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Tuesday, June 17, 2014

More EMTs Doing House Calls, Not Just ER Transport

An unidentified woman is wheeled into a hospital by members of the Bedford-Stuyvesant Volunteer Ambulance Corps (BSVAC) on June 21, 2013 in the Brooklyn borough New York City. (Spencer Platt/Getty Images)

An unidentified woman is wheeled into a hospital by members of the Bedford-Stuyvesant Volunteer Ambulance Corps (BSVAC) on June 21, 2013 in the Brooklyn borough of New York City. (Spencer Platt/Getty Images)

It’s being called the house call of the future: ambulance crews who rush when you call 9-1-1, but instead of taking you to the emergency room, they treat you at home.

Community paramedicine, as it’s called, is a growing trend across the country. It’s aim is to bring down hospital costs, but there are concerns about who’s going to end up paying for the service.

David Kimbrell, the fire chief in Hall County, Georgia, and Scot Phelps, a former paramedic and a professor of disaster science, speak with Here & Now’s Robin Young.

Interview Highlights

David Kimbrell on the advantages of community paramedicine

“They’re able to do blood withdrawals and do some analytical tests on the scene. They have a centrifuge. They can spin down blood to do various blood tests on the scene. None of those things are done by paramedics on the scene. So if you think about healthcare, we’re basically going back to the old house calls by the doctor.”

David Kimbrell on funding the new service

“We were seeing more and more people calling 911 and our medics were treating them on the scene, and then we were not getting reimbursed for that because a paramedic has to transport in order to be reimbursed by insurance and Medicare and Medicaid. So we were able to utilize a nurse practitioner. So the nurse practitioner and the paramedic teams up as the mobile care team. Then, if they go out and treat a patient, it is reimbursable through the nurse practitioner’s license.”

Scot Phelps on a previous attempt at community paramedicine

“We tried this in 1995 in Red River, New Mexico and what we found after spending hundreds of thousands of dollars was that it didn’t actually save any money or improve any care. So they abandoned it and now eight years later its the topic du jour.”

Scot Phelps on paramedics’ responses to the service

“I don’t think paramedics are really anxious about being replaced because all the data shows that all the ambulance calls across the country, and in fact, across the world, are increasing increasing at about 5 percent a year. The problem is that very few communities have sufficient numbers of paramedics. There is extraordinarily high turnover. That was one of the key conclusions of the 1995 Red River project was that with the high turnover the training costs add up kind of quickly.”

Guests

  • David Kimbrell, fire chief and director of emergency management in Hall County, Georgia.
  • Scot Phelps, former paramedic and professor of disaster science at the Emergency Management Academy. He tweets @emergencymgmt.

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  • john r

    Sr. Scott Phelps hit on it without even realizing- High turn over and training cost was the downfall to this program and why it didn’t work where he was, and he also mentioned how in the fire sector they have people that stay on for 20-30 years. Why is that? It’s because private ambulance pays poor. These paramedics are getting paid sometimes $12/hour, with poor medical coverage and no retirement (or small 401k- like 3% matching).

    At many of these fire departments they make much much more than the private ambulance paramedic, have pensions, and better medical coverage. Maybe we shouldn’t prioritize big business and executive making money of the community health coverage.

    I have been a paramedic for private ambulance, fire department, and helicopter for more than 16 years and this cycle has not changed.

  • Dan C

    Thanks for the coverage on this growing and important topic.

    Not sure if the guests selected represented a good sampling of community paramedic programs. I Believe the National Association of Emergency Medical Technicians (www.naemt.org) could point you in the right direction.

    Many community paramedic programs work independently without a middle level provider (NP/PA) and have medical oversight though a physician and function above the level of a regularly licensed paramedic.

    Educational/certifications/licensing standards, state regulatory issues need to be developed along with improving reimbursement channels (all of which is currently being addressed at the state and federal levels.

    Hopefully it will lead to the development of an advanced practice paramedic (community paramedic), who would funtion as a middle level provider (provider level above a RN or a currently practicing paramedic) in areas were paramedics practice significantly and predominantly (prehospital, critical care transport and community paramedicine areas of practice).

    Thanks again for providing coverage to this important topic in health care.

    Dan C., Paramedic, FP-C

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