Really like the sound/idea of this program. Hopefully it will succeed, could not only save money, but lives, too.

Its not as a need grows, but as the population of mexicans grows who dont understand its not a hospital on wheels.

Paramedics are trained to treat injuries not diseases. Physician's Assistants would be much more appropriate here. Why are paramedics used instead? Cheaper of course.

This is a horrible idea - paramedics are not trained to do this kind of work. They are trained for trauma and injuries, and to take care of the patient until a doctor can take over. Why not use nurse practitioners, or physician assistants, or heck, even an RN would have more know-how than a paramedic.

Just be thankful there not using day laborers to do this and save money $$$$. This is the future of health care/ job creation plan.

Paramedics are trained to handle ALL medical emergencies. These counties are testing this program because paramedics are on duty and available during those down times when not responding to other medical emergencies. Nurse practioners, etc. are not sitting around waiting for the next call to come in. I think it's a great idea to have someone  who has some training look in on a patient. It's certainly better than nothing. Often the patient or a relative has no idea if what is going on with a patient is a normal response or one requiring attention. Note also that the paramedics are working with doctors.

This is expected, rich americans will spend fortune for cosmetic surgery and soon poor american will be forced to be cared unqualified people, risking their ultimate well being.

If more doctors are trained, Physician care will be cheaper, San Marino, a small country in Europe has 47.35 Physician per 1000 population which is 20 times higher than USA (2.3 physician per 1000 people) . Worldwide USA ranks # 52 with regard to Physician population ratio.

Even countries like Greece, Russia, Italy, Uruguay, Bulgaria, Korea, Hungary, Ukraine, Moldova & Poland; let alone Switzerland, Monaco, Switzerland and France.

Poor USA, soon many people have no access to Physicians and their healthcare will be under than hand of unqulaified people.

If USA wants to encourage paramedics and PA's & NP's to take over Physicians, we should start this with Senators, HoRs & Presidents should get care from them to start with as they get their salary from tax payer's money.

This is unacceptable when these jerks at high posts get executive health care where as the regular tax payers get seen by Paramedics, NPs, PAs & MAs.

Shame Shame Shame...

Did you read the article? They are collecting information and blood samples to transmit back to the doctor. The doctor determines whether they need to come in.....unless it is an emergency in which the paramedics will do what they are trained to do.....probably talk to the hospital, start an IV, put oxygen on them and load 'em to transport them to the hospital.

Be nice to use PA or NPs or even nurses but all those are in short supply just like primary care/general practitioner doctors (note I didn`t say doctors overall), especially in rural areas.

This is a good idea to use the resources one has available in rural areas. If they are doing this on their "non-emergency response" time then why did it take an extra $700K though.

If more doctors are trained, Physician care will be cheaper, San Marino, a small country in Europe has 47.35 Physician per 1000 population which is 20 times higher than USA (2.3 physician per 1000 people) . Worldwide USA ranks # 52 with regard to Physician population ratio.

Even countries like Greece, Russia, Italy, Uruguay, Bulgaria, Korea, Hungary, Ukraine, Moldova & Poland have higher doctor population ratio than USA, let alone Switzerland, Monaco, Switzerland and France.

This sounds to me as if paramedics are doing for free what registered nurses should be being paid to do. This program to promote preventative care certainly sounds like a great idea, however it is nothing new - it is the basic principles of HOME CARE NURSING. The preventative care and screenings described in this article are certainly not within the scope of paramedic practice. And in this economy, I find it hard to believe that the nursing shortage remains, simply a shortage of agencies that are willing to pay RNs to do RNs jobs. Its not right to have these undertrained professionals caring for these patients in this way.

It's funny you think that, it is because of the lack of PA's, not because Paramedics are cheaper.

This is a great idea, and it makes sense from a practical perspective!

There are things that paramedics can do that do not require the training of an LVN or RN, and having paramedics visit patients also makes it more likely that if a patient has a problem the paramedics not only will know where the patient is located but also will have seen the patient previously, hence will have a better sense of condition changes, special needs, and so forth . . .

And I certainly would not underestimate the skill and expertise of properly trained and certified paramedics!

Doing the home patient visits probably requires more equipment in the emergency vehicles in some locations, but a lot of emergency medical vehicles already have a lot of advanced medical equipment, including the ability to do real-time telemetry to the ER doctors . . .

I think the key to doing this type of home patient care is to keep each test and procedure separate and easily done in a short amount of time, because the paramedics obviously need to be available to make emergency response calls, which basically maps to being able to complete whatever home patient activity they are doing within a minute or two and then to get on the road to the emergency response call . . .

There is a smart way to do this, and I like the concept, but it is important to pay the paramedics and to provide ongoing training, certification, and state of the art equipment, for sure . . .

For sure! :)

Well it's about time!!! In Virgina, as a Paramedic I was wage-wise over an LPN in my ER. I had ACLS, ITLS, PALS, PEPP, ABLS, yada, yada. I knew geriatrics...pediatrics...maternity...trauma...medical...certain things an RN could not do and after pulling up on the loading dock I was so limited, it was a shame. Paramedics are an untapped resource to help the medical profession...not hinder it. We need a good dove-tailed system to utilize medical people for the scopes of practice each profession encompasses. Nurse shortage? Try a medic!!! We GIT-ER-DONE!!

My initial reaction is can the paramedics answer complicated questions? Yes, this may help reduce hospital costs, but how fully are patients being served? What if they have medication questions? Alternative treatment or generic drug questions?

http://whatstherealcost.org/video.php?post=five-questions

WOW!

You can not pick and choose your patients or what care will be required.

Care for a foley catheter for the long term is much more than just a skill of sticking something into someone's pee-pee. The mentality of just another skill is inappropriate.  You also can not ignor things like bowel movements. Yes you might even have to assist with a bowel program for a paralyzed patient. Care of the chonically ill or those who have ongoing needs come with the not so glamorous tasks.  

I think your comment sums up some of the posts who believe Paramedics are not prepared for this type of work.  Wiping an ass might even be part of what you might have to do on a home visit. It seems even with your AAS you don't have the maturity to handle basic body functions and must stoop to the usual belittling comments towards those who do patient care which also involves personal needs. This also belittles the patient who much have their personal needs taken care of by others. 

Think what you want about nurses or paramedics as long as it doesn't affect patient care....I have my own opinion, take it or leave it.

I'm a Paramedic with an Associate degree and been through all the ABC courses, Cardiology and Pharmacology. In Anatomy/Physiology studied everything from the integumentary system to the endocrine system. Ages 1 week embryo to oldest known age to exist. With a standing order approved by a medical director I can perform treatments, administer medications, perform endotracheal intubations, needle decompressions and provide cold fluids and medications post Return of spontaneous circulation from VT/VF cardiac arrest. All without having the doctor online or standing over me. We must memorize what our standing orders say or recognize that even though it's not in our standing orders we could benefit the patient with a certain medication available but not noted in the orders so we can call the online medical control to get permission to proceed with an outside procedure.

My mother has been a RN since 1969...over 40 years she's been involved in health care from hospitals, doctor offices, nursing homes to hospice. RN's once out of college are specialized in a certain area...whether it's pediatric, cath lab or trauma. Registered Nurses are well aware of long term patient care, more medications, blood lab values and the seasoned RN can at times be a step ahead of the physician on duty. Times have changed and RNs must get an order to do any procedures even at times place the patient on oxygen.

Just a brief overview but to get to my point I believe both professions would agree that our job is to not look down on others unless you are helping them UP? I respect all the professions such as Paramedic, Nursing, LPN and PA. Putting another profession down is NOT respected. I guess professionalism was left out in some classes. I'm sick of the battle I see of RN verses Paramedic. Both of us recognize the feelings we experience when we loose a patient. Both experience the rewarding feeling of helping someone because we knew what to do. So those that are bashing other professions step off your high horse and look at each other at eye level. At the very least treat each other with respect. All of us at some point need to work together, so we better get used to each other. It doesn't hurt to get to know someone on the other side of the fence.

Paramedic, Nurse, LPN, PA are highly specialized in there area and can do the job as long as a Physician is in charge. Lets just face it that is why they make the big bucks, due to LONG college and residency years for Doctorate along with the liability that weighs heavily on their shoulders. It's a sue happy world out there and I don't believe any of us could afford to pay the fine.

I understand that every profession has concerns for what one might call "turf", but I am reading entirely too many posts in this topic that are focused more on asserting or protecting "turf" than on providing the best possible health care for patients, and I think that a somewhat brief history of the relevant realities can be quite helpful in putting everything into a practical perspective, really . . .

Really!

Specifically, I remember the days when "state-of-the-art" emergency medical response started by making a telephone call from a rotary-dial land-line telephone to the operator and then waiting for 30 minutes to an hour or longer for a station wagon with a single rotating red light on top and siren to appear, typically driven by some recent high school graduates dressed like house painters with cute hats, at which time the patient was loaded onto a gurney and then delivered to the local emergency room . . .

The level of medical care provided by the ambulance drivers was not significantly greater than what one might expect from a bright First Class Boy Scout who had earned a First Aid merit badge, since in those days the ambulance drivers did not do things like taking blood pressure or much of anything else other than minimal first aid and strapping for transport . . .

But around the time when NASA did the lunar missions, everything started to change, which was the direct consequence of the fact that if there were medical events while the astronauts were traveling through near space to or from the moon, it simply was not possible to call an ambulance or to go the emergency room, so NASA devoted great attention to designing a detailed strategy for being able to handle medical emergencies in space via telemetry to ground-based medical doctors, and so forth and so on, which for all practical purposes made the spaceships the most advanced mobile medical and surgical hospitals in this galaxy . . .

The lessons learned about battlefield medicine during the Vietnam War and previous wars also were central to the major advances in emergency medical responses, and this is where the "life flight" medical evacuation helicopter concept was perfected, so it was the combination of NASA and the military that led to significant advances in emergency medical responses, for sure . . .

For sure!

On the NASA side, the next thing that happened was the observation by some of the brighter candles that the same strategies and equipment used by the astronauts could be deployed in a new type of ground-based ambulance, which was when ambulances changed from being station wagons to cube vans, and very soon thereafter a few cities--typically cities with a strong NASA presence--started doing "proof of concept" experiments to work through the logistics of using onboard telemetry to communicate with medical doctors in the emergency room, which included allowing the paramedics to administer IV fluids and medications, as well as performing other procedures, under the remote verbal advice and guidance of medical doctors, and at first this tended to be viewed by many medical doctors as a vast encroachment on their turf, which at times was nearly so absurd as the prevailing view that women were not smart enough to be doctors, but it worked, and after a while the medical doctors realized it was an excellent strategy that saved lives . . .

Today, at the dawn of the early-21st century, it is entirely possible that an emergency medical response unit has nearly as much advanced stuff onboard as an emergency room--within the practical limits of physics and other sciences, of course--and for all practical purposes these units essentially are emergency rooms on wheels . . .

Add the 9-1-1 system, complete address mapping (which was completed in most areas by the mid-1980s (where for example what had been rural delivery box numbers were changed to street addresses specifically to map mail delivery points to physical street addresses), cellular telephones, GPS, and 24-hour dedicated dispatching, as well as a lot of other important stuff, and response times improved vastly, as did the everything else . . .

Younger folks probably take all this for granted, but the reality when you roll back the clock half a century (50 years) is that it was not so unusual for an ambulance crew to take an hour or two to respond to a traffic accident in a rural area, and during that hour or two the injured folks had to take care of themselves, which for severely traumatic injuries seldom had a good outcome, and for reference this also was before the "jaws of life" devices were invented, where "jaws of life" refers to the portable hydraulic hand-held machines that paramedics and firefighters use to open car doors and to bend twisted metal so that patients can be safely extracted from vehicles and whatever, and there were no "life flight" medical evacuation helicopters, either . . .

It is important to have well-defined procedures, outstanding state-of-the-art medical and emergency response vehicles and equipment, and highly trained emergency medical technicians (EMT), who as best as I understand the terminology colloquially are called "paramedics" . . .

And it is equally important that the roles and duties are well-defined and understood for all the medical folks (doctors, nurses, paramedics, pharmacists, laboratory technicians, radiological technicians, and so forth and so on) . . .

The goal is to be a finely-tuned and highly-skilled orchestra, and when it is done correctly the results are simply amazing, but from the perspective of someone in the audience who expects a stellar performance, I am not so happy to observe the oboe and clarinet sections railing on the flutists, violinists, and trombonists . . .

The fact of the matter is that all the roles and duties are important, and the songs sound a lot better when everyone plays his or her part and lets the conductor do the conducting, for sure . . .

For sure! :)

Wow! Wow, your comments are disrespectful to say the least. You hold yourself out to be an educated Paramedic with an AAS and a FTO but you resort to insulting those who actually have made some very valid points. You would have to be living in a cave on another planet to not know the deficiencies in Paramedic education in the US. Your ramblings further demonstrate you don't understand the many intricacies of providing long term care to a very fragile population or the special needs of so many different conditions. You also brag about how long a new Paramedic must spend with the FTO yet you fail to realize how long an RN must go to school, BSN required these days, and then how many patients they will take care of for the next 2 - 4 years before they might consider home health. Most will have over 10 years of experience before they consider doing home health which gives them a chance to deal with numerous patients for more than the short time an EMS provider is with a patient. That will probably include wiping some butts but then RNs know that will be part of the job because they understand patient care from many different angles.

MEDIC NREMT-P, you have listed the impressive "skills" we do but, what does needle decompression and intubation have to do with long term care? What about education and all the many, many disease processes that require an assessment most Paramedics will not even hear about? And yes, what about doing some butt wiping if that is what it takes. We already know "wow's" opinion on the subject and he holds himself to be one of the best. I do commend you for your call for respect but EMS has also got to realize its own faults before it can go forward. Trying to expand while still having so many problems within our own profession is not going to benefit the patients. It is only a bandaid and has too many holes that should have been filled in 40 years ago.

Baldenario, thanks for the history lesson but in reality, EMS has not progressed all that much since the 1970s. A few advances in the gadgets but the length of training and education is about the same. EMT is still at 110 hours and the Paramedic can be done in less than a year. The Paramedic is still considered an add on cert for the Fire Department just as it was in the 1960s. Not much has changed.

I can also give an example using the Fire department which some Paramedics might understand. It has long been an argument that Fire/Paramedics have no business doing EMS. That is within our own "profession" yet we do not believe another Paramedic has any business doing EMS even if they are equally trained. Regardless of training and degrees, we also know anyone who works for a private ambulance is a crappy Paramedic, right? Now if we can't agree upon who should do EMS, how the hell are we going to get into something like home care?

Once EMS stops getting so defensive and ceases to defend its low education standards, it might be able to move on. For the Paramedics who do hold a degree, you are still held to the same standards of the 3 month wonder Paramedic. But for now, EMS should focus on EMS and getting our own house in order before trying to expand into something we really are not prepared for as a profession.

Now enough of the butt wiping comments which are demeaning to all the nurses, techs and the patients.

Baldenario, are you suggesting the city takes an expensive EMS truck out of service with 2 Paramedics for flu shots "just in case" there is an allergic reaction? A home health nurse will give a flu shot in ADDITION to all the other services provided. What you are suggesting is duplication of services and making a system even more expensive. Nobody wins there. What is needed it funding to expand the existng services with the professionals who already have the education, training and a broard scope of practice to be available in the community. Trying to reinvent the wheel with those who are minimally trained even for their own very focused field wastes time and money as well as diverting more tax payer resources. How many people do you think will fall through the cracks by just doing a band aid on a problem as large as this? Many of these patients have fallen through the cracks already because some in EMS have not wanted to "play social worker" or "home health nurse" and fill out the paperwork through the city or county for a referrable even when this ability did exist in their EMS company.

It is also time EMS stops with the few extra hours of training stuff and starts to focus on real education. This short cut patch work mentality has played a major role in creating a mess in EMS where there are over 40 different titles for providers, not just EMT and Paramedic. What separate each apart is basically a few more hours of "skills" training but no definitive prerequisite education.

As far as EMS giving flu shots, I guess you aren't aware of the EMS companies that have tried to initiate community health services in the past and eventually stopped when the employees went to the union complaining they weren't public health "nurses". During the last major flu vaccination program for H1N1 got nothing but gripes from some in EMS especially when ammendments were made to existing regulations for Paramedics to function in this capacity.

You focus on providing just one "skill" such as giving a flu shot shows an inability to see the broader picture of what a home bound patient needs. Doing a home care assessment also takes much longer than 5 minutes and abandoning a patient in the midst of it to do an emergency is just wrong. That is no way to treat a patient requiring long term care.

BTW, many Flight programs now utilize RNs. Some with Paramedics and some without Paramedics.

Now stop living in the 1960s. You might be surprised to know what advances in techology are out there that nurses, PAs and NPs can bring to home health if afforded the backing to do their services. But, no it looks like EMS will jump on the band wagon to divert funding for a shiny new tricked out truck and divert the funding away from people who need a full compliment of services and not just someone doing a quickie assessment inbetween calls. EMS needs to focus on its own specialty since there are well documented problems in it and leave long term care to those who can provide more services in one stop for each patient. This seems more like a turf war between 3rd service or municipal/county EMS agencies trying to out do the Fire department for funds diversion. Both the tax payers and the patients lose on that one.

MEDIC NREMT-P

Accredited Associates programs are available t/o the country but if you look at the statistics, most Paramedics in the US only hold the certificate. Some schools are struggling to keep the Associates degree on the books.

Also, the NREMT doe NOT require 2 semesters of A&P to test. In many programs A&P is only an overview. Even the Paramedics in Texas which requires only 624 hours can take the NREMT.

Paramedics have been around since 1966 so it is not a young profession. There are many other health care professions half that age which are now requiring Associates and Bachelors degrees for entry. The young profession stuff is just another excuse.

According to the ACLS text, only about 50% the the ALS EMS crews in the US have 12-lead ECG capability. Very few out of that group are taught to interpret the 12-lead ECG and will take the machine interpretation or transmit to a facility.

If your state is SC, I quote from the EMS website for Paramedic training:

"Hours of training: 1,000 hours total: 496 hours of didactic and practical; 504 hours of clinical and field training"

Yes, you can stretch out 1000 hours to 2 years by going less days per week. But, don't make the requirement for your state more than it is. The EMT is 140 and the EMT-I is only 100 hours. Not much.

Ambulances have carried morphine for over 4 decades. Antiinflammatories are controversial and used only for specific situations and very few ambulances bother now. Glucose is basic first aid and so is taking a BP, RR and HR. Yes you can list every individual skill a Paramedic does but it is still the education of know what to do with those numbers that matters. EBM have made many of the things Paramedics have done disappear from their scope. This also seems to be the way intubation is headed but that is partially the fault of Paramedics and agencies failing to maintain proficiency. If Paramedics can not do well by a skill they brag about, how can they possibly keep their focus on home care? Half assed should not be acceptable in that area. We've accepted it in EMS only because doctors and managers know the patient is going to the ER.

You are also only describing what a Paramedic can do to detect an emergency. That is only one part of home health.

It is interesting that you want to keep your Paramedic certification after finishing PA school. The title "Paramedic" is part of the problem. Few want to advance their education to something which allows them to work in home health, education or the hospital in fear of losing that cool title. Very few Paramedics have had the courage to be a nurse because they do not want to be called a nurse or even associated with them. For the few hours of training these Paramedics will receive in home health, they are technicians much like PCTs and should be called something like Community Health Techs and not Paramedics.

That brings me to another point. Are those working in home health "Paramedics"? They will not be utilizing any of their life saving skills. Home health is a totally different focus. Critical Care RNs understand this when they decide to enter home health. They bring invaluable amount of knowledge but they will be focused on staying current on home health issues and education to where they will not be able to work in an ICU. If they return to the ICU, they will have to undergo extensive retraining. What about these Paramedics? Many don't get much chance to intubate and start IVs now. What happens if they are in home health for several months. The company SHOULD retrain them but again that will be more expense for the tax payer. If the company doesn't, who the hell wants a Paramedic who hasn't worked a code or intubated or started an IV in several months working on them? This is no different from the way some view Paramedics who only work for private services.

Some agencies that have established community programs or welfare checks use Paramedics who are on light duty or have been pulled of the truck for some disciplinary action and have lost ALS privileges. Some see doing community services as a punishment and it is used as such by some agencies.

Get your PA and make a difference in the community for these patients. You'll do much more good than as a Paramedic. Don't forget it is about the education and not just "training" for a couple of new skills.

I'm a Medic from Oregon and we have been talking about doing this since 2000. It's why every Medic is required to have an AAS in Emergency Medicine. Problem is that they Medics in England, Australia, and South Africa that are doing this are required to have BA's. Most Medics I know from other states complain about having to do too many CE hrs. We all want higher pay, and better working conditions. But many people want those without doing the seat time in a class room. The fact is without the education or profession will never get the respect it deserves.

She has a point mate. You have to remember most medics from other states have little to no education. Many of them don't even meet NREMT standards. They just do whats written on the protocol page because that's what a doctor wrote down, no thinking required. Were lucky being from Oregon. That being said I really think this program would work as long as Medics are willing to get the education to back it up.

I found their training program online. It requires only 100 hours of classroom and 100 hours of observation in a doctor's office and clinic. That is just a little over 2 weeks for each. Colorado's requirements to be a Paramedic are also only 110 hours for EMT and 1000 for Paramedic. All can be done in a year or less. Another patch or title is not the way to advance EMS and the profession.

I find it amusing the profession bashing that goes on, nurses bashing paramedics, paramedics bashing nurses, PAs bashing both, etc. I have only been in health care a little over 6 years and have worked both in an ED and on an ambulance but I have met horrible nurses, horrible medics, horrible PAs, horrible NPs, and horrible physicians. Granted, as a medic, I love EMS and think that the future of medics and EMS is bright, the education is very poor and it is the exact reason our profession is not taken seriously. It is because of working as a medic and meeting some very poor physicians that I am currently in medical school. However, when I do become a physician I will be an avid supporter of EMS and medics. I have read some nurses posts, Krey and Hightop, who act like nurses are the end all be all. I have many close friends who are nurses, great nurses, but I know some dumb nurses who could not take care of a goldfish, even with "all the advanced training" it takes to be a RN. Same goes for physicians, there are some dumb physicians out there, and yes even medics. I know some medics who should not be allowed to touch patients but yet they might be the person you wake up to after an emergency. As a health care provider, we can not characterize an entire professional group based on experiences with a few providers or even the providers in our area. We should all be in it for one thing and one thing only, patient care. I will step down off my soapbox now.