LAFD nurse practitioners

[Carlos Danger]

But on a positive note, I think the idea of community health programs co-run by ED's and EMS agencies, using teams led by a PA or NP is a great idea, with tons of potential. I hope it works out.

 

[gonefishing]

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.

Yes but again the use of paramedics in this area is all a mother may I system. The ems agency doesn't want to change a thing. Reason again is fire is in control.

 

[zzyzx]

I'm curious, but what do you guys think that an NP or PA working outside of an ER/clinic, or for that matter a doctor, will be able to do better than a paramedic?

 

[Carlos Danger]

I'm curious, but what do you guys think that an NP or PA working outside of an ER/clinic, or for that matter a doctor, will be able to do better than a paramedic?

History and physical exam, diagnosing & managing non-emergent conditions, prescriptions, referrals.....

 

[zzyzx]

History and physical exam, diagnosing & managing non-emergent conditions, prescriptions, referrals.....

Sure, they can do a better clinical exam. But how far can they get with only that and no labs or imaging? Let's consider a typical call for abd pain. They can make a better guess at a Dx than a medic, but in the end they will just have to tell the patient that they need to go to the hospital. How is that different than what a medic will do? Most of the 911 "super users" i know will complaints like this or chest pain or SOB.

 

[gonefishing]

Sure, they can do a better clinical exam. But how far can they get with only that and no labs or imaging? Let's consider a typical call for abd pain. They can make a better guess at a Dx than a medic, but in the end they will just have to tell the patient that they need to go to the hospital. How is that different than what a medic will do? Most of the 911 "super users" i know will complaints like this or chest pain or SOB.

Because they can treat on the spot unlike the paramedic protocol where you have to call for everything. Even if you take a sugar you gotta call mom.

 

[onrope]

I am sure they are keeping very accurate records on the type of calls ran, treatment rendered, etc. We will be able to see if this concept is even worth it in the end. Paramedics are specialists in a very small part of medicine and ultimately everyone goes to the hospital. The common complaints like CP, SOB, abd pain will end up in the ER anyway. Every now and then they may throw a few sutures in a wound and save a er trip or refer someone with flu like symptoms to a clinic or write a new rx for the person who is calling to get their meds refilled but in the end is the juice worth the squeeze? IMO it is the nursing industry trying to muscle their way into yet another field, touting that their NP education is so advanced even though most of it is useless nursing theory classes. I feel PAs are far more suited to this role especially since a majority were prior EMS. Nurses have long stated Paramedics are inadequate and should eventually be replaced by nurses pre hospital and I think this is the start of that movement.

 

[usalsfyre]

Sure, they can do a better clinical exam. But how far can they get with only that and no labs or imaging? Let's consider a typical call for abd pain. They can make a better guess at a Dx than a medic, but in the end they will just have to tell the patient that they need to go to the hospital. How is that different than what a medic will do? Most of the 911 "super users" i know will complaints like this or chest pain or SOB.

Labs and imaging are to confirm suspicions, not as a shotgun to figure out the problem. Besides, POC testing has come a long way.

 

[gonefishing]

I am sure they are keeping very accurate records on the type of calls ran, treatment rendered, etc. We will be able to see if this concept is even worth it in the end. Paramedics are specialists in a very small part of medicine and ultimately everyone goes to the hospital. The common complaints like CP, SOB, abd pain will end up in the ER anyway. Every now and then they may throw a few sutures in a wound and save a er trip or refer someone with flu like symptoms to a clinic or write a new rx for the person who is calling to get their meds refilled but in the end is the juice worth the squeeze? IMO it is the nursing industry trying to muscle their way into yet another field, touting that their NP education is so advanced even though most of it is useless nursing theory classes. I feel PAs are far more suited to this role especially since a majority were prior EMS. Nurses have long stated Paramedics are inadequate and should eventually be replaced by nurses pre hospital and I think this is the start of that movement.

More along the lines of the nursing unions. The IAFF and United Nurses are very fond of eachother. The best thing is to have a lobby group in every state for ems that is non fire or organize. But you keep out the big name unions or any name associated to another fire/nurse union or association.

 

[zzyzx]

I never said do labs or imaging as a shotgun approach. Nor are they just done to confirm an already know diagnosis. Even the most experienced ER doc can usually only make a reasonable guess based on clinical exams. My point is that for most complaints the NP is going to tell the patient that they need to go to the ER. Same thing as the medic.

 

[zzyzx]

I have never heard of nurse unions wanting to take over EMS. The thought of that is actually pretty funny

 

[onrope]

It is often subtle, so it takes some astute observation to really notice it. The nursing lobby is vehemently against community paramedicine. They claim paramedics don't have the necessary education or training and that, surprise surprise only NPs should be the ones doing preventative medicine and check ups pre hospitally. In California nurses have succeeded in keeping the Paramedic scope of practice so limited that RNs have to be used any time a pt is on a pump or a vent. There are no CC medics in California because nursing wants to keep that niche to themselves. Do I ever see a time where nurses supplant EMTs and Medics? Absolutely not, they don't want to work the crappy hours for little pay but they will continually keep their stronghold on CC and the emerging trend of having NP units perform housecalls. I don't have a dog in the fight, but one needs to realize that the IAFF and FF unions are not the only ones who have a vested interest in pre-hospital care and the eventual evolution of the current delivery model.

 

[gonefishing]

It is often subtle, so it takes some astute observation to really notice it. The nursing lobby is vehemently against community paramedicine. They claim paramedics don't have the necessary education or training and that, surprise surprise only NPs should be the ones doing preventative medicine and check ups pre hospitally. In California nurses have succeeded in keeping the Paramedic scope of practice so limited that RNs have to be used any time a pt is on a pump or a vent. There are no CC medics in California because nursing wants to keep that niche to themselves. Do I ever see a time where nurses supplant EMTs and Medics? Absolutely not, they don't want to work the crappy hours for little pay but they will continually keep their stronghold on CC and the emerging trend of having NP units perform housecalls. I don't have a dog in the fight, but one needs to realize that the IAFF and FF unions are not the only ones who have a vested interest in pre-hospital care and the eventual evolution of the current delivery model.

Actually your wrong. There are CC medics. For example Orange County. They use pumps and vents. Its primarily LA City/County that prevents this because look who is in charge as well as who it caters to.

 

[onrope]

Actually your wrong. There are CC medics. For example Orange County. They use pumps and vents. Its primarily LA City/County that prevents this because look who is in charge as well as who it caters to.

Maybe you should check your protocols before calling someone out. http://healthdisasteroc.org/civicax/filebank/blobdload.aspx?BlobID=39680 I don't work in OC or LA and it took me 1 minute to pull this up. ALS standing orders specifically state transport on a ventilator dependent pt with RN or RT on board. So unless you have some new info or special protocols please provide them.

 

[gonefishing]

Maybe you should check your protocols before calling someone out. http://healthdisasteroc.org/civicax/filebank/blobdload.aspx?BlobID=39680 I don't work in OC or LA and it took me 1 minute to pull this up. ALS standing orders specifically state transport on a ventilator dependent pt with RN or RT on board. So unless you have some new info or special protocols please provide them.

Actually I will. Since you don't work that area I will let you know its a new thing to have als ift in OC. Where as it is still a trial in a way.

 

[onrope]

So unless I'm reading the protocols wrong a medic cannot take a PT on a vent by themselves correct? Perhaps they are doing a trial in OC where medics are taking patients on vents by themselves, that would be amazing. I deal in absolutes and OCEMS protocols state no. I'm amazed OCFA and the nurses lobby down there are allowing this if that is true. I remember hearing the *****ing out here in ICEMA when we were all told private paramedics would kill patients and only FF should be paramedics.

 

[gonefishing]

So unless I'm reading the protocols wrong a medic cannot take a PT on a vent by themselves correct? Perhaps they are doing a trial in OC where medics are taking patients on vents by themselves, that would be amazing. I deal in absolutes and OCEMS protocols state no. I'm amazed OCFA and the nurses lobby down there are allowing this if that is true. I remember hearing the *****ing out here in ICEMA when we were all told private paramedics would kill patients and only FF should be paramedics.

There are only 2 allowed right now. Lynch and Med response. Both carry vents and pumps. Both the medics are well allowed to use. The medical director is pro medic and emt. He does not care about the politics and thats why the IAFF and OCFA hate him. Nurses have now become a custom to private medics. Nursing homes now call private vs fire. It's had a 100% success rate so far.

 

[onrope]

This is good then because it means progress it being made. I have heard rumors from friends still stuck in OC that Care is going to get a trial for 911 Medics in some areas that OCFA covers. I believe the system out here in ICEMA and REMS is superior but you still find people who think that OCFA medic vans are a great idea in case of FF down or an MCI or they argue that somehow the FF that went to saddleback received superior training even though they don't teach them anything about dopamine other than titrate to 30 gtts.

 

[gonefishing]

This is good then because it means progress it being made. I have heard rumors from friends still stuck in OC that Care is going to get a trial for 911 Medics in some areas that OCFA covers. I believe the system out here in ICEMA and REMS is superior but you still find people who think that OCFA medic vans are a great idea in case of FF down or an MCI or they argue that somehow the FF that went to saddleback received superior training even though they don't teach them anything about dopamine other than titrate to 30 gtts.

I highly doubt Care would make such a move. Thats why they won't run Paramedics in OC they don't want to poop where they eat or bite the hand that feeds.

 

[Carlos Danger]

Nurses have long stated Paramedics are inadequate and should eventually be replaced by nurses pre hospital and I think this is the start of that movement.

Where is your evidence that nurses want to "replace" paramedics? Where has this been "stated"?

I can assure you that 99.99% of RN's have absolutely zero interest in taking the place of paramedics.