Penelope Camarata submitted 2020-11-01

As a person in the prehospital medical field as a frontline Emergency Medical Technician, I have seen a lot of incidents that include traumas and/or medical emergencies on every call. Without being proficient in our BLS skills, we cannot in effect, be proficient in our ALS and Pediatric Advanced Life Support skills either. In order to help maintain and improve our patient’s homeostasis we need to work together with nurses and doctors in the Emergency Departments where we transport patient’s so they can continue to get that continuity of care so they will be able to go home. What makes a great medical provider, whether in the field or in a hospital setting, is making sure that our training and our perception and knowledge of our state protocols and scopes of practice are where they need to be at all times.

Community Paramedicine and the current pandemic of COVID-19 by providing substance through a gap analysis with a medical director that is familiar with community medicine and emergency medicine combined. The skills set that they are required to have include availability to the community, be able to de-escalate difficult situations, IV medications, hospice care, and communicating between the emergency department and patients for better care. Massachusetts has expanded statutory requirements and the roles of community EMT’s and Paramedics are covered through the Medical Directors license that the director can approve for better healthcare for the community as a whole with the expanded scope for these providers. Because there are a larger number of EMT’s versus Paramedics so by even having the BLS level of provider on the streets caring for the community, they can still be utilized and can determine if ALS is needed or not before it is being practiced and tied up through the 9-1-1 system.

With the rising need for more Community Paramedicine to help with the overflow of patient’s that are readmitted within 24 hours of discharges due to insurance policies, these skills are needed more than ever in the prehospital setting. In order to work with the hospitals and communities needing this type of care, it is paramount to the success of not overflowing our hospitals with emergencies that can actually be taken care of out in the field in the homes of patients who are elderly, people who are afraid to go the hospital because of the ongoing pandemic situation, and the toll and stress it is taking on the healthcare system inside of the hospitals due to their staffing issues. Working together as a community for a common goal is the big issue of collaboration and in order to do that, the EMT’s, A-EMT’s, and Paramedics need to all be on board with their skills in BLS, ALS, and Pediatric ALS so that if someone does need to go to the emergency department, the care is consistent with what they will be getting in the hospital as well.

By staying mentally and physically ready, we can better serve our communities with whatever emergency or needs are presented to the growing health community in a more positive light. Collaboration of hospitals and prehospital providers is essential in the continuity of care for all patients whether they stay home and get the assistance they need, or in the ambulance on the way to the hospital, but especially in the emergency department where that continuity continues during their stay. Training and learning new skills or updating old skills should never be too much for anyone in the medical profession. Our drive and desire to want to help serve the community should be enough of a reason to advance our knowledge, no matter our skill level or where we work in the medical field.

In the August 2018 issue of EMS1, three very valid reasons were given towards the implementation of Community Paramedicine. Chronic disease management and injury prevention was at the top of EMS1’s list regarding the benefits of this program. With the incline of Diabetes, High Blood Pressure and High Cholesterol on the rise, the maintenance welfare of these patients is paramount to making sure they are compliant with medication administration, checking on blood pressure and blood glucose levels, while confirming and maintaining that these patients are safe in their environments during their well-checks, provide referrals and help patients accident-proof their homes. Secondly, this program helps in reducing 9-1-1 calls that would otherwise tie up and overload the system with non-essential calls that can save on costly emergency department care. And lastly, these prehospital providers can help with follow up visits after being discharged from the hospital, monitor any new medications or ongoing medication regime, can offer referrals to primary care physicians if there are any complications that may arise.

As part of this practice, training for this type of community medicine requires that the paramedic or even the EMT have medical control, practical emergency experience, and can obtain the proper ALS, PALS, and BLS skills needed to be effective in the treatment and implementation of effective patient care. By bringing the emergency department to the patient, this enables the patient to get the care that they need without over-exposing them to other infections, illness, or diseases that they would normally be exposed to. The training program can actually be obtained online in a modular form and can expand on their educational process that a Medical Director can sign off on because it is their program they have implemented and approved. This training can be used in any type of community situation from rural, urban, suburban, and even citywide where the 9-1-1 system is overtaxed the most.