As the health care system collapses EMS will be doing more primary care and public health. Can a socialized concept of public health be deployed into EMS with Physician Assistant/EMT truck. Check out the link below

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I wonder what would be the better model - "upgrade" existing paramedics to have public health/home care skills, with additional scope of practice added (lots of work, primarily at the state level), OR integrate PAs in to the pre-hospital care world, in sufficient numbers to make a difference (lots of work at the federal level, where the reimbursement paradigm is controlled and directed).

PA programs are BS or MS level programs. Do we think we could get enough? And paramedics seem to resist any upgrading of their skills, knowledge, and scope of practice, if it requires more education (which it must).

Keep an eye on the work being done on community paramedicine (in the upper midwest, Gary Wingrove on point), in the international community (England, Canada, Australia), and on our advanced practice paramedic program in Wake County, NC. All are moving toward increasing EMS involvement in community health and health outreach.

Speaking for myself, I would offer my services as a PA having had pre-hospital experience and would be happy to become a member of any team. Value-added is the key, along with reimbursement issues, and acceptance within the paramedic rank and file. I most certainly feel it could benefit both the responders (offers insight into training) as well as the general public (public health issues). With the number of priority 2 calls (sick call, routine calls, no lights/siren calls) on the rise, a designated HCP could be of benefit and could keep the ALS unit ready for the real runs. A PA could also respond to prolonged extrications, MCI's, major fires (rehab assistance and oversight) and offer HCP level skills and oversight where is may not be readily available. Many possiblities, but probably not many "takers." There are a few models out there, but we would need to hear from them. I agree with Mr. Kirkwood, lots of work at the federal level for standardization, reimbursement, not to mention licensing, and state OEMS buy-in etc. New Haven Sponsor Hospital Program has a SHARP team of similar design and concept and includes physician as well as physician assistant response. Worth a look. When do I start?
I for one also agree with Alan. In the beginning, I thought of offering my services to the private EMS contractors with a soon to be RN license. However, with a change in pace, I have geared my efforst to becoming a PA. If the opportuniy arises, that PA's are introduced into the pre-hospital field, you can bet that I'll be one of those providers. I'm sure that the PA bridge will soon be as popular as the RN bridge, as providers see the opportunity to meet certain challenges in the newly developed field. Sign me up.
I like the advance paramedic program and wish I had the time to come to Wake County to take a look!! It would take lots of partnership and local, state, and eventually national legislation to work the reimbursement issues, but for now, small bites and small pieces. The issue is to not replace the existing model but to enhance and change the paradigm. We all agree the systems are fractured and it is only destined to worsen over time. There is no one model which will work unfortunately as we are not a nationalized health care system. But, change is coming so communities will HAVE TO work on other options, particularly in view of budget cuts, personnel cuts, and funding (grants in particular) shortfalls. I am but a small cog in a very large wheel. I am working my sphere of influence at the local level and hope to make the difference here. I can't make global changes and unfortunately feel I speak for the minority, not the majority. How many of my PA colleagues are even remotely concerned about pre-hospital EMS where their work is usually office or hospital-based in primary care or other specialties? The strongest voice would be of my SEMPA (Society of Emergency Medicine PAs) colleagues who have a vested interest and who work with medics/EMTs daily.
Bottom line: upgrade existing skills and practice scope and add mid level providership to maximize impact and cost effectiveness. Why not run a PA in concert with an intercept medic in another vehicle (if you will), use him to routine sick calls as well as for prolonged EMS in the field incidents, REHAB at working fires, etc.
I don't have all the answers and don't know all the rules either, but one this is for certain, I am forward thinking and see the writing on the wall. I see it in my own city and wonder why not...


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