paramedic nursing

Interesting post. You correctly identified one area - reimbursement. However, in my opinion, the problem isn't reimbursement but what we are reimbursing for. In EMS you are reimbursed if you transport the patient. You are not reimbursed if you don't. Therefore the impetus is to transport.

In the UK they are experimenting with another model which for a lack of better terms they are calling advanced paramedic practitioner. Its outlined here:
http://www.jephc.com/uploads/Woollard990156.pdf

The key to this is the ability to triage and treat the patient in the field. They are authorized to treat minor issues such as lacerations in the field. They also have the ability to triage and decide that the patient does not need to go to the ER (A&E there) but instead can follow up with their PCP in the morning. If you consider how much this would unburden the US system its rather amazing. The issue here is that since its a national health system there is no reimbursement pressure to transport. Instead there is pressure not to transfer since it saves the system money.

David Carpenter, PA-C

Again David takes my posts and makes them clearer. And I was so hoping that Grad school would help he state my thoughts clearer.

David, in the Maritimes in Canada (don't recall where) a 'paramedic practitioner' like you describe has successfully been in place for a while. They practice on islands where transport to hospital for routine calls can be delayed and expensive.

There are many models to choose from in developing programs like that. Just about every military organization in the world has a program to teach their medics how to handle those kind of situations. The hard part is deciding were it's appropirate. One of the white papers from a few years back, talked about doing that in inner cities, to help with ER over crowding. Like David pointed out, we have to change our reimbursment structure. I fear that making that kind of change would just move the problem from one jursitiction to another.

There has been a lot in the news about the need for health care reform, I hope that the powers that be, (The Obama administration) remember to include out of hosptial/unscheduled care in the discusion andthe reform.

I have nothing to add to this blog because I am actually just starting nursing school, however, I must say that I greatly enjoyed reading this. It has taught me about the differences between a medic and a nurse and the need for reform in this field. My goal is to becaome a critical care nurse but I am also interested in becoming a medic as well. Thanks guys