Issue link: https://emsworld.epubxp.com/i/336320
18 Q&A; Integrated Healthcare Delivery July 2014 www.ihdelivery.com ride-alongs to see how EMS managed patients and learned that both EMTs and paramedics respond to medical and traumatic emergen- cies in the prehospital setting. However, there is a big difference in amount of education and scope of practice. An EMT is trained to provide basic-level life support. Although it can differ state to state, EMTs can perform CPR, administer glucose, assist with inhalers, perform spinal immobilization, apply splints and take vital signs. Paramedics receive con- siderably more education in order to provide advanced life support care, including advanced airway management, endotracheal intubation, IV fluid therapy, surgical airways and admin- istering an array of critical care medications. Both providers are required to maintain their skills through ongoing training and drills. Part of the confusion arises because the naming conventions and scope of practice are inconsistent throughout the country. EMS grew organically in the 1970s to address specific community needs. A number of professional EMS groups are working to come up with a consistent name. That will help. Other parts of the world, including Canada and Australia, have decided to call all EMS providers paramed- ics—similar to calling a nurse a nurse. Within that designation, there are variations depending on the level of education and scope of practice. Q: How do nursing and EMS overcome these misunderstandings and ensure teamwork? A: While EMS is asking for a seat at the table, nursing is asking if they even need a seat at the table. That's not helpful. On the other hand, EMS is building community paramedic programs within their own silos thinking that if they can make the program work, everyone will be okay with it. It doesn't work that way and the programs inevitably fail. When initiating a community paramedic program, stakeholder engagement is key. Engage the nurses from the beginning. Meet them face-to-face. That means at the local and state level. Even if the local stakeholders are on board, a program can still be killed if the state nursing and state hospital administrators are not included early in the project design. It may take some time. You have to educate people first. One helpful document is the recently released guiding principle published by the American Nurses Association called "Essential Principles for Utilization of Community Paramedics." See www.emsworld.com/11499425 . Once you have a nurse champion, you have entry into the rest of the healthcare system and a better understanding of how it works. Don't forget to embrace the rest of the EMS community as well, including those within your own EMS service. Bring them in on the plan. It's not for everybody, but everybody needs to understand what it is. Q: You mentioned interdisciplinary teamwork. How does that work in the community paramedic model? A: This is probably the biggest challenge for the nursing profession. Everyone is concerned about overlapping roles as if that is a bad thing. There are going to be overlapping roles. Instead of fighting that, we should be working together to achieve an interdisciplinary concept. Some functions need to work with nursing. When an EMS agency is considering a com- munity paramedic program, the first step must be to conduct a needs assessment or gap analysis to determine if there is an actual need for the program. If so, how would it work in their com- munity? Where are the gaps in service and how would a community paramedic fill those gaps? Approach the nurses with a plan to help answer a recognized need goes a long way to getting their approval. They might even appreciate the help. The community paramedic programs that have not succeeded are the ones that have taken a cookie-cutter approach. You can't transplant a successful program from elsewhere. The communities needs may not be the same. Give it time to be successful. The overrid- ing consideration must be patient outcomes and patient safety. Don't let anyone push to ramp up a program just to have one. Q: What are the primary concerns the nursing profession has regarding community paramedics? A: A significant concern is that community paramedics don't have the appropriate educa- tion and training to do this work. While 6/13/14 11:24 AM