# Wake County EMS begins Advance Practice Paramedic' program



## Grady_emt (Jan 8, 2009)

_"RALEIGH - Beginning on January 6, 2009, the Wake County Department of Emergency Medical Services will begin implementation of the Advanced Practice Paramedic (APP) Program.  

This program represents a change in the configuration of the EMS response in Wake County, enhancing response to the most critically ill or injured patients while also providing prevention visits to high-risk populations.  " _

Link to full article: http://firenews.net/index.php/news/news_article/20090104_news_wake_county_ems_app_program/


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## Scott33 (Jan 8, 2009)

Good for them.

A huge step forward in changing the cook-book medic to the prehospital clinician.

The treat and release / treat and refer pathways have already been proven a success in Europe, and can free up a lot of space in the ED. 

Wake has some pretty progressive protocols, including inducing hypothermia for arrests / ROSC. I believe there are only a small handful of systems doing this nationwide.

For EMS to move forward, it takes some ballsy systems to break from the "you call, we haul" mentality, and places like Wake are showing the way ahead.

Hell, I even think they are allowed to walk stable patients...radical or what?


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## Jon (Jan 8, 2009)

Can I just take the car for a quick test-drive?


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## VentMedic (Jan 8, 2009)

> The first phase of the program will focus on patients with mental health crisis and/or substance abuse. In coordination with Wake County Crisis and Assessment, Wake EMS is working to develop a screening tool that will allow patients with these complaints but without active medical issues to go directly to the facility best equipped to care for them.


 
Will they be able to do a field toxicology screen or ETOH level? Our facilities would take an ETOH pt unless they are below 250 verified with a blood draw first. 

Do paramedics in NC also have power of detainment for psych and substance abuse patients or will this be only after PD had done the paperwork? 

I do see some wrongful detainments in situations where screening should be done. Our EDs may call a clinical psychologist and/or court officier to clear a psych hold prior to being taken to a facility if there is a simple solution or explanation such as an electrolyte or medication imbalance. That saves the patient a lot of grief including the loss of a medical license if they hold one.

The other version of this is the roving car APP will do all of those difficult things like intubations or those really hard ACLS protocols. In other words, some medics may get shoved over as the APP shows them how it is done.


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## Scott33 (Jan 8, 2009)

VentMedic said:


> The other version of this is the roving car APP will do all of those difficult things like intubations or those really hard ACLS protocols. In other words, some medics may get shoved over as the APP shows them how it is done.



Not sure that will be the case.

There are only 17 APPs at this time for 24 / 7 coverage, and they can only be in one place at the one time. It would be a waste of a rather expensive, and very public,  resource to send them to the routine jobs.


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## daedalus (Jan 12, 2009)

This is the coolest thing I have seen all week (its only monday).

Lets keep doing this in other counties.


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## JPINFV (Jan 12, 2009)

VentMedic said:


> The other version of this is the roving car APP will do all of those difficult things like intubations or those really hard ACLS protocols. In other words, some medics may get shoved over as the APP shows them how it is done.



That's one problem I see. So, you take your cream of the crop and give them all of the tough calls. Not necessarily a bad thing, but what happens when they retire? How do you know who your cream is when the number of critical calls that they actually lead goes down? Furthermore, there are problems with skill retention and a decrease in experience (seeing and doing are different things, and experience isn't gained overnight). It'll be interesting to see what happens when their APPs start leaving the system (move, retirement, etc).


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## karaya (Jan 12, 2009)

This is an article that came out on JEMS.com that provides a better insight as to how the program is managed. It's clearly not as simplistic as just sending "cream of the crop" out on bad calls. Looks like a very well thought out program. It will be interesting to see the results a year from now.

http://www.jems.com/news_and_articl...unty_debuts_advanced_practice_paramedics.html


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