Community Paramedic Programs

[Alan L Serve]

I hope I have elaborated in great detail for you.

Sorry but I remain unconvinced. A week worth of courses cannot be equivalent to an RN's training and experience with medical patients or a LMHC's ability to assess and treat psych patients.

 

[Bullets]

@Tigger have you found that your hospitals are reluctant to partner with you? Lack understanding? uninterested?

We're trying to do this at the BLS level but the local hospital has been difficult in cooperating. Initially they told us they couldnt give us any information about patients due to HIPAA, despite the fact that we already transported them

@Alan L Serve Thats because they arent treating psych patients, they are doing an assessment, which is within the regular ALS scope, then directing them to the appropriate facility? Dont you already do this? Dont you already do an assessment and then take the patient to a stroke, PCI, or Trauma unit? This is just a more focused deployment of resources with additional education.

Again, its not about treatment and long term plans, its about connections

 

[Summit]

Most paramedics haven't take General Psychology nor Developmental Psychology much less an upper division course like Abnormal Psychology. It would be great if they did... or better yet made them prereqs like they are for nursing.

Some patients can't adequately express what they need or how their living situation is, but having a paramedic who was there to see first hand can help other medical providers with understanding of the individual patient situation, that might result in them ordering a different care plan then what they were originally going to order.

That is pretty much the definition of nursing pathways...

 

[Alan L Serve]

@Alan L Serve Thats because they arent treating psych patients, they are doing an assessment, which is within the regular ALS scope, then directing them to the appropriate facility? Dont you already do this? Dont you already do an assessment and then take the patient to a stroke, PCI, or Trauma unit? This is just a more focused deployment of resources with additional education.

Again, its not about treatment and long term plans, its about connections[/QUOTE]

Medics are good at know psych vs non-psych but they definitely aren't qualified to assess and direct to resources. As far as trauma, PCI, CVA, etc we are extensively trained and tested on that which is why it is appropriate for us to assess and direct by passing non-PCI hospitals in favor of those with PCI (tho the data on this seems to support stopping at non-PCI hospitals to get t-PA and then continuing to a PCI center, but that's another issue for another thread).

 

[Tigger]

@Alan L Serve Thats because they arent treating psych patients, they are doing an assessment, which is within the regular ALS scope, then directing them to the appropriate facility? Dont you already do this? Dont you already do an assessment and then take the patient to a stroke, PCI, or Trauma unit? This is just a more focused deployment of resources with additional education.

Again, its not about treatment and long term plans, its about connections

Medics are good at know psych vs non-psych but they definitely aren't qualified to assess and direct to resources. As far as trauma, PCI, CVA, etc we are extensively trained and tested on that which is why it is appropriate for us to assess and direct by passing non-PCI hospitals in favor of those with PCI (tho the data on this seems to support stopping at non-PCI hospitals to get t-PA and then continuing to a PCI center, but that's another issue for another thread).[/QUOTE]
I took the time to elaborate as to what it is that we do, you're going to have to do better than that. Back up your stance. Why are we not qualified to determine if someone needs an a regular ED or if they can go straight to a case worker?

We are partners with "crisis response" program in our area. We worked with them to come up with theee resources, and come up with a system to determine who is and is not appropriate for different destinations. And they still need to be accepted by these different destinations. These resources are accessible by the public and we make it easier and more streamlined. In order to be admitted to an inpatient psych facility, a medical screening is needed and we can provide that. This screening was designed by the facilities. Crisis Stabilization Unit patients that come via their own means receive this screening when they arrive, we make sure it's done before that so they can be seen quicker.

Please explain in great detail how we are not qualified to do that.

As for home care, again, we are not developing these plans. We assist home health in the implementation of them while also connecting patients without home health to local resources. Again, how are we not qualified to do that?

 

[Tigger]

That is pretty much the definition of nursing pathways...

If they were there. We aren't fighting nursing over this. We work with them and help multiply their very limited local presence.

I am not saying that what we do would work everywhere. But it does not take significant education to help people find the care that they need.

 

[Tigger]

@Tigger have you found that your hospitals are reluctant to partner with you? Lack understanding? uninterested?

We're trying to do this at the BLS level but the local hospital has been difficult in cooperating. Initially they told us they couldnt give us any information about patients due to HIPAA, despite the fact that we already transported them

The real issue is how small we are. Our district is only about 20k, meanwhile the catchment area for the hospitals is over 600k. They just don't have time for us right now. We do more work with the local community access hospital, whose hospitalists are also the local PCPs. Everything is easier on the smaller level, but many of our patients don't receive care from that hospital due to its size and lack of specialties.

 

[Alan L Serve]

Medics are good at know psych vs non-psych but they definitely aren't qualified to assess and direct to resources. As far as trauma, PCI, CVA, etc we are extensively trained and tested on that which is why it is appropriate for us to assess and direct by passing non-PCI hospitals in favor of those with PCI (tho the data on this seems to support stopping at non-PCI hospitals to get t-PA and then continuing to a PCI center, but that's another issue for another thread).

I took the time to elaborate as to what it is that we do, you're going to have to do better than that. Back up your stance. Why are we not qualified to determine if someone needs an a regular ED or if they can go straight to a case worker?

We are partners with "crisis response" program in our area. We worked with them to come up with theee resources, and come up with a system to determine who is and is not appropriate for different destinations. And they still need to be accepted by these different destinations. These resources are accessible by the public and we make it easier and more streamlined. In order to be admitted to an inpatient psych facility, a medical screening is needed and we can provide that. This screening was designed by the facilities. Crisis Stabilization Unit patients that come via their own means receive this screening when they arrive, we make sure it's done before that so they can be seen quicker.

Please explain in great detail how we are not qualified to do that.

As for home care, again, we are not developing these plans. We assist home health in the implementation of them while also connecting patients without home health to local resources. Again, how are we not qualified to do that?

We'll have to agree to disagree and wait until studies come out which compel one side or the argument or not. Until then I'll maintain that EMS folks lack the training and expertise to provide community paramedicine.

 

[Carlos Danger]

We'll have to agree to disagree and wait until studies come out which compel one side or the argument or not. Until then I'll maintain that EMS folks lack the training and expertise to provide community paramedicine.

There is research on it. I don't know if any has yet been published in any peer-reviewed journals, but agencies that do this are tracking their impact and there have been lots of articles out there on it. It isn't something that I've personally spent a lot of time looking at, but all that I've heard about it is very positive.

Like you, I was very skeptical of the idea of community health paramedicine. Great concept, I thought, but there is just no way paramedics have the training to provide home-based nursing services. It made no sense to me to to spend all this time and money to train paramedics up to be able to do what nurses were already doing. My position was that it made far more sense to use whatever funding was going to be targeted to these programs to expand already-existing home services provided by nursing agencies. Just let the nurses do the nursing, and let the paramedics do the paramedicine.

However, programs like what Tigger describes are not doing community health NURSING. Of course there may be some overlap between what these programs do and what nursing agencies do, but there is also plenty of difference. I think Tigger did a pretty good job outlining that. His agencies' program sounds pretty similar to the other ones I've heard about.

What they are doing is providing what basically amounts to crisis services + providing some basic follow-up where none would occur otherwise, and referring people to more appropriate resources as needed. They aren't playing nurses and they aren't playing mental health counselors. I think it's a very appropriate role for paramedics with the proper training.

 

[Tigger]

We'll have to agree to disagree and wait until studies come out which compel one side or the argument or not. Until then I'll maintain that EMS folks lack the training and expertise to provide community paramedicine.

What exactly do you think community paramedicine is?

 

[SandpitMedic]

All I know is that there aren't not many BCCTPC certified Community Paramedics at this point.

I thought about taking that test.

 

[Tigger]

All I know is that there aren't not many BCCTPC certified Community Paramedics at this point.

I thought about taking that test.

No doubt, though the test is still less than a year old. We will hopefully have our people certified but money is a bit of an issue right now for fees.

 

[beaucait]

they are referred by a family member who feels like the patient is at high risk, or someone in the EMS community that feels that they see this patient too often for non-emergency visits. .

Also, the doctor has to approve if they believe that the patient will benefit from this program.