Community Paramedics

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vc85

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Can someone explain what exactly community paramedics are and how what they do is different from what the existing public health nursing/community health nurses do now.

Maybe it's not like this everywhere but where I live, the county health department has nurses who go check in on elderly patients, tske vitals, make sure they are taking medications etc. With politicians always decrying "duplication of services" wouldn't it make more sense to use funds to beef up these programs and maybe add some NPs who can prescribe, suture etc. rather than creating an entire parallel system?

If anyone works in an area that has both systems, how are responsibilities divided up between the two programs?
 
Summit

Summit

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CPs do the same thing, but cheaper than hiring a CHRN with a BSN because CPs don't need a degree, just a few hours of in-service and OJT.

Someone will be along shortly to tell you that CHRNs don't want to do it, but what they really mean is that EMS services don't want to pay for a RN and CHRNs don't want to do it for Paramedic wages while there are plenty of medics who are tired of being medics but don't want to get a BSN.

Someone else will try to convince you that CP is "progressing" paramedicine instead of tacking on a totally different role.

Someone else will explain how CPs are complimentary to CHRNs and not duplication... if you squint your eyes correctly...

Someone else will try to tell you that CHRNs are less experienced in running a code blue so you need a medic just in case the monthly home health visit turns south!

Someone else will be along shortly to tell you we not only need CPs, but we need a special "Paramedic Practitioner" for this role because NPs and PAs don't want to get on an ambulance (even though they do) then they'll imagine some way that this PP doesn't duplicate NP/PA and some pathway to a masters level PP that isn't a PA (and avoids "boring NP/PA curriculum content) even though we can't get a requirement for an Associates Degree for medics.

That is my summary of the dozens of pages already discussed on this subject in dozens of previous threads.

*flame suit on*
 
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EpiEMS

EpiEMS

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@Summit, this is a really interesting take, and while I'm pretty bullish on the idea of more EMS involvement in the community's general health (injury preventative measures, namely), I certainly see the possibility that duplication could occur. However, it's conceivable that in some areas, public health and community health resources are stretched thin, while EMS is (relatively) well resourced, so there's no reason why EMS providers couldn't help out.

I myself like the idea of a paramedic-type midlevel provider, but your point is well founded that it would be potentially duplicative as well. The benefit of this type of provider, as I see it, is that it would be focused on emergency and critical care needs while also being a progressive development of an existing skill-set (much like an RN can become an NP, you could have a paramedic with an associates' degree become a bachelors' level "paramedic practitioner" and gain some skills as well as, perhaps, a limited prescribing authority).

You could also plausibly argue that there is an entire class of workers "below" CHRNs designed expressly for this purpose - the Community Health Worker.

BTW...your wage-related argument is 100% sound. Shortages, by definition, only exist when you can't get something at *any given price (wage)*.
 
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Alan L Serve

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I signed up for EMS because of the very first letter, emergency. Now I do realize that many of our calls are not emergencies and for that I feel frustrated. For those people I counsel them to next time call their doctor and make an appointment for the back pain they've been experiencing for 3 years. There is an amazing group of humans called nurses and this incredibly organization known as the VNA- Visiting Nurses Association where they have men and women who are educated, degreed, and licensed to go to someone's home and check them out for non-emergencies. The VNA know when something is an emergency and I've responded to their calls to 911.

Community paramedics? No thanks. There's already a group that expertly does that and I have no desire step on their toes.
 
TransportJockey

TransportJockey

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Alan L Serve said:
I signed up for EMS because of the very first letter, emergency. Now I do realize that many of our calls are not emergencies and for that I feel frustrated. For those people I counsel them to next time call their doctor and make an appointment for the back pain they've been experiencing for 3 years. There is an amazing group of humans called nurses and this incredibly organization known as the VNA- Visiting Nurses Association where they have men and women who are educated, degreed, and licensed to go to someone's home and check them out for non-emergencies. The VNA know when something is an emergency and I've responded to their calls to 911.

Community paramedics? No thanks. There's already a group that expertly does that and I have no desire step on their toes.
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A group that is very understaffed and honestly would do well if we paired up CPs with home health nurses as a team. I've never worked anywhere that a home health or public health nurse had near enough resources to manage all their case loads.

Sent from my SM-N920P using Tapatalk
 
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Alan L Serve

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TransportJockey said:
A group that is very understaffed and honestly would do well if we paired up CPs with home health nurses as a team. I've never worked anywhere that a home health or public health nurse had near enough resources to manage all their case loads.

Sent from my SM-N920P using Tapatalk
Click to expand...

And we are in a much better position of staffing and resources? Joining forces aka doing less with two completely different trained groups. I'm not even sure it's legal.
 
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WolfmanHarris

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Interesting, Community Paramedicine is looking a little different in my area and is really a spectrum of programs that include both emergency operations and separate Community Paramedicine Unit outside regular ops. I'll attempt to describe the relationship between our current and developing programs and existing public health and homeware programs.

First by way of background, my service is a Regional (municipal) Third Service agency that is 100% funded by the public purse (50% municipal, 50% provincial) with no fee for service, though a $45 co-pay is collected on all transports. We serve a population of 1.1M over mixed rural, suburban and urban area with a staff of approximately 450 Paramedics in Operations plus maybe 100 in program development, education, management, etc. My area is very well funded and supported by the municipality and as a result our programs are not typical of Ontario or Canada; lots of services are working on various community paramedicine initiatives but we seem to have jumped in with both feet and then some.

Community Paramedicine programs:

Community Referral by EMS (CREMS)
Paramedics that identify a patient that would benefit from additional supports complete a referral that is integrated into our ePCR system. This automatically generate a faxed report to the Community Care Access Centre (CCAC) which coordinate home care and other programs in the area. The report they receive includes the narrative, Pt. contact information and a summary (in broad strokes) of why the Paramedic sent the referral. Examples include medical case management, mental health and substance abuse, assistance with activities of daily living, fall frequency or safety within the household, caregiver fatigue, etc. CCAC reviews these referrals and a case manager makes phone contact within 48 hours and manage the case from there.

Shelter Visits
Members of our Community Paramedicine unit make regular visits to the short term/emergency shelters in the region. Residents are assessed and aided with system navigation or for conditions identified that need more immediate care transport to hospital via Ambulance is arranged.

The shelters have social workers, but they don't have the medical knowledge to handle these cases (and frankly enough on their plate). Arguably this could be better addressed by Nurses, but the transient population poses challenges and the relative affluence of our area means there are limited outreach organizations positioned to address this area.

Enhancing Paramedicine in the Community (EPIC)
EPIC was a multi-year research trial that specifically looked at whether Paramedic home visits for patients under the care of a family health team could reduce exacerbations of IDDM, CHF and COPD and the resulting 911/ED usage. Paramedics received an additional 12 weeks of formal education completing a certificate (from an accredited College). Study results were promising and rather than send these medics back to operations when the study wrapped they have been repositioned to respond to individual cases that may arise, (frequent callers typically) often along with a social worker to help connect these patients with more appropriate health care.

IMPACT (I honestly can't remember the acronym at the moment)
IMPACT is the big cornerstone project for Community Paramedicine. It's predicated on the question of do we respond to all the low acuity calls by trying to educate patients away from calling 911 or do we make adjustments where we can to the service we provide to meet our patient population.

IMPACT is a multi-year, multi-phase study. The first phase was a ten year analysis of every single patient carried by Paramedics that tracked their entire course of care to discharge (and recurrence) to identify which patients were being discharged with no or minimal intervention. From this data a cohort of patients that could likely be safely left at home given proper assessment and treatment in the field was identified and a curriculum developed.

The next phase of the trial has seen ten of our Advanced Care Paramedic complete an additional six months of education. They will be the intervention arm of the trial with study population randomized to calls they are dispatched to and the control being the rest of operations. Because I've been in school myself I don't know the entirety of their scope of practice but it will include POC blood testing and urinalysis, additional assessments and I'm sure lots of things I'm forgetting. In the next phase these medics will complete their assessments, consult with a study MD via phone to confirm the treatment plan and initiate it AND still transport as before. The next phase will see assess treat and refer with continued MD consult and confirmation and finally the proposed final phase will be assess treat and refer without direct consult. As the study continues it is expected that more ACP's will be added to the intervention arm.



To me to avoid Community Paramedicine just being a cheaper homecare/nursing (which given similar pay between Paramedics and RN's isn't really a cost savings) the focus needs to be on short term management of these patients with referral as soon as possible to the more appropriate professionals/agencies for the job.
 
VentMonkey

VentMonkey

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I honestly don't care who does it, but it needs to be done. For the publics sake, for the EMS and hospital staffs sanity, for sustainability, it just needs to happen. A joint effort between a home health and EMS service seems logical, but we all know where logic fits in with life...

IMO, it's pretty sad we still have providers that don't embrace it, and/ or say they just want to "run emergency's". That phrase alone indicates the same type of hero-complex generated by TV, and the media. It's what's wrong with our field, but moreover, not wanting to change, or accept/ embrace new roles is worse.

What is most of the job in my area with "emergency calls"? Social work, albeit low level perhaps, but I fail to see how better preparing street paramedics with an education fit for a more in-depth assessment with mental health patients, and better educating both the paramedics, and patients in understanding how one comes to be a "super user" is a bad thing for either one.

Not to mention the humanity in it, but again, if we're still (as a whole) isolating ourselves to the "I got in to this for the emergency" mindset then we're only further serving to alienate us from the healthcare industry as a profession, and we deserve nothing more than the "just get me to the hospital" response and mindsets from the public. I also feel there's a disservice we do with an already limited skillset. But I guess there isn't anything cool, or sexy about helping an entire system by decreasing the workload of other providers so that they can run the calls that are "emergency's". Ensuring that these people are getting the proper care they need doesn't count as any sort of skill I suppose, but how selfless does one have to be to make these contributions? IMO, pretty selfless, and that's heroic.
 
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EpiEMS

EpiEMS

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Apropos to this discussion, an interesting model proposed by a working group, if you will.
 
Tigger

Tigger

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I have expounded on this many times and will have to see if I can find long *** post I left in a different thread.

In short, we completely overhauled the provision of mental health response in our community since no one else would.
 
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