JEMS.com Editor’s Note: Click here to read “Wake County Discusses Advanced-Practice Paramedic Program,” which talks about what is different about the N.C. county’s advanced-practice paramedic program.
On Jan. 6, the Wake County (N.C.) Department of Emergency Medical Services began implementation of a revolutionary new way to deploy ALS resources in an EMS system — its Advanced-Practice Paramedic (APP) Program.
Designed by Wake County’s visionary medical director, Brent Myers, MD, the program strategically sends some of the EMS system’s most senior clinicians to calls involving the most critically ill or injured patients and also provides prevention visits to high-risk populations.
Wake County EMS’ APP vision statement is a concise summary of the intent of this innovative new EMS delivery system: As a result of the actions of the Advanced Practice Paramedics, the citizens of and visitors to Wake County will suffer fewer preventable illnesses and injuries, have timely access to appropriate medical and mental health assistance, and, where the prevention efforts have been unsuccessful, receive world-class pre-hospital emergency medical care during acute illness, injury, or mental health crisis.
Wake County APPs completed an intense, 225-hour academy designed by Wake EMS leadership in conjunction with many community partners. The academy focused on essential elements of public health, prevention, statistics, advanced medical practices and potential complications of the high-acuity patient encounters.
The APPs will operate as single providers in specially equipped Dodge Charger emergency response vehicles and focus their activities in three key areas:
1. Joint response with Wake County ambulances to high-acuity situations:The co-response places highly experienced APPs on scene at high priority calls to assist other paramedics and EMTs and provide direct patient care where necessary. This allows for optimal care and the opportunity for high-level mentoring to occur during actual incidents. The APPs are highly trained and highly motivated, and have passed a rigorous training and evaluation process.
2. Prevention and public health visits:The APP program’s prevention and public health focus will initially be directed to impact patients with congestive heart failure, diabetes, pediatric asthma, and falls. The program’s goal is to ensure that these patients have optimized outpatient regimens in order to promote health and decrease ambulance calls.
3. Alternative destinations:The APP’s alternative destination focus will initially focus on patients with mental health crisis and/or substance abuse. In coordination with Wake County Crisis and Assessment, Wake EMS is developing a screening tool that will allow patients with these complaints but no active or significant medical issues to go directly to the facility best equipped to care for them.
In Wake County, ambulances are designated as “EMS” units. The new APP units will have the radio designation “Medic.” The distinctive design of the APP response vehicle matches the reflective striped safety makings of all Wake County EMS units.
National Registry Executive Director Bill Brown espoused the virtues of an advanced-practice paramedic position in the article “A Missing Link: How the New Level of Advanced Practice Paramedic Would Fill the Gap,” in the February 2008 issue of JEMS. In the article, Brown points out that “although paramedics — currently the highest level of EMS licensure — are initiating progressive interventions in some systems, neither comprehensive core patient care nor professional needs are really being addressed.”
Brown noted that many systems are functioning as they were originally designed 20 years ago, with some deploying hundreds of paramedics not all at the same level of expertise. He called for a reassessment of both the skill and career paths in use in EMS systems and the adoption of the Advanced-Practice Paramedic level as a way to not just reward seasoned, highly-trained paramedics, but use them in clinical, educational, research and mentoring roles.(Click here to read the complete article.)
Wake County’s new Advance-Practice Paramedic program has taken the core values and vision that Brown and others had for this new EMS position and put it into operation. JEMS will follow the progress and impact of the Wake County APP program and provide you with future updates here on jems.com and in the pages of JEMS.
