcare provider for many patients.  It's part of the culture.  Instead of tying up an ER bed with a patient that has been having symptoms for weeks and randomly decides they want to get something checked out, I'm all for sending out a NP that can refer the patient to more appropriate treatment if it's beyond the NP's protocols.


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## triemal04 (Jul 18, 2015)

zzyzx said:


> the patients who call 911 are gonna have different complaints than people who seek out a Minute Clinic. Yes we do have people who call for a stubbed toe, but really this is a small percentage of 911   Also, stuff that could be treated, like say a minor lac that needs no xray and only needs suturing, is going to put the ambulance out of service for a long time.
> More importantly, we should not be catering to these idiots who call 911 for Fastrack complaints.


Do you actually work in an agency that responds to 911 calls?  Because if you do and actually have a good grasp of what really needs to be done for various complains and why some things are done and still have that attitude...I want to work where you do.  Because you must have the world's smartest, nicest, most compliant patients who really only do call 911 for true emergencies.

While I do agree with the last part of the post, it doesn't change the reality that we currently live in.  For decades we have drilled it into peoples heads:  if you don't know what to do, call 911.  If you don't know where to go, go to the ER.*  Now we are reaping the real benefits of that and are faced with either changing what people do (which, as it's a mindset that took generations to create, will also take generations to fix) or finding a way to fix the problem in an easier more socially acceptable way.  Hell, it might even be a better way.

The sad truth is that nationwide, the vast majority of people who call 911 do not have a real emergency.  They do not need an ER.  Many don't even need an Urgent Care.  But, do to many, many factors, a lot of which people in EMS will have zero control over, these people will continue to call 911 and expect some type of service.  This is one way to help free up the units that are allegedly capable of dealing with true emergencies to deal with those, keep everyone a bit happy because they got some type of help, and at the same time ease the burden on ER's.  And on hospitals; let's not forget that part of the push for this (and a potential source of funding for anyone thinking of implementing a program like this) is obomacare's penalties towards hospitals that readmit patients for the same complaint within a certain timeframe.

Really, in all honesty, this country is really screwed up.  Whatever you regard as the root cause of getting us to this point, this is just another symptom of it.

*yes, there is more to it than this, but this is a large part of the problem.


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