JEMS.com Editor_s Note: For more on community paramedicine, check out the September JEMS article, ˙Beyond EMS.Ó
Leaders of initiatives to create community paramedicine programs to help fill health-care gaps, especially in rural and remote areas, convened Sept. 19-21 in Queensland, Australia, to share strategies, successes and solutions to common challenges. Approximately 100 people, including six from the U.S., several from Canada and others from Australia and New Zealand, participated in the third annual International Roundtable on Community Paramedicine and Rural Health Care Delivery, which met in conjunction with the Australasian Council of Ambulance Authorities_ Rural and Remote Symposium. The CAA represents 10 ambulance jurisdictions in Australia, New Zealand and Papua, New Guinea.
˙We_re moving across Australia to extended-care paramedics, who provide more primary health care to fit the local needs,Ó said CAA Executive Director Lyn Pearson. ˙We_ve been doing a lot of research on this for a lot of years, looking at what_s happening in the United Kingdom and around the world.Ó Queensland just graduated its first class of extended-care paramedics.
˙The role of the extended-care paramedic in rural areas is developed in collaboration with all the health services and the community,Ó Pearson said, adding, ˙You may find things that are successful in the country areas that may flow into the city.Ó
Before the symposium and roundtable, some 20 participants joined a week-long bus tour to visit programs serving rural and remote areas of Queensland. Kevin McNichols, owner of Med1 Ambulance Service, which serves the small town of Grand Rapids, Minn., with 40 employees and four ambulances, said he_s interested in community paramedicine both to fill rural health-care gaps and to provide a career ladder for aging paramedics who now leave EMS. During the bus tour, he was impressed with how Queensland manages to cover large remote areas with a small number of ambulance crews. ˙Where I would have four or five crews, they have two, but other crews are on standby or callback,Ó he said. They visited one village served by a single community paramedic who enlists volunteer drivers.
In other communities too small for even a paramedic and perhaps four hours from the nearest physician, McNichols said, ˙They put a Âdoctor box_ in someone_s home. If you have a problem, you go to that house, and they call a doctor. After discussing the problem, the doctor says, ÂLook in the doctor box, and take the medication in box 27 three times a day and call me in two days.Ó
˙We started these [symposia] five years ago, and so much more is happening now,Ó Pearson said. ˙It was fabulous to have all these people there [from other countries] to share ideas and thoughts. We_ve now set up links and will have sharing Web sites for much more interaction, and we_ll be sharing research.Ó
Gary Wingrove, director of government affairs for the Mayo Clinic_s ambulance service in Minnesota and Wisconsin, and a founder of the IRCP, noted the symposium included several sessions on mental health, ˙which is a key topic when you talk about community paramedics,Ó but has rarely been discussed among IRCP members from the U.S. and Canada.
According to Wingrove, reimbursement for extended-care paramedics is still an issue in Australia, despite its single-payer health-care system. ˙In their system, if you propose something new that would be more cost-effective if someone else did it, they take money from others, and if you start taking money from hospitals and giving it to ambulance services, you get a lot of resistance,Ó he said.
Wingrove found that EMS leaders in the U.S., Australia, Canada and New Zealand are working on many similar issues and projects. For example, he said, after he talked at the meeting about the U.S. National EMS Information System, ˙there are now discussions on how Australia might move forward using the NEMSIS data system.Ó
The IRCP will co-locate with an EMS Chiefs of Canada meeting in 2008, with the CAA_s Rural and Remote Symposium in New Zealand in 2009 and with the Critical Illness and Trauma Foundation_s biannual Rural and Frontier EMS and Trauma Summit in 2010.