Using EMS education as a stepping stone?

[Veneficus]

NPs and PAs supported each other for the benefit of the people. The focus was on patient care. If Paramedics had a viable plan for the public, they might help the cause and support them also. As it is, EMS is too busy fighting amongst themselves to care about patients.

That is exactly my point.

 

[Ridryder911]

One has to remember, you could be a P.A. with only a certificate until about 8 yrs ago. I know, the program I was in offered either a degree or certificate. The same with NP's; especially Neonate NP's was mainly OJT with additional classes. Now, alike EMS should go with most will now require a degree. Not only a degree but a formal post graduate.

In regards of EMS not billing, really there is. It is has been approved for Medicare to extend teh payment structures for advanced level of care such Advanced Paramedic/Practitioner. Details are still being worked out as the levels of education, scope, etc is still being evaluated. This has been drafted a while back by American Ambulance Association. There are other options in billing that will off set costs but will require more education than is provided and as well clinical skills to accompany them.

Again, the future of medicine and Prehospital care (not EMS) will be changing; it has to; to meet the future demands of the patient load and alternative way to provide care.

R/r 911

 

[Sasha]

Spoken from years of experience?

Sorry, I didn't know you needed years of experience to recognize the better pay, professionalism and higher standards of another profession.

 

[curt]

So the first step would be raising our educational standards as a whole, but how do we do that without calling in the politicians? I mean, even if every one of us went on to be five-star instructors turning out a class of twenty or so each year, we wouldn't come close to throwing a monkey wrench into how badly these 'three-month-wonder' and 'zero-to-hero' programs are degrading the integrity and the quality of care of the profession.

Also, I didn't necessarily mean that EMS needs more 'skills' under its belt so much as I meant that I'm both hoping and expecting the EMS curriculum to begin dipping its hands into the cookie jar of 'treat-and-release' in order to both streamline medical treatment and systems and to reduce undue strain on ERs. As for middle-level providers (I'm assuming these are going to be I85's/I99's) demanding some of those treat-and-release 'skills', I'm fine with it. A basic truck, headed by an intermediate under these sorts of protocols I'm talking about, could handle most 'minor' emergencies while leaving the ALS units to the big fish, so to speak, or only calling them in once they're lead to believe in the presence of a higher emergency.

( I'm not sure if any of that made sense. I'm not revising it, though. I hope it's legible, but it's been one of those days, and definitely the worst day in recent years, I'm mentally and spiritually battered, and I'm hoping I'll feel better with some sleep. )

 

[VentMedic]

As for middle-level providers (I'm assuming these are going to be I85's/I99's) demanding some of those treat-and-release 'skills', I'm fine with it. A basic truck, headed by an intermediate under these sorts of protocols I'm talking about, could handle most 'minor' emergencies while leaving the ALS units to the big fish, so to speak, or only calling them in once they're lead to believe in the presence of a higher emergency.

No, the mid-level providers discussed here are NPs and PAs.

The intermediate level for EMS just further complicates the education issues by providing a few more skills with very little education.

 

[VentMedic]

I was just watching the news and saw Walgreens are promoting their in store clinics staffed by NPs. Their services will be free to the unemployed. Of course, the medications will not be free.

http://www.floridatoday.com/article/20090331/BREAKINGNEWS/90331055/-1/SEVENDAYS

http://www.huffingtonpost.com/2009/03/31/walgreen-free-care-for-jo_n_181178.html

Other news articles and the NP's involvement in community health issues.

http://www.smartbrief.com/news/aanp...tegoryid=7B651A9C-543B-43A9-909D-CC5F80F69335

This is an interesting report concerning the PAs proposal to raise their education requirements for entry level.

PA Clinical Doctorate Summit
Final Report and Summary
April 15, 2009​

http://www.aapa.org/clinissues/PAClinicalDoctorateSummiFinalReportSummary.pdf

Video for promoting healthcare from the PAs' point of view. Great promotion.
http://www.aapa.org/index.html#paha

Other healthcare professionals also have similar PR from the national associations to get the message out that they care about the patient and still promote their own agendas.

While EMS might still want to promote the "treat and release" or "transport refusal" programs, there must be a higher level of care still available so the patient is not just left on the curb wondering how to get more definitive treatment. At this time EMS is too limited in education to make many definitive decisions or treatment care plans for their patients especially those with medical problems either diagnosed or new onset. Eventually EMS will have to get over the "what can the patient and healthcare do for me" mentality and view the issues for what is best in terms of patient care.

 

[medic417]

While EMS might still want to promote the "treat and release" or "transport refusal" programs, there must be a higher level of care still available so the patient is not just left on the curb wondering how to get more definitive treatment. At this time EMS is too limited in education to make many definitive decisions or treatment care plans for their patients especially those with medical problems either diagnosed or new onset. Eventually EMS will have to get over the "what can the patient and healthcare do for me" mentality and view the issues for what is best in terms of patient care.

You are right it is about what is best for a patient. But what is best for a patient may be leaving them at the curb. But not leaving them wondering. We would educate them as to the agencys they can get help from. We will help get them scheduled with those services. Bit it will require better education. When we do actually become Pre Hospital Medical Professionals we will do more good for our patients than we do now as the ambulance drivers that so many seem content to be. I do see more services after making sure their medics are educated developing more treat/assist and release systems.

I do push for the right to deny transport but more and more comments I read on here and other forums makes me see though that many Paramedics just are not educated enough to even do what they are currently allowed much less to add this important but dangerous protocol.

 

[silver]

There is currently a discussion in the upper echelons of PAs to make it a requirement to have a residency, instead of it being optional like now. This would most likely get PAs to specialize more, and possibly expand what their scope is.
However there are like two factions (i think both are national organizations) and they can't agree on the subject.

So we will see...

 

[VentMedic]

We would educate them as to the agencys they can get help from. We will help get them scheduled with those services.

Are you (Paramedics) making the actual appointments?
Are you able to do an official insurance (private, state or Federal) referral form?
Or, are the patients given a generic phone number to an agency that then puts them through a maze of unanswered extensions?
How much time are you allowed with each patient for a thorough assessment, filling out the appropriate referral forms and making the agency contacts as well as arranging for alternative transport?
Taxi vouchers? Wheel chair van vouchers? Who pays and where does the additional funding come from?
Any studies done as to how long between the time the patient sees you and the clinic or other agency?


Are you (Paramedics) able to do nutrition and diabetic counseling after fixing that "little glucose problem"?
Are you able to prescribe medications or recommend OTC meds?
How much wound care knowledge do you have for educating the patient?
How much indepth education do you have for teaching patients about their illnesses?
Are you following the triage guidelines suggested by EMTALA even though it does not necessarily apply to prehospital situations but does address many questions for the proper level of care?

 

[VentMedic]

There is currently a discussion in the upper echelons of PAs to make it a requirement to have a residency, instead of it being optional like now. This would most likely get PAs to specialize more, and possibly expand what their scope is.
However there are like two factions (i think both are national organizations) and they can't agree on the subject.

So we will see...

There are 4 recommendations listed in the link I posted earlier.
http://www.aapa.org/clinissues/PAClinicalDoctorateSummiFinalReportSummary.pdf

1. The PA profession opposes the entry-level doctorate for physician assistants.

2. The PA profession endorses the master’s degree as the entry-level and terminal degree for the profession. As of 2012 the degree conferred upon completion of a PA program will be a singular degree entitled the Master of Physician Assistant Practice (MPAP).

3. The PA profession supports colleges and universities offering postgraduate, nonprofession-specific clinical doctorates (e.g., doctorate of medical science, doctorate of health science, or other non-PA-specific clinical doctorates) as options available to PAs.

4. The PA profession should explore the development of a model for advanced standing for PAs who desire to become physicians (sometimes called a "bridge program").​

 

[medic417]

My answers in line.

Are you (Paramedics) making the actual appointments?
Yes, or we call and tell the agency what we have then put patient on line to make final arrangements.

Are you able to do an official insurance (private, state or Federal) referral form?
If patient requires that at this time we help them get it from their doctor or a clinic.

Or, are the patients given a generic phone number to an agency that then puts them through a maze of unanswered extensions?
We do provide people with a list beyond doing the above as many people are unaware of the various services provided whether medical or even financial. It is obviously many posters statements on this and other forums that most Paramedics and emt's have no clue what their areas have available.

How much time are you allowed with each patient for a thorough assessment, filling out the appropriate referral forms and making the agency contacts as well as arranging for alternative transport?
We stay until finished if critical need. If it is not critical need we may leave for another call and then return to finish helping.

Taxi vouchers? Wheel chair van vouchers? Who pays and where does the additional funding come from?
We do not provide these. We do give them information about various government, church, paid, and other services in the area. A big government one for Medicaid patients is the medical transportation funds which will pay them to drive themselves or pay a friend to take them, or pay a taxi, bus, even plane if needed.

Any studies done as to how long between the time the patient sees you and the clinic or other agency?
No actual study but anytime I have called a service they have gotten them worked in immediately or if not emergent first business day.

Are you (Paramedics) able to do nutrition and diabetic counseling after fixing that "little glucose problem"?
We do some very basic counseling but we primarily do the above, that is help them get into proper service for help needed.

Are you able to prescribe medications or recommend OTC meds?
Actually we can recommend OTC meds. We also can treat and have them follow up with their doctor. Another service actually carrys 3 day supplies of meds that they give the patient and then schedules a follow up with a doctor or clinic for them to get the rest of the prescription filled.

How much wound care knowledge do you have for educating the patient?
Again we only provide basic advice on wound care but help them again as above get scheduled with proper service.

How much in depth education do you have for teaching patients about their illnesses?
At present again we only provide basic advice on illness but help them again as above get scheduled with proper service.

Are you following the triage guidelines suggested by EMTALA even though it does not necessarily apply to prehospital situations but does address many questions for the proper level of care?
Good question. I am not sure if that is what current protocols are based on.

 

[VentMedic]

Are you able to prescribe medications or recommend OTC meds?
Actually we can recommend OTC meds. We also can treat and have them follow up with their doctor. Another service actually carrys 3 day supplies of meds that they give the patient and then schedules a follow up with a doctor or clinic for them to get the rest of the prescription filled.

What class of meds and what are the med dispensing regulations for your state?

Even hospital EDs are restricted by the type of medication and amount they can give a patient under some dispensing regulations. That will sometimes include inhalers such as Albuterol.

Are Paramedics specifically covered (although nowhere in the U.S. can Paramedics write scripts) or is this done purely through online med control under the physician's prescribing privileges?

Are the meds clearly marked in case of search by PD since there may not be a script available to show proof of who the meds belong to?

Actually we can recommend OTC meds.

What type of OTC meds?

Please don't say Sudafed, Primatene Mist or TUMS.

 

[VentMedic]

I do push for the right to deny transport but more and more comments I read on here and other forums makes me see though that many Paramedics just are not educated enough to even do what they are currently allowed much less to add this important but dangerous protocol.

As you already probably know the agency in this thread boasted its "deny transport" protocol.

http://www.emtlife.com/showthread.php?t=12274

This is not their first treatment of a patient that has come into question. Their protocol had been made available a few months ago on another EMS forum. However, with a look at their P&Ps now, it does not define their "deny transport" protocol.

Yes, the P&P you have previously posted is thorough but still, EMS providers are trained for Emergency Medical situations. That still leaves alot of other diagnoses that are less obvious. Those that may not seem to be emergent now like a young adult with flu like symptoms. However those symptoms may be the early signs of something that will later become deadly. The elderly person with an abrasion or a fever may also be at risk for something more serious even though it may seem minor now. These are also the reasons the NPs and PAs are promoting more education and clinicals for their entry level programs. Now if they believe a Master's degree is barely adequate, where does that leave the Paramedic with 700 hours of training who also wants similar treat and release responsibilities?

 

[medic417]

What class of meds and what are the med dispensing regulations for your state?

Even hospital EDs are restricted by the type of medication and amount they can give a patient under some dispensing regulations. That will sometimes include inhalers such as Albuterol.

Are Paramedics specifically covered (although nowhere in the U.S. can Paramedics write scripts) or is this done purely through online med control under the physician's prescribing privileges?

Are the meds clearly marked in case of search by PD since there may not be a script available to show proof of who the meds belong to?



What type of OTC meds?

Please don't say Sudafed, Primatene Mist or TUMS.

All meds are distributed by off line protocol under the doctors license. I have not seen what type of notation is on the meds.

We suggest OTC based on what is going on.

 

[medic417]

As you already probably know the agency in this thread boasted its "deny transport" protocol.

http://www.emtlife.com/showthread.php?t=12274

This is not their first treatment of a patient that has come into question. Their protocol had been made available a few months ago on another EMS forum. However, with a look at their P&Ps now, it does not define their "deny transport" protocol.

Yes, the P&P you have previously posted is thorough but still, EMS providers are trained for Emergency Medical situations. That still leaves alot of other diagnoses that are less obvious. Those that may not seem to be emergent now like a young adult with flu like symptoms. However those symptoms may be the early signs of something that will later become deadly. The elderly person with an abrasion or a fever may also be at risk for something more serious even though it may seem minor now. These are also the reasons the NPs and PAs are promoting more education and clinicals for their entry level programs. Now if they believe a Master's degree is barely adequate, where does that leave the Paramedic with 700 hours of training who also wants similar treat and release responsibilities?

The problem that service had was Paramedics not following protocol and also the fact that the protocol did not make it harder to deny than to transport thus opening it up to abuse by the lazy ignorant Paramedics. What I see in our case is most transport because they are to lazy to do all the work that is required when you deny transport.

And vent you know I push for increased education.