Editor’s note: New York’s Emergency Medical Services Public Advocacy Council wrote the following policy statement. It is being reprinted here in its entirety.
The proposed budget for 2023 includes a definition change that would codify the work emergency medical technicians (EMTs) and paramedics perform beyond the limited and outdated roles as a prehospital transporter of the emergently injured or ill. It specifies expanding roles as community paramedics, critical care transport paramedics, emergency department technicians and more.
The recent New York State Nurses Association (NYSNA) testimony regarding the Proposed FY 2023 Budget opposes the change of definition that defines EMS as the “care of a person to, from, at, in, or between the person’s home, scene of injury, hospitals, health care facilities, public events or other locations emergency, non-emergency, specialty, low acuity, preventative, assessment, treatment, transportation, routing, referrals and communications with treatment facilities, public education, injury prevention, administration of immunizations, and follow-up and restorative care.” The budget language that NYSNA opposes doesn’t change anything radically. The definition accurately defines the ever-shifting workplace of the qualified EMS clinician. The adoption of the budget language will influence decades of education and training, as well as change the dynamic evolution that has transformed American paramedics into expert clinicians within the home, hospital, and public arena. Despite NYSNA’s allusion to a dangerous future of poorly trained and unsupervised paramedics that run amok in the hospital, they are adept and educated clinicians who already fulfill roles far beyond the limited scope that the NYSNA suggests. In addition, the budget language specifically calls for increased oversight of EMS and direct supervision from physicians as a team approach in patient care. EMSPAC opposes the NYSNA stance stating EMS should be limited in their location and craft to emergencies that must be transported to the hospital.
1. EMSPAC supports efforts to improve community health and access to public health services where EMTs and Paramedics can play an important role.
We support coordination across the spectrum of care with enhanced integration of providers and caregivers in order to achieve these goals. We are concerned, however, that certain segments of the healthcare industry, motivated by profit, will seek to manipulate efforts to improve the healthcare delivery system and compromise the quality of care. The NYSNA proposes a solution to this that pigeon holes EMS into outdated roles and job definitions. In order to improve our healthcare system, EMTs and paramedics must continue to use their versatile skill sets outside their “traditional” no role. Using aggressive fear tactics and political clout, the NYSNA has abandoned any attempt at improving healthcare by collaborating with EMS and other advanced specialties, instead focusing on preserving their own economic interests.
2. The language in the budget proposal reflects the true capacity, care and expertise of highly trained paramedics.
EMTs and paramedics operate autonomously by using protocol guidelines; either written standing orders from physicians or orders that can be obtained through communication via phone or video conference. EMS practitioners are clinicians who are best known for responding to emergencies via public safety or other activation systems; 911 or similar programs. However, EMTs and paramedics are an essential component of the larger healthcare system.
EMTs and paramedics operate both as healthcare workers and as first responders. Traditional roles include high-acuity 911 emergencies, frequent low-acuity 911 calls, well-being checks, critical care transports, as well as integration with law enforcement and fire departments as a unified public safety front. They can easily be integrated into hospital settings; most commonly in the emergency department. EMS practitioners also work in non-emergency situations, such as transporting chronically ill patients who require advanced care, outside of the hospital setting and to and from treatment centers.
Paramedics receive substantial education and training past the essential EMT level. The primary role of a paramedic is to bring a high quality skill set and strong decision making to dynamic settings. In some diverse areas, advanced paramedics with additional training are addressing social determinants of health by providing in-home care to ill patients who are at high risk of hospitalization; a practice known as community paramedicine. The role of the paramedic in the United States is versatile but still nascent in comparison to the wide scope of PCP-referring paramedics in the UK or independently licensed paramedics practicing in Australia.
The development of the EMS profession has been a gradual move from simply transporting patients at emergency scenes to more advanced treatments in homes, hospitals, austere environments, and much more. Paramedics often take on the role of preventing hospitalizations entirely by communicating to patients in a way they can easily understand. Under physician direction, community paramedics are able to prescribe certain medications and undertake “see
and refer” visits, where the paramedic directly refers a patient to specialist services without taking them to a hospital. This concept has grown in recent years secondary to the ET3 legislation in the U.S..
3. Within the defined scope of paramedic practice, the EMS professional is already responsible for assessing the condition of the patient, developing a care plan consistent with the diagnosis and orders of the physician, administering care and educating the patient. The current role of EMS is far beyond the restricted vision of NYSNA.
A paramedic plans, supervises, and evaluates the care of each patient and may, under appropriate circumstances and with advanced medical direction, refer the care of each patient to other medical personnel in accordance with the patient’s needs. EMTs and paramedics are trained and their skills focus on providing emergency, on-scene assistance to patients and expeditiously transporting them to the appropriate hospital or other care setting for further medical treatment. EMS is unique in its role within the healthcare system and should not be pigeonholed into a corner by a NYSNA suggestion. With the increased need for community paramedicine, personnel can create and implement treatment plans with physician consultation, and then educate patients about their ongoing health status and needs.
The NYSNA raises unfounded concerns about the standards that hospital administrators will apply to this expansion. They seek to undermine the clinical acumen of paramedics to protect their current area of practice in the community and in non-emergent prehospital settings. Instead, we suggest that the expanded role of EMS workers has improved healthcare and will work to address the burden of short staffing and the hazards that creates.
4. The proposed budget language expands the settings and tasks that may be assumed by EMTs and paramedics. It sets the framework for the DOH to oversee the use of EMS in New York, which would ensure that EMS providers can be more successfully integrated into the changing healthcare landscape.
The new language must include specific criteria to expand the practice of paramedicine and allow better codified integration into the healthcare system. NYSNA seems to envision an RN or NP at every single nexus of healthcare at a time when we are short-staffed in all healthcare specialties, and have become reliant on the flexibility that EMS brings to the healthcare system. NYSNA is using the language of patient advocacy to foster a more expensive and often unnecessary provider level in disparate parts of the health sector. Utilizing EMTs and paramedics in the hospital, for community paramedicine, flight medicine, and critical care transfers does not decrease the quality of care patients receive nor does it infringe on the work of nurses. In fact, the increased utilization of EMS in the emergency department would allow for nurses overburdened with unfair staffing ratios and poor working conditions to deliver improved care.
Allowing paramedics to assist in the ED with triage, IV placement, EKG application and interpretation, intubation, and resuscitation would not replace the registered nurse, it would improve the scope of care, quality of life and patient satisfaction throughout our combined patient populations. What NYSNA fails to realize is the unique role EMS can play in improving the quality of overall patient care. Allowing clients to receive proper teaching, planning and hands-on care is how our health system should function.
5. EMSPAC and other EMS organizations must be consulted in the drafting of new regulations that affect the EMTs and paramedics. As currently drafted, the proposed legislation requires only that the DOH “consult with appropriate stakeholders.”
Paramedicine, now approximately 50 years old, is rapidly expanding nationwide. We are aware that hospital systems may try to use this information to hamstring nurses and their unions, however instead of exclusionary tactics, we feel interest groups such as NYSNA should be included in the continued development of EMS from field transport only into the hospital and other locales. A collaboration between stakeholders, like the NYSNA and EMSPAC, would lead to an improved healthcare system with well-paid nurses and safe patient staffing ratios and an improved patient experience. Nurses and paramedics need to be at the table together as legislators while bureaucrats in Albany determine the future of healthcare in New York.
6. Conclusion
EMSPAC and its allies support the proposed legislation in its current form and hope to see future NYSNA collaboration with their EMS colleagues. Together we can create a healthier society as a unified healthcare system that improves the quality of patient care across New York.
EMSPAC Board of Directors
February 2022