Issue link: https://emsworld.epubxp.com/i/336320
19 www.ihdelivery.com July 2014 Integrated Healthcare Delivery Q&A; education programs have been growing in size and number, they need to look similar to national standards for critical care paramedics, flight paramedics and technical paramedics. See the Board for Critical Care Transport Paramedic Certification at www.bcctpc.org. At the national level, the Paramedic Foundation is taking the lead. See www.paramedicfoundation.org . In our program, we learned that this was a top priority and worked to evolve a cur- riculum that is based in a college or university. Some paramedics don't have a college degree. We determined that this college-level course is necessary for the type of critical thinking needed for a community paramedic. Where a paramedic needs to know how to respond to a particular illness or trauma—stabilize, treat and transport the patient—a community paramedic must ensure an appropriate support system once the patient has returned home, review medication, understand why the patient became ill or injured in the first place, and look for ways to prevent future hospitalizations. In order to get the respect and buy-in from nursing those education pieces need to be in place. Frankly, I think we are going to change the industry. The paramedic course of the future is going to evolve because of community paramedic programs. Q: Are there other concerns? A: Patient record keeping is a challenge. EMS has been limited by system design. Because they are only reimbursed for each transport, they record each transport as a separate patient encounter. When they see a patient five times in one month, there are five separate patient care records. When a hospital or physician sees a patient five times, each visit gets added to a single patient record. The ultimate goal is patient safety. But it's going to take a change in the reim- bursement model for EMS to make sig- nificant changes in record keeping. Q: What about other data collected? A: The way EMS has tended to collect data is to document performance indicators, such as whether or not aspirin was given to a patient with chest pain, rather than track patient outcomes. In Colorado, we recently published 18 months of patient data on the community paramedic program. It is closer to the type of informa- tion that needs to be gathered by all of EMS. For example, did community paramedics effect change, including avoiding a hospital readmis- sion? We need to prove that what we are collect- ing is the right thing so we can standardize it. Q: What role do physicians play in community paramedic programs? A: Our push is to ensure that the medical directors who oversee these programs have some experience or background in primary care or public health. Typically, medical directors for an EMS agency are emergency department physicians. Because of the clinical component of their education, the community paramedics will need this added expe- rience from the medical directors. The American College of Emergency Physicians (ACEP) is in support of this effort and recommends co-medical direction. This is going to push the envelope to require some medical directors be more hands-on. Q: What will community paramedicine look like in the future? A: Like EMS, that will depend on the com- munity it serves. Regardless of the EMS delivery system—fire-based, hospital-based, third party, privately owned, volunteer—all EMS agencies will need to consider these recom- mendations to launch a successful program. Ultimately, the programs that work alongside the rest of the healthcare community will succeed. Healthcare is going to filter them. Q: Looking back on the last five years of the commu- nity paramedic program in Colorado, do you have any advice for others looking to start a similar program? A: Innovation is hard. It's tough to have people coming at you. My advice is to stay strong. Don't take the easy way out. In the end, the right way will be the standard. The challenge is getting there. 6/13/14 11:24 AM