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    Default Sedans may replace ambulances

    Sedans may replace ambulances
    Move mulled to free up ERs
    By: Mary Agnes Welch
    Winnipeg Free Press - ONLINE EDITION

    Forget the huge white ambulance. Forget the lights and sirens. Forget the long wait to be handed off to an emergency room doctor.

    Winnipeg paramedics could soon arrive at your door in a much homelier vehicle -- a Ford Focus. If the provincial government approves the idea, a paramedic could be sent by car to triage and treat some of the thousands of non-life-threatening cases called in to 911 every year.

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    The move is part of a bold new plan meant to reduce pressure on city emergency rooms, ease the chronic shortage of paramedics and cope better with the looming H1N1 flu pandemic.

    A Ford Focus could be on the streets in a few weeks, with five paramedics cruising the city in sedans by the time the worst of the pandemic hits, said Winnipeg Fire Paramedic Service Deputy Chief Ken Sim.

    The city would still send a full-scale ambulance to critical cases, like heart attacks or car accidents. Those are only about 10 per cent of the cases medics attend.

    The new "community paramedics" would act more like nurses who make house calls, responding to a whole host of less serious cases that don't need a $1-million ambulance, two highly trained medics and an automatic trip to the nearest emergency room. That includes everything from worrisome flu to sprained ankles, diabetes and seizures.

    The community medics would come equipped with most of the same gear an advanced-care paramedic carries, like medications and intravenous supplies.

    However, they would use a slightly more sophisticated triage checklist like the one nurses use in the emergency rooms. Based on that checklist, the medics could treat someone on the spot, or call a taxi or stretcher service to transport someone to a clinic, or strap the patient into the Ford's passenger seat and provide a lift to an urgent-care clinic or even the ER.

    "We'd be able to get a trained paramedic to people sooner than having to wait for a two-person ambulance," Sim said.

    Right now, patients with non-life-threatening problems can wait hours for an ambulance to arrive, in part because call volumes have increased nearly 15 per cent in the last five years. Call volumes plus delays off-loading patients in crowded emergency rooms have taxed Winnipeg's paramedic service almost to the limit in recent years.

    The WFPS is waiting for Health Minister Theresa Oswald to give the pilot project her approval.

    Provincial regulations say patients can only be transported by ambulance, so the city needs a ministerial order allowing medics to give patients a lift in a Focus.

    The province says it's reviewing the proposal and hopes to have an answer for the WFPS in two weeks.

    Paramedics have long been arguing for smarter ways to treat people who call 911 and they applaud the "community paramedic" approach.

    "The idea is to have medics out in the community engaging people with problems and find the best place in health care for them instead of a system of 'you call, we haul,' " said paramedic union president Chris Broughton. "The system of emergency medicine has never really evolved over the years."
    Huh?
    Last edited by CdnFD24; 11-07-2009 at 05:40 AM.
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    They already have this. They're called visiting nurses. And that is exactly what EMS would turn into if this concept were really instituted.
    PROUD, HONORED AND HUMBLED RECIPIENT OF THE PURPLE HYDRANT AWARD - 10/2007.

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    Quote Originally Posted by GeorgeWendtCFI View Post
    They already have this. They're called visiting nurses. And that is exactly what EMS would turn into if this concept were really instituted.
    The problem we run into as nurses (at least here in Oklahoma) is that we are not allowed to see pre-hospital patients. We can only see patients that we already have orders for and that have already been seen by a physician. We can do home visits on patients that have been discharged form the hospital, nursing homes, or patients that have a home health program set up by their physicians. We cannot do anything without having orders from a doctor that has seen the patient.

    In the hospital I'm an RN. When I'm responding to a call I'm an EMT-B who cannot do any advanced procedures. I don't know if any other states are more flexible regarding pre-hospital nursing, but that's the problem here.

    I agree with the concept of doing a triage/visiting system that they are proposing. I think that nurses would fit the role alot better, visiting nurses are a big part of nursing history. But I know in Oklahoma the only providers who would legally be allowed to provide this type of care would be EMT's.
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    Quote Originally Posted by MarcusKspn View Post
    The problem we run into as nurses (at least here in Oklahoma) is that we are not allowed to see pre-hospital patients. We can only see patients that we already have orders for and that have already been seen by a physician. We can do home visits on patients that have been discharged form the hospital, nursing homes, or patients that have a home health program set up by their physicians. We cannot do anything without having orders from a doctor that has seen the patient.

    In the hospital I'm an RN. When I'm responding to a call I'm an EMT-B who cannot do any advanced procedures. I don't know if any other states are more flexible regarding pre-hospital nursing, but that's the problem here.

    I agree with the concept of doing a triage/visiting system that they are proposing. I think that nurses would fit the role alot better, visiting nurses are a big part of nursing history. But I know in Oklahoma the only providers who would legally be allowed to provide this type of care would be EMT's.
    That wasn't my point. My point was that EMS is called for enough BS and nonsense as it is. When folks find out that EMS will come out to "check you out", the system will be abused much more than it is now.

    We all have stories about EMS calls for utter BS. Just wait until we are called to check on Johnnie's sniffles or Becky's tummy ache on a daily basis. Remember, the first word in the name is EMERGENCY.
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    Quote Originally Posted by GeorgeWendtCFI View Post
    That wasn't my point. My point was that EMS is called for enough BS and nonsense as it is. When folks find out that EMS will come out to "check you out", the system will be abused much more than it is now.

    We all have stories about EMS calls for utter BS. Just wait until we are called to check on Johnnie's sniffles or Becky's tummy ache on a daily basis. Remember, the first word in the name is EMERGENCY.
    True that.

    Remember the days when doctors would actually do house visits?
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    Quote Originally Posted by GeorgeWendtCFI View Post
    We all have stories about EMS calls for utter BS. Just wait until we are called to check on Johnnie's sniffles or Becky's tummy ache on a daily basis. Remember, the first word in the name is EMERGENCY.
    I think this is exactly what they're attempting to address. Why send a full unit to a call for the tummy ache or sniffles? We currently do this daily. A system with latitude to better triage the response seems in order in places that are losing employees and staffed units, but still are seeing increasing calls. I think there is a lot of potential for abuse, but we're already seeing it anyway and it's tying up resources. I can't see how the public would "find out that EMS will come check you out" anymore than they already do, since our units do. It's certainly not a strategy to address the real problem of system abuse without careful consideration. But given the current federal trend and administration, I doubt that system abuse will decrease any time soon.

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    Why send it at all? Hire NP's or MA's to do phone triage and send these units to real EMERGENCIES.
    PROUD, HONORED AND HUMBLED RECIPIENT OF THE PURPLE HYDRANT AWARD - 10/2007.

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    At one time I heard talk that the future of EMS was "Paramedic Practitioners". These medics would be able to perform sutures, write prescriptions, run labs from a mobile lab, and things like that. The idea was to reduce the stress on the ER's and allow treatment at home with a follow-up at their personal physician. Cases that needed immediate care would be transported by ambulance.

    This sounds like a move in that direction.

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    They have something similar around here. They have paramedics that drive around in Ford Expeditions and go to calls. They can go to houses and handle smaller calls, or they meet up with BLS ambulances and provide ALS services. Although these are Non Transport vehicles, they do not transport patients to the hospital, only call for backup units if needed.

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    The point isn't that we don't already go to a ton of bs calls. The point is this will simply encourage MORE people to call for help for MORE bs.
    Even the burger-flippers at McDonald's probably have some McWackers.

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    The big problem with this concept is that currently you can not bill for ambulance service unless you transport. The big players, Medicare, Medicaid and most insurance companies only pay for transport. We have a fee schedule for paramedic treatment at the scene but are very seldom able to collect it. This concept is a step in the right direction but needs a lot of study.

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    Quote Originally Posted by GeorgeWendtCFI View Post
    They already have this. They're called visiting nurses. And that is exactly what EMS would turn into if this concept were really instituted.
    Wake County, NC has Advanced Practice Paramedics that respond in Dodge Chargers. As I understand it, the APPs are authorized to make transport decisions (no, we will not take you to the hospital for your toothache) as well as perform "preventative" healthcare. In their first year, they've found patients unconscious and having diabetic emergencies while doing home visits on frequent fliers.

    From mync.com...
    The program will ensure that at least one additional, experienced paramedic is assigned to each high-acuity EMS call, which often requires multiple paramedics to perform time-sensitive procedures in a short period of time. In the past, the system sometimes used two ambulances to provide the necessary number of paramedics. APP will allow many of those patients to be treated while allowing the second ambulance to remain in service.

    APP's will also evaluate, educate and provide preventive care for selected patient populations; including senior citizens at high-risk for falls, those with certain diseases or a history of substance abuse. By improving the health and well-being of these patients, many medical emergencies will be prevented.

    Advanced Practice Paramedics will also seek alternative destinations for EMS patients that would be better served somewhere other than emergency rooms. In certain situations, APP's will identify and arrange transportation to substance abuse treatment centers or mental health care facilities. This will free up the ambulance for other calls.
    Last edited by cozmosis; 11-07-2009 at 07:12 PM. Reason: Add link & story from mync.com

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    Lightbulb European Striping In North Carolina

    This is one of Wake County's Advanced Practice Paramedic Chargers. Originally, they were supposed to have a dozen or more cars on duty. I've read that budget cuts have decreased their usage to only two or three on the road at a time.


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    Coz,

    Has there been any turf wars with nurses about this program? We had issues letting EMTs and paramedics in the hospital settings to help with nursing shortages. Just wondering, everyone is so protective of their playground.

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    Quote Originally Posted by lexfd5 View Post
    Has there been any turf wars with nurses about this program? We had issues letting EMTs and paramedics in the hospital settings to help with nursing shortages. Just wondering, everyone is so protective of their playground.
    Obviously, I'm not in North Carolina but I haven't read anything about that sort of conflict with the Wake County experiment. I'm not sure what group of nurses would protest, though. From what I've read, these APPs are doing field work only. So, if they're keeping people out of the ER, the emergency room nurses are probably big fans of the program.

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    i got no problems with the program.

    now that car. that is one ugly thing. was the person color blind?

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    Quote Originally Posted by cozmosis View Post
    Wake County, NC has Advanced Practice Paramedics that respond in Dodge Chargers. As I understand it, the APPs are authorized to make transport decisions (no, we will not take you to the hospital for your toothache) as well as perform "preventative" healthcare. In their first year, they've found patients unconscious and having diabetic emergencies while doing home visits on frequent fliers.

    From mync.com...
    That is because the director of Wake County EMS and their medical director are light years ahead of the crap that people are doing in most other parts of the country. Say all you want about the South being backwards, but I have seen things in the South that people in Massachusetts will not be doing for another 10 years - and they will still think that they are the first ones to do it.

    Your job is public safety and public service. I don't see many fire departments, or even third service agencies adopting programs like this in the future - even if they know it works. Really quite sad actually.
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    Never mind. My opinion about this is all wrong.

    My wife (BSN, CEN and former MICN) tells me that this is a great idea. So that means I am wrong.

    I, on the other hand, LOVE that car.
    PROUD, HONORED AND HUMBLED RECIPIENT OF THE PURPLE HYDRANT AWARD - 10/2007.

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    Quote Originally Posted by GeorgeWendtCFI View Post
    Never mind. My opinion about this is all wrong.

    My wife (BSN, CEN and former MICN) tells me that this is a great idea. So that means I am wrong.

    I, on the other hand, LOVE that car.


    Next time they redo the forums they should add an extra button for all us married men. Everytime we post, it will be forwarded to our wifes for approval before it will show up or be deleted .
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    I think this is a great idea. I would love to see the data this program must have produced. Deferred trips, valid bls run, valid als run... etc.

    I dig the car too... sharp.
    I am now a past chief and the views, opinions, and comments are mine and mine alone. I do not speak for any department or in any official capacity. Although, they would be smart to listen to me.

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    Quote Originally Posted by ChiefKN View Post
    I think this is a great idea. I would love to see the data this program must have produced. Deferred trips, valid bls run, valid als run... etc.

    I dig the car too... sharp.
    Yup, me too. Curious as to how much this saves the system from the bogus runs.
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    Hi guys, I'm on the F.D. side of things but can comment a little on our system in Wake County. First, the Medical Director and his staff are awesome. They're bringing new ideas here, which have pushed Wake County to be the area with the most successful cardiac arrest resuscitations. The Raleigh F.D. and Wake County EMS Admin. have an awesome working relationship, and all have the best interest of the public in mind (haven't seen a single turf war between anyone). This area has come so far in the past 10 years, it's crazy. As far as us being behind, that might have been true 10-20 years ago, but you've got a surge a people from all over the U.S. to this area due to real estate prices, climate, and location. It's definitely been a blessing, as it's brought in new ideas and opened the minds a little, turning from strictly reactive to a more proactive approach.

    The A.P.P. program is being criticized by some people, mainly because of their Dodge Chargers. What people don't understand, is that the cars were put on the same bid as the Sheriff's Department to save money in the long run, versus putting out a separate bid for something else. And, I don't see them complaining when the stats speak for themselves. Hello idiots, we have the most successful cardiac resuscitations in the nation!! It's obvious, whatever the Medical Director and his staff are doing is working!!

    The A.P.P.'s have their "rounds to make", where they check on frequent flyers, and they also check in with Medic units on those calls where an extra medic would be essential. We still see the "taxi" calls here, but, I think the A.P.P. program has proven successful. I'll say this, those guys that are A.P.P.'s run their *****e$ off....

    Hope this helps a little....

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    Oh yeah, and as far as the cars go, they're sweet.

    With the proven affectiveness of neon colors and visibility during the day time, the old color scheme of just blue and white ambulances has now been supplemented with neon green.
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    Last edited by RFDGloWorm; 11-09-2009 at 02:11 PM.

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    My local EMS agency has been sending a first responder for about 10 years. They almost always beat the ambulance to the scene, do a "triage", and update the ambulance as to what may/may not be needed. Many times, they have cancelled the ambulance response.

    Call volume has remained the same year after year, around 1500.

    Ambulance responses have gone down. For us, the program has been working well.
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    Just a little more about Wake county EMS (from the web site);

    "The system responded to more than 69,000 requests for service in FY 2008, and transported more than 48,000 patients.

    Among the systemís major achievements have been a nationally recognized cardiac arrest save rate, implementation of a pioneering ICE (induced hypothermia by EMS) protocol for post-cardiac arrest patients, and system-wide closest-vehicle dispatching using GPS-based automatic vehicle location and the MARVLIS in-vehicle navigation system".

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