Orange County, CA to introduce private service paramedics. Call for comments.

JPINFV

Gadfly
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So Orange County, CA has decided to start allowing paramedics to operate on private company, interfacility ambulance units. Prior to this point, the only paramedic provider allowed in the county was the fire departments running 911 calls. Private companies used EMT-Bs (EMT-I [one]), RNs, and RTs to meet the needs of interfacility transports, including transports going to the emergency room.

Now for people who aren't familiar with the screwed up California system, direct EMS system management is left to the "Local EMS Authority" which is either the county or a group of counties. There are three levels, EMT-I (one, EMT-B), EMT-II (two), and EMT-P. There is a list of expanded skills for EMT-B which must be approved by the state. Similarly, counties can only use EMT-IIs [known as "limited advanced life support"] if they absolutely can not provide paramedics and only after approval by the state.

Here is the current proposal:
http://ochealthinfo.com/docs/medical/ems/i...ort%20units.pdf

I can't, for the life of me, see how this is useful. The drug list is essentially limited to glucose, nitro, saline, albuterol, ASA, narcan, and EpiPen. No ACLS drugs. No pacing. Only combitubes. SAED monitor (not sure if they'll allow manual defib). Probably the best part is if the patient crashes, the medic has to request a 911 medic. Why even use a medic for this? Why even apply for a medic spot with these restrictions?

Call for comments memo:
http://ochealthinfo.com/docs/medical/ems/45dayreview.pdf
 

VentMedic

Forum Chief
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Have they expanded the scope for the Paramedic to provide the care required on some interfacility transports? Even for the counties that do allow this, their scope is very limited so why bother attempting to do this at all. It just adds inconvenience to the hospitals that must free up an RN to accompany the patient where as with the MICN working on transport, that is not always an issue.

RNs from must hospital must be sent even with the FD paramedics if it is an emergent IFT for a stemi when the private CCT with an MICN is not available.

Alameda County, California

How it began:
https://www.acgov.org/PublicHealth/organization/divisions/ems/Resource/newsletter_December_2004.pdf
https://www.acgov.org/PublicHealth/...policy_manual/CCTP/CCTP_Program_Standards.pdf

PARAMEDIC INTERFACILITY TRANSFER (CCT-P) PROGRAM STANDARDS
Program Approval June 1, 2006


A. CCT- Paramedic Scope of Practice
The Counties CCT-P Scope of Practice includes each of the County’s Basic and Optional Scopes of
Practice for paramedics listed in the Alameda County EMS Prehospital Care Manual. In addition, CCTP’s
have an expanded scope that includes the administration of intravenous (IV) nitroglycerin (NTG),
potassium chloride (KCl), lidocaine, amiodarone chloride, and heparin by IV pump. The use of Automatic
Transport Ventilators(ATV) for ventilator dependent patients and midazolam for sedation of ventilator
and/or agitated patients.

B. Transferring Physician Orders
The transferring physician specifies standing orders for a patient based on skills and medications
included in the County CCT-P scope of practice using a County-approved form.

C. Patient Care Outside of the Paramedic Scope of Practice
1. When a patient's treatment/care is beyond the CCT-P paramedic scope of practice, that patient may
be transported by a CCT-P unit only when:
a. A licensed medical professional (e.g. RN, Nurse Practitioner, Nurse-midwife, PA or MD) is in
attendance and assumes control and responsibility for providing patient care outside the
Paramedic Scope of Practice; AND,

b. Medication or equipment needed by the patient that is not stocked on the ambulance unit are
provided by the sending facility.

2. Accompanying licensed medical personnel providing care function under their own written standing
orders and document any care provided.


Here's the policy for Contra Costa County which is essesntially the same.
http://www.cchealth.org/groups/ems/pdf/policy_28_paramedic_interfacility_transfer_program.pdf
 

daedalus

Forum Deputy Chief
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NO, They are allowing EMT-Bs to staff ALS units all alone! As long as they maintain ACLS and PALS and have the optional scope upgrade, they will be allowed to staff an ALS unit without a paramedic!
 
OP
OP
JPINFV

JPINFV

Gadfly
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NO, They are allowing EMT-Bs to staff ALS units all alone! As long as they maintain ACLS and PALS and have the optional scope upgrade, they will be allowed to staff an ALS unit without a paramedic!

Since I'm no longer in the area, I can't necessarily get a proper feel for the medical director. That said, allowing optional scope of practice for basics would mean that the medical direction of EMS in OC has switched from being extremely conservative to extremely liberal. The training for the advanced practice basic is over several optional modules, all of which must essentially recert for those modules every 6 months. That is going to make it a large headache for the companies that do use them, but it's still a dangerous road to go down.
 
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