terrible one
Always wandering
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LAFD nurse practitioners
- Thread starter terrible one
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Interesting. I've said for a long time that it makes more sense to use NP's and PA's this way rather than community health paramedics.
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Properly done, that's a great thing. The hard part is identifying early on which patients that call 911 are really "clinic" patients that would benefit from a visit by a prehospital NP or PA.
EpiEMS
Forum Deputy Chief
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Hopefully covered by very detailed protocols.
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Or able to be called in after the arrival of the first in EMS unit rather than transporting.
EpiEMS
Forum Deputy Chief
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Certainly true.
I wonder why they wouldn't put the NP on his/her own fly-car -- seems a bit more efficient. LA has their own way of doing things, I guess...
SandpitMedic
Crowd pleaser
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I like it, but I think the cost will out weigh the benefits in the long run.
Jim37F
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Vehicle wise, I would guess they're just using a reserve ambulance they conveniently had in a garage somewhere. Staffing wise, the IAFF likely made an argument about "firefighter staffing fire apparatus" and "pre-hospital expertise." For better or for worse that seems to be the LA modus operandi.
gonefishing
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You are correct. The IAFF is already trying to prevent the private sector from doing just this.
Summit
Critical Crazy
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I believe this is happening in Denver too.
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That is the best (only?) reason to be using paramedics in the community health system. Paramedics can provide these services at a much cheaper cost, and in some areas as part of the regular EMS staffing.
Summit
Critical Crazy
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Some of the services... Community Paramedics are not NP/PAs. Will the extra services and higher level of care be billable to justify the cost? I think so depending on the model and system
The reality is these one off specialty programs are mainly publicity stunts. Any union in their right mind would never let this become permanent and widespread unless of course they were able to absorb the PA/NPs as fulltime represented employees. Will the cost of these programs ever be justified?
gonefishing
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The L.A. County scope of practice for emt and paramedic hasn't changed much since johnny and roy. It keeps getting watterd and dumbed down due to it being a primarily fire system and every time fire screws up something gets taken away. Private medics are not allowed to pace unless a company pays the county to have a special class on pacing and you have to than have a special license. You cant start an iv without even calling mom! Even if you do you gotta call mom for documentation purposes.
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That is absurd.
You need to understand that outside of SoCal and the major metros, the scrotum of everyone involved in EMS is not firmly within the grasp of the fire union bosses. Most of us are not beholden to the IAFF.
Also understand that community health is not new - it has been a thing since long before EMS even existed - and right now there are strong economic drivers for expanded community health services. It makes sense for EMS to be involved, but if the IAFF or tradition or just failure to get our act together keeps us from getting involved, the community health train will simply leave the station without us. A team of RN's or NP's or PA's does not need the IAFF or local EMS agencies permission to just go ahead and expand programs that have already existed for decades.
gonefishing
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Actually it does in LA city and County lol
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I assure you that there absolutely are nursing based home health agencies in LA county that have nothing at all to do with the EMS or fire systems. If the local hospitals and government agencies decided to expand on those programs with mid-levels there would be nothing that the IAFF could do.
gonefishing
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Right! But when it comes to the transportation factor fire won't stand for it. Hence why in la city or county privates can't respond to emergencys unless requested by fire.
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Years ago when I was doing my community health practicum for my BSN program, I remember being really shocked at how much healthcare actually takes place outside the hospital. Usually its older, chronically sick people, especially ones who've had recent major surgeries or hospitalizations, because that's the only people that most insurers will pay to have these services. I remember at the time wondering why EMS didn't have anything to do with this stuff, and as I've seen things go on with the healthcare system (especially ED overcrowding and EMS frequent flyers) over the years, I've often thought that a big part of the solution was a massive increase in home health services, which EMS should be a part of. But the point is, when most paramedics talk about doing "community paramedicine", they often act as though it is some cutting edge new thing that was invented by the progressive EMS systems. I would have thought the same thing probably, had I not gotten exposure to it through my nursing education. But in reality, community health nursing has been around for a long long time, so much of the infrastructure for these programs already exists.
Most places in America, that won't be an issue, because the EMS agencies aren't all on their knees in front of the IAFF.
But even in a place where it is that way, ambulance transportation doesn't even really have to be part of the equation - in fact, avoiding ambulance transportation is largely the point of this whole thing.
All it will take for one of these programs to really get off the ground is for hospital ED's to realize that it is in their interest to help fund any initiative that will significantly reduce frequent flyer visits. Once you get a few hospitals working together to help fund one of these programs, it will take off with or without the involvement of the local EMS community.
When transportation is needed, use non-emergent transport services (WC van or stretcher van) or simply call 911.
Most places in America, that won't be an issue, because the EMS agencies aren't all on their knees in front of the IAFF.
But even in a place where it is that way, ambulance transportation doesn't even really have to be part of the equation - in fact, avoiding ambulance transportation is largely the point of this whole thing.
All it will take for one of these programs to really get off the ground is for hospital ED's to realize that it is in their interest to help fund any initiative that will significantly reduce frequent flyer visits. Once you get a few hospitals working together to help fund one of these programs, it will take off with or without the involvement of the local EMS community.
When transportation is needed, use non-emergent transport services (WC van or stretcher van) or simply call 911.