Community Paramedics in Virginia
By Alan Perry
Description and Goals
of Community Paramedicine
Many patients with chronic illness lie in a no-man’s land
between emergency medicine and primary care. Community paramedicine was devised
for the purpose of caring for these individuals who frequently become “super
users” of EMS and emergency room services. Community paramedicine can also be
used to address public and patient education and improve the quality of
healthcare in underserved populations. The main goals of Community Paramedic
programs are to decrease hospital readmissions by “frequent flyers”, decrease
EMS and emergency room workloads, reduce the overall costs of healthcare and
improve access to preventive care by “at-risk” populations. I have described
this type of solution in my first publication “EMS Manifesto” which looks at the broader cooperation needed across
all healthcare disciplines that are needed to make this work.
Challenges and
Obstacles
The protocols and training used in current EMS programs were
not created for the purposes of Community Paramedicine; it is a new concept
which will require modification of current practices if not an entirely new
program. It will need the cooperation of all involved parties including EMS,
hospitals, public health departments, social services, private providers,
insurers & Medicare. Funding for Community Paramedic programs will be a problem;
private insurers and Medicare have been slow to recognize treatment provided by
Community Paramedics. Through cooperation and the adoption of alternative
treatment and transport possibilities it may be possible to establish a
Community Paramedic program in Virginia.
Legitimate questions
Community Paramedicine intersects several areas of medicine
including EMS, Public Health, Primary care and preventive care. Because of this
fact it seems to be re-writing the definition of what a paramedic is. Does this
shift the responsibility for primary care? Is this a reaction or consequence of
the lack of primary care? Will this further enable users of the system making
them more dependent? How does this differ from the other options currently
available such as home health care and clinics? These are all powerful
questions that can significantly alter how a program is implemented or stop it
completely. The reality is that the gap in service has been identified; the
question remaining is who will fill it.
How to Proceed
Last year I queried the director of Public Health for my
city about her position on greater cooperation and collaboration in the realm
of EMS and forwarded to her my “EMSManifesto”, her initial reaction was positive, but we have yet to sit down
and discuss it further. This is but one of many discussions that need to be
had, ultimately it should probably be initiated at the regional level and
involve the VAOEMS, hospitals, Public Health Departments, primary EMS agencies,
Billing and insurance representatives, TEMS and providers from the region. The
Scope of practice will need to be defined, new protocols established, a medical
control plan put in place, and a means to recover the costs of the program. I
would be happy to do further research on this for our region and work to
collaborate with the other stakeholders to craft a plan that works for all
parties.
Be Safe,
References:
Red River EMS project, New Mexico
Western Eagle County Community Paramedic Program Guide
NAEMT, community paramedicine
Brave New EMS World, EMS Manifesto
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