As is the case in EMS every so often, we’ve attached ourselves to the supposed “next big thing” that will ensure adequate EMS funding, give EMS a level of professional respect, and provide for cleaner, minty-fresh breath. As of late, that latest panacea is “community paramedicine” or “mobile integrated healthcare.”
Before I inject the lawyer’s skepticism, let me say that I wholeheartedly support an expanded role for EMS professionals in the world of healthcare. I believe that EMS professionals are vastly underutilized in the healthcare field. Personally, I believe that a variety of clinical settings would benefit from EMS providers being on site as a “rapid intevention team” to respond topatients who are acutely ill and/or rapidly decompensating. Our ability to think under pressure, independently, would go a long ways towards improving patient outcomes.
However, let me throw out a couple of concerns with how/why “mobile integrated healthcare” may not yet be the solution that fixes EMS’s perceived woes.
- Who’s going to pay for this? Right now, there are a lot of pilot programs being funded from a variety of sources. Eventually, this funding is going to dry up and/or the funding is going to have to continue past a trial/pilot period.
- EMS providers are pretty darned good at reacting to acute events. Many EMS providers don’t yet have the education in patient assessment, pathophysiology, and pharmacology to be effective in a longer-term setting.
- Attitude. Sadly, look at the number of EMS providers out there who want to limit themselves to a minimal standards mindset and who don’t even see themselves as healthcare professionals. Thrse are the same ones who recite the shopworn mantras like “diesel bolus” and “we can’t diagnose.” “You call, we haul” is their mentality.
So, what will fix EMS and give us a place at the adult table in healthcare? I thought you’d never ask me.
- EMS needs to be reimbursed/paid for the care/interventions we provide, not solely as a glorified medical taxi with reimbursement for transport.
- We need to develop an identity of who we are and what we do. Further, we need to ensure that, like any other regulated profession, we do not let others intrude into our professional, regulated space.
- Let’s embrace what EMS excels at — namely, using a public safety framework to deliver unscheduled, acute or urgent care medicine.
How can we achieve this? We have to do the one thing that nursing beats EMS in every day — advocacy. We need to be at the state capitol and in the halls of the regulatory agencies advocating for the future of EMS, rather than having various “stakeholders” define who they want EMS to be. A professional identity would go a long ways towards making EMS a respected healthcare field. The problem is that we aren’t educating the public and we aren’t making our presence known at the state house or at the myriad of regulatory agencies with oversight of what EMS does.
Of course, none of this is easy. It’s a lot easier to look for the “next big thing” or maybe find a new t-shirt slogan.
CMS is already looking at a number of those MIHC/CCP programs. If they prove their worth, we may well see CMS reimbursement for community paramedicine in the foreseeable future.
And while I agree 100% with the need for EMS advocacy, higher standards and establishing a professional identity, I think that community paramedicine is attracting a better level of provider than the “diesel bolus” mindset.
Also, I believe very few MIHC programs are thrusting paramedics into that role unwillingly, with no additional training. They’re picking their medics best suited for it, and educating them for the role they’ll be playing.
Now, should that additional education be a part of all paramedic education? Yes, it should.
But uou gotta start somewhere.
Really nice article Wes. Excellent job pointing out that in order for growth to occur, the funding has to be consistent. The point I want to address is the one you’ve left out: EMS gets calls for primary care on a consistent basis. MIH-CP is a name (and a funding source) for what 911 medics are doing as I type this. The primary care calls create a demand that we are limping along trying to meet. Why not educate the medics to match the demand? Once we are properly educated, we will have the credentials to tell patients what resources they need (and don’t need for that matter). As you have very correctly pointed out….all of this depends on the funding to pay the future “triage medics.” Let’s keep talking it out.
Another concern is how does mobile integrated health care scale? One or two providers serving a handful of patients is merely interesting.