Laws can be changed...

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Veneficus

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http://www.emsworld.com/article/10686290/who-you-callin-community-paramedics

Over my time here on EMTlife, we have many times discussed the future of EMS, paramedics operating in an expanded capacity, and all manner of expanded roles and education.

I have many times advocated that an expanded role for paramedics was required for the ongoing feasability of EMS as the US experiences the inevitable evolution of common diseases.

We have identified funding as a major hurdle in expanding the scope and value of EMS.

This is the first state level law I have seen in the effort to undertake a move to move EMS in the direction that I think it must inevitably go.

Many of you also have come to understand my general dislike for mid-level providers. But I cannot help but point out that this article describes paramedics doing exactly what mid-level providers were supposed to be doing.

Further pointing out that they are not band-aid they were supposed to be.

But now that I have given some background, let us discuss something from an angle we may not have considered before...

Preemption.

One of the skills I gained during my time in EMS is the ability to predict not only what illnesses and injuries people aquire, but the trends in which they aquire them. Not because I can see the future, but because I remember all of the misfortune of the past and see a pattern.

I am sure many of the experienced providers here also share such a skill.

So here it is, if you could change your scope of practice, with the intent on saving money by providing intervention prior to a 911 call, what do you think would help your area most and why?
 
Proszę wybaczyć pisownię.
 
MedStar up in Ft. Worth is doing something that I really think is excellent. As a recap, their APP's drop in and check on their frequent flyers, make sure they're set up with meds, etc.

It appears to be working well.
 
Reinventing answers for an ongoing need.

Visiting Nurses and community health nurses used to fill that roll. Urban community centers ("Hull Houses" or "settlement houses") offered some clinic services usually on a periodic basis, but you had to be able to get there. County Clinics sometimes still offer services if you can get there.

Learning about community health and public health could be good starters, then pass the protocols. Get RID of the adrenaline junky aspect of PEMS.
 
Paramedic initiated refusal with official/sanctioned advice on what to do instead, like go to an urgent care.

Home assessments for fall prevention, but that doesn't really involve expanding scope.

Collaboration with hospice to allow us to medicate pts using their hospice standing orders. Sometimes families freak out and call us without calling the on call RN. I would like to be able to call the hospice RN and with their agreement take care of whatever the problem is, rather than waiting for the hospice RN to get there.

Offer periodic home visits to those who volunteer for them and those who are determined to need assistance either because of frequent 911 calls or via hospital referral after they are discharged. These would involve monitoring ongoing conditions and ensuring they are taking their meds. It would also help prevent readmissions by identifying illness before the pt becomes super sick, ie doing a urine dip on someone who was admitted for uti. This could also be used as a stop gap while normal in home care is arranged since it can take some time.

Minor issues, Falls, hospice, non compliant pts having exacerbations , and recent discharges are a large % of our preventable transports.
 
Monitoring meds, home visits to take vitals, home visits to make sure safety railings and non-slip pads are in place, etc.

EMS could do much better at injury prevention and disease prevention if only we were willing to make the effort to get legislators to understand that an ounce of prevention is worth a pound of cure. Better to spend a hundred bucks for a paramedic to spend an hour at an elderly frequent flyer's house to obtain vitals, make sure they have their meds (and know when to take them), and ensure they're doing ok than to come for a serious call again and again due to medication compliance issues, say.
 
Aidey said:
Paramedic initiated refusal with official/sanctioned advice on what to do instead, like go to an urgent care.
Click to expand...

Yes, yes, and yes!
 
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