Let's see how many people I can make angry with this one...

Community paramedicine isn't paramedicine, it's social work.  It might be economically advantageous to a department because it reduces the number of repeat, unnecessary calls the department receives.  It might bring some relief to EMS workers who immediately recognize the address they were just dispatched to and who know that the person calling simply needs some attention.  But it's not paramedicine, and it's not a good use of our training or skills.

Since community paramedicine is a combination of social work and emergency medicine, who used to provide those services?  Social workers and nurses, of course.

In today's conservative political culture, it's pretty unpopular to employ social service agencies staffed with social workers who go out in the community and provide the services that community-paramedicine providers now do.  I know in our county, for example, there's exactly ONE publicly-employed social worker that can be called to assist in managing a person's needs.  Shame on us for being so stingy.

Nurses are trained in long term care plans that meet the medical and social needs of patients.  They address home, family, and care needs of individuals, and they are often "in it for the long haul" instead of the quick, mostly anonymous contact that EMS providers are used to.  But nurses are expensive.  They have better publicists, and the recent decades of increased demand for nursing services for an aging population resulting in a shortage of nurses has led to quite respectable salaries.  Salaries too high, it seems, to send them out into the community to provide long term care for those who need it.  Shame on us for being so stingy.

So here comes community paramedicine as a solution to so many problems and "the future" of EMS.  It's trendy.  It's popular.  And it has the word "community" in it.  Students of American history and sociology are well versed in the American struggle between individualism and community (see Bellah, Madsen, Sullivan, Swidler, and Tipton).  We also know that individualism won the struggle about 75 years ago.  Efforts like "community oriented policing" enjoyed great popularity, and many departments still cling to the idea because anything with the word "community" attached to it must be a good idea right?  Refer back to this blog post in twenty years, please, for similar "community paramedicine" results.

My argument against community paramedicine is two-fold:  

First, it's using EMS providers as a cheap alternative to a problem that already had a solution.  For patients whose needs were psychological and social, social workers were the best tool.  For patients whose needs were medical, nurses were the best tool.  Now, with the public's unrealistic expectation that every penny of tax dollars go to prisons, law enforcement, and homeland security, we turn to EMS providers as the cheap, plastic, disposable alternative to the more expensive solutions.  It demeans us as professional EMS providers.  And it's embarrassing how eagerly we jump to assist in that process.

Second, it's not emergency medicine.  We are specialists.  We are prehospital experts in cardiac, respiratory, and trauma emergencies.  Nobody knows more about prehospital care of those emergencies than us.  We also throw in some endocrine, orthopedics, and metabolic expertise in very specific areas, but cardiac, respiratory and trauma are OUR prehospital domains.  It takes a lot of initial training, and a lot of continuing education to remain experts in those areas.  When we arrive at the emergency department and give our transfer of care report, and discuss a bi-fascicular block, second degree type II, and periods of bigeminy during transport, there's a reason the nurse doesn't ask for additional information about those issues.  The medications that we carry and give patients at our own discretion are medications the nurse can't even withdraw from Pyxis stations without a doctor's order.  Our expertise is hard earned.  We should devote our energy to honoring what it took to earn that expertise.

Community paramedicine dilutes that expertise.  It's a cheap alternative that cheapens what we do.  It might save money.  It might save frequent-flyer aggravation.  But it's not paramedicine.

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