Yes, Community Medics

I’ve been low on blogging inspiration, so a big thanks to Mr. Morse for his post on Community Paramedicine. He seems not to care for it much, and lists 10 of his top reasons why.

My reply to his ten reasons:

  1. I may not know much about insulin pumps and how best to maintain proper insulin levels, but I want to learn. I don’t care to learn about how to perform high-angle rescues, but I won’t put down the person who wants to learn how.
  1. The emotional well-being of our patients should be a priority of ours. This includes counseling drug addicts, or at least referring them to the persons who can provide them with adequate psychological care. When we revive a heroin overdose, do we just spend the next several minutes ignoring the patient in the back of the ambulance? Or do we initiate a conversation with the patient?
  1. See #10. Why are we afraid to learn about drugs and therapeutic regimens?
  1. “Ambulance” is not synonymous with “Paramedic.” If a registered nurse can provide the same level, or higher level of care than a paramedic, then why are we concerned? Isn’t the care of the patient our foremost concern?
  1. I don’t see this as a “cradle to grave government funded approach to healthcare” at all. Even though Congress and our President would disagree with me. But I also work for a private service.
  1. It probably takes more thought to learn how to counsel people on how to avoid things that may trigger allergic reactions. We might as well stick with what we know, right? See # 10 and # 8.
  1. I also like nurses. Especially pretty ones who smile and talk to me. Nurses like what I do as a community paramedic, because I can reduce their workload. If I can prevent one readmit to the Emergency Room, that makes triage times quicker, allows nurses to focus more on their patients since they have less of a workload, and can raise reimbursement rates for the hospitals.
  1. At least 80% of our job consists of responding to non-acute problems. But yes, we should forget about that 80 percent and instead focus on the remaining 20. I work in a very busy area of the country, and probably run one or two true emergencies per month.
  1. Why would the concerns of another group be a concern of the community paramedic? There is a void in healthcare, and nobody is stepping in to fill it. Paramedics already work in the community, and are a logical solution to the puzzle.
  1. Ah, yes, the image of EMS.  Maybe, just maybe, members of the community will see the paramedics in a different light: perhaps they will have the image of the paramedic that is willing to make appointments to follow-up, check-up, and to help them meet their healthcare needs.

He is right, we should “be excellent at what you do, and respect those who are excellent at what they do.” Mr. Morse seems to only focus on one-third of the initials in our profession: the “E.”

Emergencies is what we do. But we also do Medical Services. There is a huge gap in our healthcare system, and we are positioned to fill that gap.

We should be more invested in the health and well-being of the members of our community. We should be proactive and prevent emergencies from happening, instead of reacting to them.

Community Paramedicine isn’t just about checking insulin pumps or reconciling med lists. It is about preventing the little old lady from the fall, and answering questions, and so much more. It is about keeping people from needing the trip to the Emergency Room. I believe community medicine will play a large part of the future of EMS and healthcare in general.

We can either lead or follow.

Those who don’t want to lead, and aren’t willing to follow, should simply get out of the way.

Comments

  1. Well done, CCC, The RP post was by design a starting point, both for me and anybody who reads the thing, to think about and research Community Paramedics, if they haven’t already., I thought my post might elicit some good dialogue, and your post made mine worth the trouble.

    • This is something I am passionate about, and believe in.

      Thanks for the inspiration, I think I may even get another post out of it!

  2. Flash Larry says:

    I’m not necessarily opposed to a community paramedic model. What I am opposed to is being required to take more schooling (at my expense), obtain more certifications (at my expense), and do a more extensive and varied level and amount of work at the same pay that I’m making now.

    The nature of the laws of economics says that people will go for the thing that costs the least. If the paramedic becomes essentially a community health nurse but is not paid at that level even though the company is being reimbursed, then I can’t say I’m enthusiastic about branching out.

    My experience leads me to believe that whatever happens, if they can, we’ll be the ones to get screwed while someone else collects a lot of money.

    • Skip Kirkwood says:

      Flash — who suggested any of that? None of the existing community paramedicine programs work that way, and none have talked about it. So why would you invent artificial obstacles out of whole cloth?

      It think some therapy, or perhaps some medications, are in order.

  3. I love the community (or advanced practice depending on where you go) paramedic concept. But Flash has good points about who’s going to pay for us to become those medics. I also know that, as a fellow private medic, it’s going to be very hard to get that education. But this is a problem that plagues paramedics of all shapes, sizes, and paycheck providers. It’s also a whole different issue. In my part time job, our service area would benefit in a big way from even small variations on the services provided by “community” or “advanced practice” medics throughout the country.

    • Skip Kirkwood says:

      Wayne,

      CP is not a “thing” that medics go out and do on their own. It is part of a SYSTEM. The system worries about things that have to be taken care of. You show up, take the training, so the work, and get the paycheck.

      Where has all the naysaying and doom and gloom come from. If your profession makes you so unhappy, it might be tie for a new one!

  4. CCC, I’m curious – these all seem like implementation challenges, but what I’m not clear on is the objective. What is the purpose of community paramedics? What do you see as the void in health care that they’d fill, and what makes paramedics more suited to fill it than, say, community RNs or Occupational Therapists? I’d agree that community healthcare (and by extension, primary/preventive care) will be the focus of medicine in coming years, but I’d love to hear your thoughts on how it might take shape….

    Cheers!

    Chris

    • Skip Kirkwood says:

      If somebody asked for MY objectives, they would be:

      1. Fill gaps in the existing health care system utilizing personnel that have expertise working with sick people in all sorts of environments.

      2. Reduce the load on emergency ambulance services by providing an alternative that can provide at-scene care and direct patients to more appropriate resources.

      3. Provide career opportunities for paramedics who will be displaced from their jobs when governmental health programs stop paying excessive amounts for unnecessary transports, or for those who want to expand their knowledge and skills so that they have increased career opportunities besides “the front of the truck” and “the back of the truck.”

      4. Help the rest of the health care system to get each patient to the place and the level of care, using appropriate means, that match their particular health needs.

      What makes paramedics more suited is that they are experts at delivering care at all hours of the day or night, in neighborhoods where other home health providers fear to tread. We know how to get along with everybody, and they know that most of us do right by them.

      • Cheers Skip!

        1. What gaps, exactly? Are they following up on patients after discharge to prevent bouncebacks, regularly checking up on frequent flyers to stretch their time between ED visits, conducting in-home preventative screenings for prostate cancer and melanoma…? Would you specialize them in any one field (e.g. wound care nurses, stoma nurses, family practice NP) or stick with a “one size fits all” qualification?

        2. Makes perfect sense, but what more appropriate resources are you thinking of? “It’s a cold not pneumonia, call your GP in 3-5 days if it doesn’t get better”? “Your sugar’s been a little off, might want to start exercising more”? They’re not easing the burden on emergency services unless they’re further trimming the ED’s workload, which means either true home care or transports to doctor’s offices, community care centers and the like.

        3. Increased career opportunities and extra jobs available makes perfect sense for paramedics, but it isn’t a system benefit except in keeping skills and experience in the workforce. Still, it’s a worthwhile objective and an excellent inducement for experienced medics to buy in – might be a good way to reduce burnout and staff turnover as well. Good call!

        4. How, exactly, would this be accomplished? Do you see this as a non-emergent transport service, or is this a figurative description of a service that would principally provide in-home assessment and treatment the way old-timey country docs used to? Would the system be activated by calling 911, by emergency services as a follow-up to a refusal, by calling a “home treatment hotline”…? Would it be accessible to all or require a doctor’s referral (as many community care programs do today)? Would it be publicly supported, or user-pay?

        (5) – This loses me a little – one of the ways you save health care dollars is by *not* providing non-emergency treatment at all hours of the day and night. Surely it’s better to expand the authority to refuse treatment and transport than to call out a community care team at 0300 for an ingrown toenail? It’s true that paramedics provide care in neighborhoods where other health services fear to tread, but that’s probably more to do with how long they’re there for and what other services are likely to show up more than the inherent invincibility of paramedics. It’s also true that experienced paramedics are generally trusted by their patients and good at getting along with them, but that’s not a skill that qualifies them to be chronic care providers in and of itself and I’d say much more of it is provided by experience than training.

  5. Skip Kirkwood says:

    1. What ever gaps exist! One of the neat things about doing C/P is that it can be tailored to the local level. One that I know of is really strong at mental health and substance abuse; another at managing chronic CHF. Depends on what the community needs.

    2. There are lots of resources between “home care” and “ED.” The concept is not “ease the burden on emergency services” – it’s getting the right level of care for the patient. Medics will need to become more aware of all aspects of the local health care system – think of playing the larger role of a “patient direction coordinator.” Every patient seen in an ED costs a lot more than a patient seen in a public health clinic. Right care, right cost, right time.

    3. The system benefit is huge. MCI? Epidemic? All of a sudden you’ve got 5 or 15 or 55 mobile medics that you can pull off less acute care for response to a disaster. Surge capacity – something that you never had before. And being an EMS guy, I call “providing more and better career opportunities” for my fellow medics a benefit in and of itself.

    4. A whole spectrum, and again tailored to the needs and resources of the local community. Maybe the patient has a car and insurance – “go to the ED in your POV.” At the other extreme, the patient has nothing – “Let me call and arrange a ride for you on the county invalid transportation system, to your appointment at public health tomorrow at 1000.”

    5. Nobody has the authority to “refuse care.” In the US, people get sick or hurt and they call 911. That’s how we built it and that’s how we want it to be. Somebody calls 911 for a stubbed toe at 0300, no, you don’t call out the community care team – but you get that ambulance back in service, by providing an alternative. It’s not “ambulance to the ED or nothing” – there are a multitude of options that are cheaper and more appropriate.

    I guess if you think that caring for the needs of sub-acute and chronic patients is just plain wrong, this concept is not for you. On the other hand, those who have done it seem to like it, and the community appreciates it. It may not be for everybody – but the opportunity for EMS organizations to thrive doing “just emergencies” is probably going to further diminish.

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