1. Reducing Non-Emergent Use of Emergency
Resources in New Brunswick, New Jersey
Source: PicGifs
Submitted by:
Matthew Valentine, EMT-B
Rutgers University, the State University of New Jersey
New Brunswick, New Jersey 08901
Submitted to:
Mary O’Dowd, M.P.H.
Commissioner
New Jersey Department of Health
P. O. Box 360
Trenton, NJ 08625-0360
Submitted on:
April 30, 2015
Scientific and Technical Writing
355:302:69
Professor Arete Bouhlas
2. i
Abstract
Misuse of pre-hospital and hospital emergency resources is a serious problem in New
Brunswick. As patients enter the emergency department with non-emergent complaints and
illnesses, space is taken up from others. At capacity, the emergency department closes its doors
and sends new incoming patients to other hospitals, ultimately resulting in a higher mortality
rate. Additionally, research shows that patients already being treated within the overcrowded
department are faced with a higher rate of death than those being treated with the same condition
in a different ER. Furthermore, the mental health and well being of providers in chronically
overcrowded emergency departments is significantly impaired when compared to peers in other
departments. Similarly, emergency medical services are misused by patients with conditions that
are not considered emergencies. Research shows that individuals abuse emergency resources due
to lack of financial capability, no provider to handle their overall care and impatience with
scheduling appointments.
This proposal suggests that the misuse of these resources can be counteracted through the
implementation of a community paramedicine and treat and release program within the city.
Paramedics trained outside of their traditional emergency response scope of practice will serve as
a primary care provider for patients who are at high risk for abusing the healthcare system. In
addition, paramedics that are involved in emergency response will also have the ability to treat a
patient with a minor affliction on the scene of an incident and discharge them using a
standardized list of guidelines and protocols. Through the use of these new programs, there will
be a reduction in the amount of non-emergent use of the emergency department and emergency
medical services within New Brunswick.
Keywords: emergency, community paramedicine, emergency medicine, treat and release,
emergency medical services, ER, EMS, overcrowding, non-emergent
3. ii
Table of Contents
Abstract.………………….……………………….……………………….…………………. i
Table of Contents……………...……………….........…………………….…..……….…… ii
Table of Figures....…………………….…….......……….…………….…..………..………iii
Introduction………………...………………………………..………….………………..…..1
New Jersey Emergency Medical Services..………….............……..………….….......1
Emergency Medicine and the Emergency Department……….…….....……..……….2
The Current Issue.………………………….………....………………………….…...2
Reasons for Misuse….…………………...................…………………………………..4
Literature Review.……..……………….................……………….………...……………….5
Case Study…………………………………………………………………………………….5
Previous Models of Success…..…………………………..………...…………........................5
Community Paramedicine…….………..…………….……………….……….5
Treat and Release Program……………………...……...……………….…….6
Plan…………………….………………………….……………….……………………...…..8
Overview………………...……………………………………………..………...........8
Education……..……………………………..………………..……………….8
Logistics……………………………………...…….……………..…………..9
Limiting Liability………………………………...……………..….….………9
Budget…………………..………………………………………………….………………...11
Rationale……………………………………………………………………………..11
Discussion……………………………………………….……………………………...........12
References………………………………………………….…………………………..........13
Appendices…………………………………………………………...…………….……..…16
4. iii
Table of Figures
Figure 1: 10 Day Mortality of Patients Admitted to a Hospital Ward from Both
Overcrowded and Non-Overcrowded Emergency Departments in
Australia………………………………………………………………………………...…2
Figure 2: Patient Outcomes Using a “Treat and Release” Program at a Large Music Festival
…………………………………………………………………………………....6
Figure 3: Community Paramedicine Initial Budget……………………………………..11
Figure 4: A Self-Reported Questionnaire Evaluating Patient Behaviors………………..16
Figure 5: A Treat and Release Protocol for Allergies/Benadryl® use………………….17
5. Valentine 1
Introduction
In order to delve into the problem at hand, an explanation into the current procedures and
systems throughout the state need to be addressed. Both the emergency medical service
and emergency medicine at the hospital level are intricate arenas that are worlds of their
own.
New Jersey Emergency Medical Services
At the current time, New Jersey functions through a two tier approach to emergency
medical services. The first tier is known as basic life support (BLS) and is provided by
state certified emergency medical technicians (EMTs) who operate ambulances
throughout the state (Summary Overview of New Jersey’s, 2013). Across the state, basic
life support ambulances respond to every medical emergency incident that arises and
initiate treatment of the patient. Of those patients that are critically injured or severely ill,
an advanced life support unit may be requested (Summary Overview of New Jersey’s,
2013). Advanced life support (ALS) units are made up of two paramedics that arrive in a
specially designed sport utility vehicle equipped with all the equipment and medication
necessary to perform various hospital level interventions. If the situation warrants a
higher level of care than can be provided by the EMTs, an ALS unit may meet the
ambulance on scene or en-route to the hospital. The paramedics will assume care of the
patient to provide various medications or surgical techniques that are outside of the EMT
scope of practice (Summary Overview of New Jersey’s, 2013). While advanced life
support units have the capability to handle any emergency, BLS units easily handle the
large majority of medical emergencies that arise since paramedics are only often
necessary for approximately “one third of the calls” throughout the state (Summary
Overview of New Jersey’s, 2013).
In an ideal world, there would be unlimited resources in every township, municipality
and city to handle every emergency that arises. Through financial and personnel issues,
that ideal world is only a dream. Each municipality across the state of New Jersey only
has a finite amount of resources while still being responsible for protecting the safety and
well being of its residents. Due to the need to serve the residents of each municipality
while each town not having enough resources to respond to everything, the concept of
mutual aid is utilized (Summary Overview of New Jersey’s, 2013). Through contractual
agreements, municipalities agree to lend support through personnel and equipment to
pick up any calls that the original town cannot get to (Summary Overview of New
Jersey’s, 2013). For instance, at Rutgers University, there are 3 ambulances staffed at all
times ("Personal Interview," personal communication, February 28, 2015). If for some
reason all three ambulances are answering calls and another call comes in, the University
has a contractual agreement with Robert Wood Johnson University Hospital who will
then respond to that call in an effort to help the University serve all of its students, faculty
and staff in a timely manner.
Every time an ambulance is requested to respond to an incident, that crew has no choice
whether or not to answer the call or face legal ramifications (New Jersey Department of
Health, 2015). Failing to respond when requested is considered a “failure to act” offence
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and can result in loss of professional licensure and fines (New Jersey Department of
Health, 2015). Once these crews are assigned to an incident, they have no option but to
respond to the first call, regardless if the second call is more urgent.
Emergency Medicine and the Emergency Department
Starting in the late 1940’s, emergency medicine came about as its own specialty based on
battlefield medicine techniques used in WWII ("The History of Emergency," n.d.). Prior
to this, physicians in their own offices handled emergency care privately and if a hospital
did have a dedicated space to receive emergencies, it was only run by nurses who would
call the patient’s private doctor to come evaluate them ("The History of Emergency,"
n.d.). Since the introduction of battlefield mentalities in dealing with emergencies,
physicians started to specialize in treating only emergencies and the emergency
department has grown into what is colloquially termed the “emergency room”. Rooted in
the art of detecting and treating life-threatening illness, emergency departments are
equipped to deal with any emergent issue that may arise and put someone’s life in
danger ("The History of Emergency," n.d.). While the original philosophy of the
emergency department was to prolong life in critical moments, current legislation allows
individuals to misuse the service. All emergency departments function following the
same set of laws and regulations. Through an act known as the Emergency Medical
Treatment & Labor Act (EMTALA), emergency departments are not able to refuse
treatment to any person that requests to be evaluated and treated regardless if they have
an actual emergency or the means to pay for the services (Zibulewsky, 2000, p. 339).
While the philosophy of the emergency department is completely appropriate for patients
who have a true medical crisis, over-burdened emergency rooms can lead to improper
management of one’s care.
The CurrentIssue
With the current systems in place, emergency departments have become a haven for
individuals to be evaluated for a myriad of conditions, most of which are not life
threatening or emergent. Evidence has proven that on average, 43.5% of patients in
United States emergency rooms have conditions and illnesses that are not considered
“emergencies” and are able to be safely treated within 61 minutes to 24 hours after onset
(Center for Disease Control, 2009, p. 9). As this happens, the limited space is taken up in
the emergency room for individuals who truly need emergency care. Even with the
triaging system, every patient does need to be seen eventually and at the time of
evaluation, a bed is occupied that could be better spent for someone in more serious
condition. When emergency departments run into a lack of beds the department is labeled
as being on “diversion status.” (Kratovil, 2014). This new status indicates that the
emergency department is filled to capacity and is no longer accepting new patients, either
walk in or via ambulance. Through the barring of new admissions to the department,
individuals seeking care must find other facilities to be treated at, which have the
possibility of being a significant distance away.
Additionally, the patients that are being treated in the overcrowded emergency room are
not immune to the repercussions either. As physicians and other providers take on more
patients at a time, the quality of care has been shown to decrease (Bernstein et al., 2009,
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p. 9). Due to the practitioners having to spend more time with more patients, a lower
quality of care is given overall. In fact, patients who were initially treated in an
overcrowded emergency department and transferred to another unit for further care have
a higher mortality rate than those that were admitted from an ER with less patients
(Richardson, 2006).
Figure 1: 10 Day Mortality of Admitted Patients from Overcrowded and Non-
Overcrowded Emergency Departments
Source: (Richardson, 2006)
As can be seen in Figure 1, almost every age group of patients had a higher overall
mortality after being admitted to the hospital from an overcrowded emergency
department than a patient the same age who was in the ER when it was not overcrowded.
While no definitive cause has been pinpointed, one can speculate that the emergency
department providers missed something important with the patients, as they were busy
tending to a higher load of patients.
Patients are not the only ones to suffer from emergency room overcrowding. Physicians
and other providers are also affected by misuse of the department. Providers report
mental and physical strain as a result of the overwhelming workloads (Popa, Raed,
Purcarea, Lala, & Bobimac, 2010). The strain has gotten so intense that there is also
correlational evidence to support the notion that there is an increase in mental illness
among practitioners with a large majority either changing specialties or leaving the
clinical side of medicine altogether (Goldberg et al., 1996). Without individuals to care
for the sick and dying in emergency rooms, the emergency department and its
overarching goal to prolong the life of those most critically ill is fruitless. While the
hospital environment suffers much of the effects of overcrowding, pre-hospital medical
care is susceptible as well.
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Similar to the emergency department, emergency medical services also feel the effects of
emergency department misuse. Every time that an ambulance is called for a patient with
complaints that do not warrant an actual emergency, that ambulance is now held up from
helping out with actual emergency calls that are received. The ambulance is then required
to transport the patient to the emergency department, thereby serving a role in the cycle
of emergency room overcrowding (New Jersey Department of Health, 2015).
Additionally, the more severe patients that actually constitute emergencies must now wait
for another ambulance to respond. If there are no other available ambulances in that town
due to lack of resources, the mutual aid protocol must be activated, resulting in an
ambulance from another municipality to respond. In a true emergency, every second
counts and evidence has shown that a delay in transport times to definitive care because
of long ambulance wait times actually increases the mortality of an individual in a true
emergency (Wilde, 2013). For each moment that an ambulance is tied up with a patient
whom does not truly need emergency care, the chances of another individual surviving
while waiting for an ambulance sharply decreases.
Reasons for Misuse
The reasoning behind the misuse can be evaluated through exploring the mentality of the
individuals who are abusing the emergency healthcare system. In order to look at the
justification behind why individuals utilize the emergency room for minor ailments,
researchers at Robert Wood Johnson University Hospital conducted a study with a
sample of individuals who have a history of misuse. As seen in Appendix A, subjects
completed a questionnaire to gauge their thoughts and rationale behind the behavior. One
specific area that was explored was whether the individuals understood the concept of
emergent and non-emergent issues and was correctly able to differentiate between the
two (Wilkin, Cohen, & Tannebaum, 2012). Surprisingly, even though the individuals
were known abusers of the healthcare system, they were able to accurately choose what
an emergency was and what a non-emergent condition was and which required
immediate treatment and which did not require immediate treatment (Wilkin, Cohen, &
Tannebaum, 2012). Researchers probed farther into why someone would choose the
emergency department over more appropriate facilities. The majority of answers revolved
around three specific reasons: the individuals did not have a primary care provider, they
did not have a means to pay for the services and it was easier to walk into an ER than
schedule an appointment with their own physician (Wilkin, Cohen, & Tannebaum, 2012).
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Literature Review
Case Study
Robert Wood Johnson University Hospital (RWJUH) is no stranger to emergency
department overcrowding. On the night of October 31, 2014, Robert Wood Johnson had a
massive influx of individuals with alcohol intoxication into its emergency department.
(Kratovil, 2014). This surge in new patients was brought in mostly from emergency
medical service crews who had been requested by 911 callers or the police themselves.
Although some of these individuals were most likely intoxicated enough to be considered
medical emergencies, a large majority of them were not. With the current protocol of NJ
EMS to transport all patients to an emergency room, a severe overcrowding occurred
forcing RWJUH to close its doors, as they simply no longer had room for any more
patients. Responding times also drastically increased for anyone who requested 911
assistance, as crews were tasked with each intoxicated patient. Of the ambulances that
were available to answer incoming 911 calls, they were sent to JFK Medical Center in
Edison, New Jersey, a nearly 20 minute commute from RWJUH (Kratovil, 2014).
Through this incident, there is no denying that New Brunswick is plagued by non-
emergent use of emergency resources.
Previous Models of Success:
To deal with the overzealous use of emergency services, communities around the country
and world are implementing new programs to lessen the strain on emergency departments
and the resources that fall under them. Within the United States, various versions of
programs implementing an expanded utilization of paramedics and other healthcare
providers have been adopted.
Community Paramedicine
In an effort to bridge the gap and provide access to healthcare in areas with a lack of
physicians that can provide primary care, two communities in Colorado have enacted
similar, but slightly different programs. With a population of 54,000 people, over half of
who are uninsured, Eagle County, Colorado has created a program that expands the scope
of paramedics in the rural county (Hunsaker Ryan, 2011, p. 7). Within the confines of
this program, a few specially accredited paramedics are shifted from their traditional 911
response duties and instead visit the residences of uninsured individuals who do not have
proper access to healthcare (Hunsaker Ryan, 2011, p. 30). Through this program, a
paramedic will meet with the individual on a recurring basis (based on the individuals
specific medical needs) and assess them from a primary care standpoint (Hunsaker Ryan,
2011, p. 14). While not able to order laboratory tests or dispense many medications as a
physician would, the paramedics have the skills necessary to provide a head to toe
assessment, electrocardiograms, blood sugar checks and medication compliance (New
Jersey Department of Health, 2015). Although this program is solely intended to provide
healthcare to those in a rural area of Colorado, modifications will allow it to be utilized in
the urban setting of New Brunswick.
Similarly, Littleton, Colorado has a slightly modified community paramedicine program
from Eagle County, Colorado. Instead of relying solely on paramedics to provide the
10. Valentine 6
primary care, a paramedic is paired up with a physician assistant (PA) who holds many of
the same capabilities of a physician (Bryce, 2015). Unlike a paramedic, a PA is able to
prescribe medication, order and interpret test results and perform procedures that are
considered outside the scope of practice of a community paramedic. While following the
same logistical framework of the Eagle County community paramedicine program, the
PA and paramedic would visit the residences of uninsured individuals or those without a
primary care provider in order to serve as a primary care practitioner for that individual
(Bryce, 2015). In contrast to the Eagle County program, the Littleton program will also
be available to respond to emergency calls that are deemed non-emergent in order to save
an actual ambulance and emergency crew from being used on an unnecessary call (Bryce,
2015). After the first month in existence, a 4% decrease in non-emergent 911 transports
was noted (Bryce, 2015). Littleton, Colorado’s program further purports the efficacy that
a decrease in non-emergent use is possible.
Treat and Release Programs
In order to free up the amount of ambulances that respond to non-emergency patients, a
community in Australia issued a new protocol that actually allows emergency medical
personnel the authority to treat a patient with a minor injury on scene and then discharge
them (Feldman, Lukins, Verbeek, Burgess, & Schwartz, 2005,p.214). Following a set of
written protocols, such as that seen in Appendix B, paramedics and EMTs follow
guidelines set by a licensed physician. If a patient meets the strict guidelines, EMS
providers then have the unspoken authority to treat and release the patient without having
to contact a physician for approval. This program is unlike the current system in the
United States that forces any patient treated by EMS to be transported directly to the
hospital even if their condition is minor (New Jersey Department of Health, 2015).
Through the pilot program developed in Australia, there has been a marked decrease in
non-emergent emergency department use for the specific community that the program
has been implemented (Feldman, Lukins, Verbeek, Burgess, & Schwartz, 2005,p. 217).
Figure 2: Patient Outcomes Using a “Treat and Release” Program at a Large Music
Festival
Source: (Feldman, Lukins, Verbeek, Burgess, & Schwartz, 2005,p. 214)
11. Valentine 7
Figure 2 shows the effectiveness of a treat and release program through its implantation
at a large music festival in Toronto, Canada. Of the total 396 “medical emergencies”, 357
(91%) of them had conditions that fell within the protocols and were treated on scene
(Feldman, Lukins, Verbeek, Burgess, & Schwartz, 2005,p. 214). This saved 357
ambulance runs to the hospital allowing the ambulance crews the time and resources to
tend to the 39 legitimate medical emergencies that needed further care.
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Plan
With the current effects of healthcare overcrowding affecting individuals physically and
mentally, change needs to occur. New Jersey needs to address this especially in urban
areas where the misuse is exceptionally prevalent. Using previous models of success as a
framework with slight modification to each program, a community paramedicine
program will work for New Brunswick, New Jersey.
Overview
The community paramedicine program in New Brunswick will be comprised of two
aspects: a primary care paramedic and also a treat and release system for first responders.
At the current time, Robert Wood Johnson paramedics are the only paramedics in New
Jersey to enroll in this program, as no other hospital in the county has a paramedic
department (Summary Overview of New Jersey’s, 2013). All use of paramedics for
Middlesex County falls upon RWJUH’s EMS department. Within this program, a
paramedic from RWJUH that is certified in primary care through an accredited program
will visit with patients who have a known history of using the emergency healthcare
system for non-emergency purposes. During their visits, the paramedics will provide a
physical assessment to the individual (within their scope of practice and training) and
ensure that they are in compliance with any previous medical instructions. For instance, if
the individual is a diabetic, the paramedic will monitor the patient’s blood glucose level
to ensure that they are staying on top of their condition. The second part of this program
will let all paramedics and emergency medical technicians to treat and discharge patients
at the scene of an incident by use of standing protocols defined and documented in
advance by the medical director who oversees that particular service.
Education
Using the program developed in Eagle County, Colorado as a framework, a pairing with
Middlesex County College’s Health Science Department will be established. Specifically
designed courses in various aspects of primary care and prevention that are not normally
taught in the standard national paramedic curriculum will be completed by interested
paramedics from Robert Wood Johnson University Hospital. For example, counseling
patients on complying with their medication would be a topic offered through this
partnership. Paramedics, who complete the 14-course certificate program to be a certified
community paramedic, will then undergo a preceptor program in-house. This program
will require that the medical director accompany the newly certified community
paramedic on their two dozen calls with the exact time of preceptorship being based on if
the physician feels that the provider is competent in providing a primary care based
approach to healthcare. At the time that the preceptorship is over, the community
paramedic will function as a solo provider in providing future visits. Even though the
physical preceptorship may be over, the physician will meticulously review all notes and
documentation of assessments that the paramedic conducts to ensure quality care is being
provided. Identical to paramedics across the country in the traditional emergency
response role, community paramedics will need to recertify every 2 years with at least 72
hours of continuing education credits through refresher courses ("Paramedic (NRP),"
2013). By following through with the continuing education and refresher courses every 2
13. Valentine 9
years, the community paramedics will stay on top of the latest recommendations and
protocols when dealing in primary care.
Logistics
Under this system, patients would be referred to the community paramedicine program
by other emergency medical service providers, hospital staff or through their private
physicians. In today’s digital age, all patient charting is already completed electronically.
A referral to the program would require something as simple as checking an additional
box on the patient’s electronic medical record. Analogous to the similar programs across
the country in existence, common reasons for referral will be that the patient has a past
history of using the emergency department and EMS for non-emergent issues,
noncompliance in the self care of their medical conditions or a generalized concern of a
patient by one’s primary physician (Hunsaker Ryan, 2011, p. 26). During the initial
evaluation, the community paramedic will travel to the patient’s home in an outfitted
non-emergency SUV and would perform an overall assessment of the patient, which will
include at the very minimum a collection of vital signs and a medication review and
compliance check. Depending on the situation and patient’s medical history, the
paramedic may inspect the patient’s living situation for any potentially hazardous
situations resulting in a possible fall risk. Other medical procedures may also be
conducted depending on the patient’s medical history such as a glucometry test if the
patient is diabetic or an electrocardiogram if the patient has a history of cardiovascular
disease. On a patient-by-patient basis, the community paramedic will determine if follow
up appointments are needed or if the patient is in need of other services. Other services
may include: a higher level of medical care in patient’s with conditions outside the
paramedic’s scope or a referral to social services for additional help outside of healthcare.
The treat and release program will be incorporated into all New Brunswick EMS
services. This program will allow paramedics and EMTs to evaluate patients with minor
conditions that do not require emergency medical attention against a list of well defined
and delineated protocols set forth by the medical director of each EMS service. If the
patient falls exactly within the criteria set forth in the strict protocols, the emergency
personnel will have the ability to treat the patient and discharge them without
transporting them to the hospital. If a patient does not fall within these guidelines or their
condition changes, the option to discharge is considered null and transport to an
emergency department is warranted.
Limiting Liability
There is no additional liability among paramedics than there is among paramedics acting
in the traditional emergency response sense. Using the same framework of traditional
EMS, a physician would oversee the program at all times. Initially, the community
paramedic would be accompanied by the medical director who will supervise the
individual on for a probationary period. Once the medical director feels that the
paramedic is equipped to handle primary care patients on his or her own, he will
indirectly supervise that medic. Pursuant to New Jersey state law governing physician
oversight of emergency medical services, the medical director will then review all patient
charts within 72 hours of the patient interaction (New Jersey Department of Health,
14. Valentine 10
2015). Through this oversight system, the physician will only be needed on a part time to
review charts, as is the system with traditional emergency medical services. Depending
on initial enrollment of patients into the community paramedic program, additional part
time physicians may be hired to help with the abundance of chart reviews. During each
emergency department shift at RWJUH, one physician will be deemed on call to answer
any urgent concerns that a community paramedic may have while in the field. This on
call system will rotate through the emergency department staff and that physician will
receive additional compensation for being on call. There is also little liability in adequate
care not being provided in patients with a condition that is outside of the realm of primary
care. If the paramedic senses that a patient is severely ill and needs emergency medical
care, they are still trained in providing advanced emergency care and will be able to radio
an ambulance to transport the patient. In terms of the treat and release program, there is
no additional liability for the EMS providers. When the physician initially determines the
protocol, they are acknowledging that the emergency crews are operating within the
confines of their training by following the criteria set forth. If an individual follows the
protocols exactly, they are acting within their protocols and are free from liability.
15. Valentine 11
Budget
Figure 3: Community Paramedicine Initial Budget
Rationale
1. Salaries: The salaries listed above cover the one-year wage expenses for
employees of the program.
2. Vehicles: This expense is a one-time expense to purchase two discreet non-
emergency vehicles for the community paramedics to travel to see patients in.
3. Medical Equipment: On each vehicle, there will be $27,500 of medication,
equipment, tools and medical devices. This equipment will be a combination of
non-emergency and emergency equipment (in case the patients would need it).
4. “Tough Book” laptops: All charting and documentation will be completed
electronically on 2 durable laptops that will remain with the vehicles when not
being used. These laptops will cost $1,400 each.
5. Verizon Wireless “Air Cards”: This expense will provide the paramedics with
wireless capability anywhere when using the Tough Books, so that they may
upload and sync their reports automatically in a cloud based system. The expense
will be $80 per month per card (2) for 10 gigabytes of data. This is a yearly
expense of $1,920.
16. Valentine 12
Discussion:
Clearly, the emergency resources of New Jersey and particularly New Brunswick are
being misused and strained to their limits. Generally, when individuals think of
emergency care and treatment, there is a universal expectation that emergency resources
will always be rapid and available when needed. They want quick, quality care in
emergency situations, an expectation that New Brunswick cannot always fulfill in its
current state. Patients and providers alike are feeling these repercussions. Patients with
actual emergencies are left with longer times to receive definitive care resulting in an
increase in mortality (Wilde, 2013). Similarly, those who do receive prompt emergency
care while in an overcrowded emergency department also tend to have a higher mortality
indicating that a lower standard of care is often provided when providers are taxed with
an increased patient load (Richardson, 2006). Providers, themselves, are faced with a
higher chance of “burn out” and mental illness when routinely dealing with a excessive
amount of non-emergent patients (Popa, Raed, Purcarea, Lala, & Bobimac, 2010).
As community paramedics take on the task of prevention and primary care of referred
and at-risk individuals, individuals will be less likely to allow their conditions to
deteriorate enough to the point that emergency care is warranted. Additionally, those with
access to a more affordable primary care provider will be able to receive convenient care
in the comfort of their homes. Moreover, treat and release protocols for emergency
medical service providers will lessen the previous constraints that once confined them to
transporting every patient to the hospital and thus break a chain the cycle that leads to
overcrowding. With a community paramedicine program in place, New Brunswick would
be able to achieve a better utilization of its emergency resources, as the community
paramedics will now serve as a conduit for individuals to better manage their care.
The effectiveness of this program will be quantified after one year of it being in place.
Data will be collected from the emergency department and EMS on the acuity of patients
and compared to national averages. If there is a decrease in the amount of patients with
non-emergent complaints over that year compared to the start of the year and also the
national average, the community paramedicine program will have been effective in
accomplishing the intended goals on a population scale. If the program shows enough
success in New Brunswick, it has the flexibility to be implemented statewide and one day
nationally. Individually, if the program saves just one critical patient from an extended
time to reach treatment, it can also be seen as effective, as the overall goal of medicine is
to help those that are suffering.
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Appendix A
Figure 4: A Self-Reported Questionnaire Evaluating Patient Behaviors
Source: (Wilkin, Cohen, & Tannebaum, 2012).
