Nurse Practitioners and Physician Assistants in EMS

[Kavsuvb]

Here's a Question for ya, can you see in the Future where Nurse Practitioners and Physician Assistants become the new standard of EMS medical care in the field. Do you think the future trend in EMS is heading towards where Nurse Practitioners and Physician Assistants become the new version of Paramedics in the field.

 

[Carlos Danger]

I would not be surprised to see NP's and/or PA's play more of a role in EMS in various ways, as they already are doing in areas of healthcare that you didn't used to see them much. But replacing paramedics? No, I don't see that happening.

 

[VentMonkey]

I wouldn't mind taking medical direction from a well-versed PA or NP. Most medical directors, specifically those who still practice EM full-time, don't have the time to dedicate to their respective EMS agencies in my opinion.

 

[Kavsuvb]

Could you see the Future where EMS becomes a PA/NP focus rather than a Paramedic focus

 

[gonefishing]

NPs and PAs are already doing this in some areas. The mysterious NP1 and NP2 of LA city fire which is rarely seen and some say used is out there some where at the tune of $200k a year for one NP with additonal cost don't have the numbers in front of me but I know it was a huge number. In other areas you have them playing a great role in community medicine doing catch and release programs of most frequent flyers or simpe aid that does not need to go to the hospital. If they do need a hospital they can make that call.

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[Summit]

There is room for them in the community care delivery model, but then there is also actually far more room for RNs for community mobile health care. Especially when you have to consider cost and efficiency.

Im sure we'll see more PA and NP in the field however you will continue to face the fact that they just can't see as many patients that way and it's better to have the ambulance bring people to a family practice office.

 

[VentMonkey]

Could you see the Future where EMS becomes a PA/NP focus rather than a Paramedic focus

No, "meatwagon medicine" will always have its place in the emergency setting. Even more so if it came back around full circle, which I'm certain it eventually will.

PA's and NP's are an excellent asset in certain settings, but then you need to factor in things such as EMS fundings, budgets, and allocating of such resources for a plethora of advanced practioners. We're already "bursting at the seams" with healthcare funding as it is. Last time I checked the government still hasn't fully accepted EMS into the healthcare realm.

In short, a handful of "mobile PA/ NP" cars becoming the norm, sure. An NP or PA working directly under a physician for an EMS agency, and actively becoming involved in protocol writings, and revisions...one could only hope.

 

[Kavsuvb]

Can you see a role starting in 2020 where NP's and PA's become the norm in EMS. Which would mean if you want to really make money in EMS, you would have to progress to the level of NP or PA. Do you think EMS is heading towards a NP/PA based system?

 

[SpecialK]

It has been talked of Nurse Practitioners having a role on the specialist low-acuity response cars (Sierra/UCC) but this hasn't happened yet in the approximately five years it has been running and is unlikely to happen in the near future.

There are only a tiny number of NPs around (the Nursing Council puts it at 142 vs 47,488 RNs in 2015 - or 0.002% of the Nursing workforce) and I bet not very many work in an appropriate acute setting to transition properly e.g. ED or an A&M clinic.

Physician Assistants (called Physician Associates) have been trialled twice - the Ministry of Health is not interested in pursuing them further and honestly I do not think it should be really. There was some grind from the Junior Medical Officers about them working in acute care and that is fair enough. They would be great in the smaller areas where attracting GPs is proving difficult, and will forever be difficult I suspect. That however, is another topic.

To be fair, no I do not think the value is worth the hassle; the vast majority of what an NP would do is already undertaken by ambulance personnel in terms of making a diagnosis and plan of action for what that patient needs; if I get on the blower and give their GP a swift one they'll generally be seen the same day especially if they have a good history, otherwise if it's just an acute problem the local A&M will always see them on a walk-in basis. This takes care of the "other half" of the problem in that ambulance personnel cannot prescribe, and nor do I think it should be.

 

[GMCmedic]

Why are you asking the same question over and over again?

No, I dont see them being the norm. At least not with current reimbursement rates.

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[hometownmedic5]

The repetitive questions with slight modifications are sounding an awful lot like we're doing your homework for you, but I'll bite.

The system as a whole could never shoulder the financial burden of replacing <$20/hr paramedics with >$50/hr(at least) mid levels. As previously stated they may find a niche in community medicine when actual field treat and release protocols become a large scale thing. My company is currently utilizing a small number of RNs in an IFT capacity, at a much inflated cost compared to paramedics. I don't see the program growing much beyond the current version of one fly car staffed occasionally.

There will always be paramedics because we are the cheapest way to provide ALS. Even as our certificaion requirements increase, and so does our pay, we'll always be the cheapest option to satisfy the objective.

 

[VFlutter]

I see NP/PAs possibly becoming more common for medical control and in community medicine but not for traditional EMS. Maybe even a select few in fly cars like some places do with MDs. But the marginal benefit does not justify the cost.

I still don't get why you keep saying 2020. It's almost 2018. You think things are going to drastically change in two years? Like I said in your other post even 2030 is being optimistic.

 

[Tigger]

Can you see a role starting in 2020 where NP's and PA's become the norm in EMS. Which would mean if you want to really make money in EMS, you would have to progress to the level of NP or PA. Do you think EMS is heading towards a NP/PA based system?

Trying to figure out your degree?