New ÂCommunity Paramedics_ prepare to serve rural areas
This fall, 10 paramedics in„Minnesota, will become the first in the nation to train as ˙Community ParamedicsÓ (CPs), and will work as cross-trained„EMS providers and public-health workers in rural communities. They_ll also provide referrals for primary care, disease management and mental health in areas with critical shortages of health-care professionals and services.„
˙The CP will not replace existing health-care services, but would fill the gaps revealed by assessing each community,Ó stresses the Community Healthcare and Emergency Cooperative (CHEC), the group of EMS and rural health leaders„„ from„Minnesota,„Nebraska and„Nova Scotia that developed the CP curriculum and pilot program.„
CPs provide primary care in some remote parts of„Nova Scotia and„Ontario (see ˙Beyond EMS: Community paramedics make house calls,Ó September 2007 JEMS). CHEC leader Gary Wingrove, director of government relations and strategic affairs for the Mayo Clinic_s Gold Cross Medical Transportation, notes that in the first five years of the CP program on two islands in„Nova Scotia, resident visits to emergency departments dropped by 40% and clinic visits declined by 28%.
These new CPs ˙will have expanded roles, not expanded scopeÓ of practice, Wingrove says. ˙We will not compete with or duplicate any existing service.Ó
Ann Willaert, MS, director of project design and development for Healthcare Education Industry Partnership, a project of„Minnesota„State„Colleges and Universities, led the development of the CP curriculum and says, ˙We interviewed EMTs and paramedics from rural communities and asked if they_d be interested in pursuing more than„EMS. They said they were the go-to person in their communities [and wanted] to be able to do more than quick emergency treatment. We dreamed up how to teach a paramedic to be an advocate, a liaison, a connector to services.Ó
According to Wingrove, the CPs will learn only one new clinical skill: suturing. TheyÂll also learn to remove fishhooks, provide immunizations, identify infections, give antibiotics, treat non-emergent respiratory problems and monitor and manage care plans for chronic diseases.
For the pilot program, educators from„Hennepin„Technical„College in„Eden Prairie,„Minn., will use the new CHEC curriculum to educate 10 experienced paramedics who work for Mdewakanton EMS and serve the Mdewakanton Sioux Tribe in„Minnesota and„Nebraska.„
˙The tribe has a mobile clinic and we have a mobile simulation unit and will utilize both in the training,Ó says Bob McCarthy, BS, EMT,„EMS education director at the college. ˙We expect this will turn into an advanced occupational certificate program, but depending on the institution, it could become a two- or four-year degree program.Ó The exact hours of the pilot program are still undecided, but he predicts students should spend approximately 150 hours on the program over four months, meeting two evenings a week and on Saturdays.
CHEC will make the CP curriculum available to any college or university in the worldƒbut with safeguards to ensure they maintain the curriculum_s integrity and quality. ˙We already have a waiting list of 15Ï16 universities in four countries,Ó he says. ƒMannie Garza
Should EMTs/paramedics be forced to cover tattoos?
The„Los Angeles (City) Fire Department (LAFD), the primary 9-1-1 transport agency for the nation_s second largest city, instituted a new policy May 1 forbidding its personnel from having tattoos visible while on duty. Those with arm tattoos must either wear long sleeves or patches to cover the body art.
˙We have hair standards and uniform standards, and those aren_t about the fire station but how we appear when we_re providing service to the public,Ó LAFD Deputy Chief Emile Mack told the„Long Beach,„Calif., Press-Telegram, adding that most department members approve of the new rule. But not everyone agrees with the policy. Firefighter John O_Connor told the Press-Telegram that the tattoos on his arm depict the GPS coordinates of his daughter_s grave and flames that pay tribute to the fire service and 9-1-1. ˙Everything I have signifies blood family or fire service family,Ó he says. ˙It_s really disheartening to cover up these things.Ó Another firefighter complained of a rash caused by the patch he now wears over the eagle on his forearm.„
But the biggest source of controversy appears to be that the policy requires employees to cover their body art even while in the station. What do you think? Let us know at www.jems.com. ƒAnn-Marie Lindstrom
PRO BONO> Blood-Draw Laws Put you in a Tough Spot
Some states have passed laws authorizing or requiring paramedics and other appropriately trained„EMS providers to draw blood, at the direction of a law enforcement officer, from a person suspected of DUI who may have caused a serious injury or death. These laws often place„EMS providers in a difficult position, where they must balance patient care with the demands of police officers.„„
In„Kansas,„Florida and other states, law enforcement can direct a paramedic to draw blood even if the suspect refuses permission, and officers can reasonably restrain the individual to do so. A forcible blood draw may run contrary to what many„EMS providers learned about patient consent and refusal of care. Although these laws typically provide some immunity from civil and criminal liability for providers who draw blood at the direction of law enforcement, little case law has tested the scope and breadth of those immunity protections.
Such laws also raise privacy issues as well as concerns about law enforcement interference with patient care. As for privacy, HIPAA permits disclosures of protected health information whenever state law requires such disclosure. But the issue of interference with patient care is more complex.
The„Kansas law, for instance, contains an exception for situations in which drawing a police-ordered blood sample could jeopardize a person_s life or cause ˙serious injury.Ó However, the statute also confers the responsibility for making that determination on law enforcement officers, who typically lack medical training.„
In addition, whenever an„EMS provider draws blood pursuant to a police order, questions could arise regarding whether or not that creates a provider-patient relationship. In some cases, we_ve heard reports of police officers requiring„EMS providers to draw blood but preventing them from rendering any other care.
Many of these problems could be avoided if these laws were amended to place responsibility for performing forcible blood draws on the police themselves, which some communities in„Texas have done. Training police officers to perform this task helps avoid blurring the line between patient care and law enforcement.„
EMS organizations should familiarize themselves with the requirements of state law and work out difficult issues in advance with local law enforcement agencies. Although these laws typically don_t include penalties against health-care providers who refuse to follow the directive of a law enforcement officer to draw a person_s blood involuntarily, an EMS provider who fails to comply could conceivably be charged with obstruction of justice or another similar offense and/or be accused of professional misconduct by their state„EMS office.„„
In addition,„EMS providers should consider a forcible blood draw to be a patient encounter and document it accordingly. That documentation should include any instance where law enforcement prevents an„EMS provider from rendering appropriate care or transporting a patient who requires it.
Pro Bono is written by attorneysDoug Wolfberg andSteve Wirth ofPage, Wolfberg & Wirth LLC, a national EMS-industry law firm. Visit the firm_s Web site at www.pwwemslaw. com for more„EMS law information.
A Vision Renewed
˙We_re just starting to become what we_re supposed to be, and Jim Page helped shape that,Ó Ed Racht, MD, Austin/Travis Counties (Texas) EMS medical director (above), said during a July 30 benefit dinner hosted by the James O. Page Charitable Foundation. Some 300 family, friends and lifelong students of Jim_s attended the event on the deck of the USS Midway in„San Diego to benefit the James O. Page Collection at UCLA_s Louis M. Darling Biomedical Library. In an emotional speech, Jim_s son Tom (below) read from his father_s unpublished autobiography. Racht closed by saying, ˙He gave us a lot of tools, and we_ve got the toolbox to move forward.Ó
From EMT to EMT-P in Record Time
Crowder„College, a community college in„Neosho,„Mo., may expand its accelerated paramedic training program from 10 students to 15 and is working toward national accreditation in 2009, according to the Neosho Daily News. The program crams 18 months of paramedic training into just 27 busy weeks that include ACLS, PALS and PHTLS, plus 400 hours of hospital rotations and 400 of field rotations. ˙This is a really challenging program, and it_s not for everybody,Ó paramedic instructor Kristin Spencer told the press. Students must be licensed EMTs to enroll, and the course costs $4,000.
Do You Bill Dead Patients?
Medicare won_t pay for any prehospital services without transportƒwith one exception: Medicare pays the basic BLS emergency rate if„EMS is dispatched to a call but the patient is declared dead on scene. ˙What they pay depends upon the time of legal pronouncement of death,Ó notes„EMS attorney Doug Wolfberg. If death is declared after a patient is worked and loaded on the ambulance, Medicare pays for the care provided. Some services bill every deceased patient and try to collect from their insurer, family or estate. Others won_t bill at all if they don_t arrive at an ED with a patient who_s alive or undergoing a working code. See the August EMS Insider or visit www.jems.com/EMSInsider for more on services that bill deceased patients and one county where the proposal has sparked debate.
Flooding rivers have submerged communities in„Indiana,„Iowa,„Illinois,„Missouri,„Minnesota and„Wisconsin since May.
In response to 90_ heat and the sheer number of volunteers at this Winfield,„Mo., sandbag staging area,„Lincoln„County (Mo.) Ambulance District (LCAD) put an extra ambulance and crew into service to work solely with volunteers. LCAD paramedics kept watch for overheated and injured volunteers, and even helped pack sand bags for delivery to various levees along the„Mississippi River. The NAEMT Foundation_s EMS & Rescuer Relief Fund is raising funds to help EMTs and paramedics affected by the floods. To donate, visitwww.naemt.org/Foundation/donate/NAEMT+Donation+Form.htm. For more on this story, go towww.jems.com/news_and_articles/articles.