Planting the Community Paramedic Seeds

Once a week I precept a group of my paramedic students in the emergency department.  It is one of the highlights of my work week.  I get to watch the students apply what we cover in the class, get my own contact with patients, and interact with the ED staff.  One day two of the “regular” patients, each of whom I had transported dozens of times as a paramedic, were occupying adjacent rooms.  One has a history of repaired thoracic aortic dissection who vomits frequently, and calls 911 almost daily with chest pain.  The other has COPD that is poorly controlled on a good day, and not controlled at all most others.  After we help the staff take care of these patients, I mention to the staff that in some areas, paramedics visit their regular patients between calls.  They try to figure out what they need before a 911 call is made, and get them help outside of the emergency department.  Some can even medically clear psych patients and transport them directly to a psych facility.  Wow, that would be great, most of them say.

One of my regrets about leaving the field to teach full-time was that I would not have the opportunity to practice as a community paramedic.    Last year Medic SBK and I met with one of Rep. John Carney’s staffers and explained the early success of programs in Wake County, Fort Worth, Pittsburgh, and Eagle County.  He later co-sponsored the Field EMS Bill.  Still, there are no serious discussions about starting one in my neck of the woods, and I’m not sure how one would fit with the tiered system in place today.  No matter how much noise we made about it, it would not happen soon enough for me to pass up the teaching opportunity that opened.  I soon realized, however, that as an educator I have a chance to inspire the next generation of paramedics to want to do more than transport everyone to the emergency department.

Teaching about community paramedic programs fits nicely into some of the less sexy topics.  During the behavioral emergencies module, I pulled up this New York Times article about Wake County EMS directing patients to psych facilities instead of emergency departments.  Instead of tying up an expensive ambulance to transport a patient to an expensive emergency department that is not designed to managed their problem, with a little extra training and a lot of oversight they figured out something better.  For hematology, the textbook states that paramedics rarely respond to hematologic emergencies.  Not in Buffalo, were this gentleman was transported by ambulance to the emergency department 600 times over two and half years for sickle cells crises.  Whatever your position on healthcare reform is or what you think the role of a paramedic should be, everyone would agree that there must be a better way.

I have not yet been asked the dreaded “why we need to know this” question, but I always have an answer prepared just in case.  Like it or not, the days of you call, we haul are ending soon.   Paramedics in the future will need to know more about chronic conditions, and the ones who are only interested in cardiac arrests and shootings will be left behind.  The once limited career path for paramedics is widening, and we are finally developing areas to specialize. They get to be a part of finding a better way, and there has never been a more exciting time to be in EMS.




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