There's No Time

Don’t Re-invent Community Paramedicine, There’s no time!

By Alan Perry

September 25, 2013

It baffles me that the issues of community paramedicine, integrated healthcare and implementation of the EMS agenda for the future are still not resolved. Here we are, less than 30 days from major portions of the Patient Protection and Affordable Care Act (PPACA) being implemented, with most agencies having no clue how they will be affected and how/if they are going to make any changes. We have got to start thinking outside the box (pun intended). As we gather to meet and discuss these eventualities we need to stop trying to re-invent the whole process every time. There is a large body of work already completed working programs in place by nearly every variety of EMS system and free money to make it all happen. Duplication of effort is never a good idea, we must learn quickly to take the good work already done and apply it to what we are doing, or need to be doing.

Here’s the problem, the PPACA does not specify how medical care will be provided it only specifies the desired outcome and the penalties for not achieving the “triple aim”. So everyone involved in the process, especially those with the most to gain or lose, are moving aggressively to develop programs with little consideration on the effect on EMS services. The EMS community apparently does not feel threatened by this, much like our apathy about the recommendations of the EMS agenda for the future we think we have all the time in the world and that our federal or state officials will tell us how to proceed. I can tell you now that the Federal and State officials tasked with oversight of EMS don’t have a plan. The hour is growing very short; we are approaching a point where we will have to transition from being proactive to being reactive.

The best publication I have found so far is from the National Consensus Conference on Community Paramedicine, the meeting in October of 2012 produced an excellent summary of how a program should work that can be easily tailored and implemented incrementally by any EMS service. I am aware that the National EMS Advisory Council (NEMSAC), State offices of EMS, Local EMS councils and individuals are also working on their own plans, expending great amounts of time and effort to go through the same process already completed by acknowledged experts. Why? I suspect part of the problem is that it is not a priority. EMS still takes a back seat to other emergency services in many locales. Those tasked with this project may not have funding, and although grants may be available it may not be a priority for the senior administration.

Any program of this type must go through some necessary developmental steps that don’t necessarily need to occur in a chronological order. While you are obtaining the data to quantify the problem you can also be developing a general selection and training program for your providers, having dialog with the other stakeholders and creating your grant requests, and building the infrastructure to support it. This is possible because of the large body of work already completed and some known variables for your program. We must be seen by our healthcare partners, the public and policy makers to be taking positive steps to move our systems forward toward improving outcomes, reducing costs and improving the overall healthcare experience.

Acknowledge the quality of the work already done, use it, build upon it, and modify it. Build upon this foundation of what will be a new way of doing business, embracing the goals of the EMS agenda for the future and the PPACA. They are defining what we do and what the public needs and expects from us.

References:

Patterson DG, Skillman SM. National Consensus Conference on Community Paramedicine: Summary of a Expert Meeting. Seattle, WA: WWAMI Rural Health Research Center, University of Washington; Feb 2013.

DOT, HHS. Innovation Opportunities for Emergency Medical Services: A Draft White Paper. NEMSAC, July 2013.

Goodwin J, Finding a New Seat at the Healthcare Table, Best Pactices in Emergency Medical Services, Vol. 16, No. 7, July 2013