National Ems Scope Of Practice Model

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Presentation to EMS National Scope of Practice Model Task Force and National Review Team.

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  • 06/07/09 by Nikiah Nudell, [email_address]
  • National Ems Scope Of Practice Model

    1. 1. National EMS Scope of Practice Model A Western Perspective For the National EMS SoPM Task Force and the National EMS SoPM National Review Team June 13, 2005
    2. 2. SF Collaborative Presentation <ul><li>Nikiah Nudell, NREMTP, CCEMTP </li></ul><ul><ul><li>EMS Agency Specialist, San Francisco EMS Agency </li></ul></ul><ul><ul><li>Member of NAEMT, NEMSMA, NRHA, NNAEMSA, CSRHA, and Advocates for EMS </li></ul></ul><ul><ul><li>Instructor of AHA, AAP, NAEMT & DHS programs </li></ul></ul><ul><li>Niels Tangherlini, NREMTP, BA </li></ul><ul><ul><li>Paramedic Captain, San Francisco Fire Department </li></ul></ul><ul><ul><li>Organizer of SFFDs “Homeless Outreach & Medical Emergency Team” </li></ul></ul>by Nikiah Nudell, NREMTP
    3. 3. California EMS Systems <ul><li>State EMS Authority licenses paramedics, regulates Local EMS Agencies and provides statewide disaster support functions </li></ul><ul><li>San Francisco EMS Agency regulates EMS, EMT Licensure and Paramedic Accreditation in the County </li></ul><ul><ul><li>Similar in perspective to many State EMS Agency roles </li></ul></ul><ul><li>SF DPH provided ambulance transport beginning in 1867 </li></ul><ul><ul><li>Now regulates the EMS System, not an operational entity </li></ul></ul>by Nikiah Nudell, NREMTP
    4. 4. &quot;Computers in the future will weigh no more than 1.5 tons.&quot; Popular Mechanics 1949 <ul><li>The NHTSA Vision for Our Future: </li></ul><ul><ul><li>Community-based health management </li></ul></ul><ul><ul><li>Fully integrated with health care system </li></ul></ul><ul><ul><li>Identify & modify illness & injury risks </li></ul></ul><ul><ul><li>Provide acute/follow-up care for illness/injury </li></ul></ul><ul><ul><li>Contribute to treatment of chronic conditions & community health monitoring </li></ul></ul><ul><ul><li>More appropriate use of acute health care resources </li></ul></ul>by Nikiah Nudell, NREMTP
    5. 5. EMS Education Agenda <ul><li>For the Future? In 2010… </li></ul><ul><ul><li>Provide basic competencies for EMS to serve the needs of the population </li></ul></ul><ul><ul><li>Educate Injury & Illness Prevention, risk modification, chronic treatment, and community/public health </li></ul></ul><ul><ul><li>Significant flexibility for local needs </li></ul></ul><ul><ul><li>Entry level competence managed nationally </li></ul></ul><ul><ul><li>Facilitate adaptation as CH/PH needs and roles evolve </li></ul></ul>by Nikiah Nudell, NREMTP
    6. 6. What EMS models are in place? <ul><li>25% cross trained FD </li></ul><ul><li>20% third service </li></ul><ul><li>19% “other” </li></ul><ul><li>12% private service </li></ul><ul><li>8% Public utility model </li></ul><ul><li>Source EMS Magazine 2 nd Annual EMS System Survey </li></ul>by Nikiah Nudell, NREMTP
    7. 7. The Community/Public Health Model <ul><li>Using EMS resources to monitor, respond, prevent and modify community/public health </li></ul><ul><li>The Vision describes a CH/PH focus for EMS </li></ul><ul><ul><li>Describes the future EMS entity as: </li></ul></ul><ul><ul><ul><li>“ New” or reborn from its prior existence </li></ul></ul></ul><ul><ul><ul><li>Continuing as the public’s ‘safety net’ </li></ul></ul></ul><ul><li>The SoPM should support the Vision </li></ul><ul><ul><li>Focus of the EMS Education Agenda is competency based national licensure and local accreditation </li></ul></ul>by Nikiah Nudell, NREMTP
    8. 8. Competence defined <ul><li>” The ability to perform work to a set standard… the emphasis is not on knowledge or skills” </li></ul><ul><li>Rowanhill Consultants </li></ul>by Nikiah Nudell, NREMTP
    9. 9. Proven Competence is… <ul><li>Judged by what people produce in the course of their work, not what they put into it </li></ul><ul><li>Focuses on the outputs from activities, not inputs </li></ul><ul><li>Measured by Quality Improvement programs integral to Risk Management </li></ul>by Nikiah Nudell, NREMTP
    10. 10. Adaptive Competence is… <ul><li>Defined as the ability to read a new situation and adapt or apply appropriate competencies </li></ul><ul><li>About asking the right questions and developing the means to resolve problems </li></ul><ul><li>Seen as “learning to learn” or “thinking outside the box” </li></ul><ul><li>Exemplified by independent practice providers </li></ul>by Nikiah Nudell, NREMTP
    11. 11. Draft 2.0 <ul><li>Does not address the Vision </li></ul><ul><ul><li>APP may be a critical role </li></ul></ul><ul><li>Legal definition of “certification” may be inconsistent with SoPM use </li></ul><ul><li>“ Evolving” population=Baby Boomers </li></ul><ul><li>Layperson skills should be included for all levels </li></ul><ul><ul><li>Auto-injectors (i.e. EpiPen, Narcan) </li></ul></ul><ul><ul><li>Glucose check, administer oral glucose and Rx glucagon </li></ul></ul><ul><ul><li>Oral pain medications (i.e. ASA for ACS, NSAIDS for trauma) </li></ul></ul><ul><ul><li>Beta agonist MDI (Rx) </li></ul></ul>by Nikiah Nudell, NREMTP
    12. 12. <ul><li>EMR Scope </li></ul><ul><ul><li>Tourniquet </li></ul></ul><ul><li>EMT Scope </li></ul><ul><ul><li>Monitor/maintain IV infusions </li></ul></ul><ul><ul><li>Insert multi-lumen & esophageal airways </li></ul></ul><ul><li>Paramedic Scope </li></ul><ul><ul><li>Initiation of synthetic volume expanders </li></ul></ul><ul><ul><li>All airways (i.e. RSI, surgical, retrograde, etc) </li></ul></ul><ul><ul><li>Simple central venous access (i.e. single lumen) </li></ul></ul>Draft 2.0 continued by Nikiah Nudell, NREMTP
    13. 13. Education requirements <ul><li>Minimum competency to graduate </li></ul><ul><ul><li>No specific hour requirement mandated </li></ul></ul><ul><ul><li>Flexibility for course design, student population and instructor base </li></ul></ul><ul><ul><li>Immediately sets the minimum to acceptable level </li></ul></ul><ul><ul><li>Supports the Vision </li></ul></ul><ul><li>Current CE courses do not assure continued competence </li></ul><ul><ul><li>Ineffective remediation </li></ul></ul>by Nikiah Nudell, NREMTP
    14. 14. Advanced Practice Paramedic <ul><li>DEA licensing, CMS-NPI, Mid-Level </li></ul><ul><li>Graduate level education & competency </li></ul><ul><ul><li>Primary Care Paramedic </li></ul></ul><ul><ul><ul><li>Antibiotics, prescriptions </li></ul></ul></ul><ul><ul><ul><li>Suture removal & simple suturing </li></ul></ul></ul><ul><ul><ul><li>Wound care </li></ul></ul></ul><ul><ul><li>Mental Health Paramedic Module </li></ul></ul><ul><ul><ul><li>Involuntary holds </li></ul></ul></ul><ul><ul><ul><li>Medication management </li></ul></ul></ul><ul><ul><li>Critical Care Paramedic Module </li></ul></ul><ul><ul><ul><li>Invasive management </li></ul></ul></ul>by Nikiah Nudell, NREMTP
    15. 15. Acute Care Paramedic Module <ul><li>Emergency Surgical Procedures </li></ul><ul><ul><li>Field amputations </li></ul></ul><ul><ul><li>C-Sections </li></ul></ul><ul><ul><li>Chest tubes </li></ul></ul><ul><ul><li>Escharotomy </li></ul></ul><ul><ul><li>Cross clamping </li></ul></ul><ul><li>Research based care for the future </li></ul>by Nikiah Nudell, NREMTP
    16. 16. “ Improvise. Adapt. Overcome.” USMC <ul><li>Does the SoPM encourage “learning to learn”? </li></ul><ul><li>Is it fully integrated into healthcare delivery systems? </li></ul><ul><li>Does it serve Special Needs populations? </li></ul><ul><li>Does it contribute to treatment of chronic health conditions? </li></ul><ul><li>Does it provide more appropriate use of acute health care resources? </li></ul>by Nikiah Nudell, NREMTP
    17. 17. 2005 Gap Analysis <ul><li>Significant gap remain unaddressed: </li></ul><ul><ul><li>Provide basic competencies for EMS to serve the needs of the population </li></ul></ul><ul><ul><li>Injury & Illness Prevention, risk modification, chronic treatment, and community/public health </li></ul></ul><ul><ul><li>Significant flexibility for local needs </li></ul></ul><ul><ul><li>Entry level competence managed nationally </li></ul></ul><ul><ul><li>Facilitate adaptation as CH/PH needs and roles evolve </li></ul></ul>by Nikiah Nudell, NREMTP
    18. 18. Who are the providers? <ul><li>43% career paid providers only </li></ul><ul><li>26% volunteer providers only </li></ul><ul><li>31% mixed providers </li></ul><ul><li>77% serve populations under 50,000 </li></ul><ul><li>Source EMS Magazine 2 nd Annual EMS System Survey </li></ul>by Nikiah Nudell, NREMTP
    19. 19. Suggested EMS Scopes <ul><li>EMR </li></ul><ul><ul><li>First Responder competencies similar to today </li></ul></ul><ul><li>EMT Basic </li></ul><ul><ul><li>Basic competencies similar to today </li></ul></ul><ul><li>Advanced EMT </li></ul><ul><ul><li>Competencies similar to ‘Paramedic’ of today </li></ul></ul><ul><ul><li>First Response ‘ALS’ Level </li></ul></ul><ul><ul><li>Focus on BLS skills with ‘basic’ advanced skills </li></ul></ul><ul><li>Paramedic </li></ul><ul><ul><li>Professional medical provider, advanced by today's standards </li></ul></ul><ul><li>Advanced Practice Paramedic (multi-tiered) </li></ul><ul><ul><ul><li>Primary Care Paramedic (i.e. Alaska/IHS CHA Program) </li></ul></ul></ul><ul><ul><ul><li>Mental Health Paramedic (i.e. MH Technician, LCSW) </li></ul></ul></ul><ul><ul><ul><li>Critical Care Paramedic (i.e. CCT Mid-Level provider) </li></ul></ul></ul><ul><ul><ul><li>Acute Care Paramedic (i.e. EM Mid-Level Provider) </li></ul></ul></ul>by Nikiah Nudell, NREMTP
    20. 20. “ Role Creep…” Protect the Status Quo! <ul><li>Prevents “integration” of healthcare delivery systems </li></ul><ul><ul><li>Freezes progress for EMS Professionals trying to realize the potential of integration </li></ul></ul><ul><li>Does not encourage “learning to learn” </li></ul><ul><li>Who does this statement benefit? </li></ul><ul><li>EMS providers regulated by SoPM should define their ‘new’ role in healthcare </li></ul>by Nikiah Nudell, NREMTP
    21. 21. The EMS role of today <ul><li>49.4% respond to Emergency Requests </li></ul><ul><li>50.6% respond to Emergency & Transfers </li></ul><ul><li>73% ALS transport </li></ul><ul><li>64% BLS transport </li></ul><ul><li>28% ALS first response </li></ul><ul><li>36% BLS first response </li></ul><ul><li>Source EMS Magazine 2 nd Annual EMS System Survey </li></ul>by Nikiah Nudell, NREMTP
    22. 22. EMS Roles <ul><li>EMR </li></ul><ul><ul><li>First Responder in rural/wilderness/mass gathering </li></ul></ul><ul><li>EMT Basic </li></ul><ul><ul><li>Routine transports </li></ul></ul><ul><li>Advanced EMT </li></ul><ul><ul><li>First Responder in Fire Based or non-transport EMS </li></ul></ul><ul><ul><li>Non-transport sole provider </li></ul></ul><ul><ul><li>1 on 1 partner for Paramedic </li></ul></ul><ul><li>Paramedic </li></ul><ul><ul><li>1 on 1 or dual paramedic </li></ul></ul><ul><ul><li>Essential/minimum ALS level provider </li></ul></ul><ul><li>Advanced Practice Paramedic (multi-tiered) </li></ul><ul><ul><ul><li>Primary Care Paramedic- Underserved populations, treat/release, etc </li></ul></ul></ul><ul><ul><ul><li>Mental Health Paramedic- Crisis management, disaster support, liaison </li></ul></ul></ul><ul><ul><ul><li>Critical Care Paramedic- Specialty Care Transport for all age groups </li></ul></ul></ul><ul><ul><ul><li>Acute Care Paramedic- EM for high acuity responses & standby </li></ul></ul></ul>by Nikiah Nudell, NREMTP
    23. 23. EMS Competence Management is… <ul><li>A systematic framework within which the regulators and administrators manage all the competencies needed </li></ul><ul><li>Ineffective if based on the least common denominator </li></ul><ul><li>Does the SoPM encourage adequate Competence Management for the Vision? </li></ul>by Nikiah Nudell, NREMTP
    24. 24. National Scope of Practice Model <ul><li>Is a necessary project, however: </li></ul><ul><ul><li>Cannot be separated from the future roles of NHTSA, FICEMS, DHS or others </li></ul></ul><ul><ul><li>Should support </li></ul></ul><ul><ul><ul><li>EMS System design </li></ul></ul></ul><ul><ul><ul><li>Quality Control </li></ul></ul></ul><ul><ul><li>Should not negatively impact community based interventions </li></ul></ul>by Nikiah Nudell, NREMTP
    25. 25. &quot;Why not go out on a limb? That's where the fruit is.&quot; Will Rogers, 1879-1935 <ul><li>Improved advertisement of project </li></ul><ul><ul><li>Periodicals (JEMS, EMS Magazine, Internet) </li></ul></ul><ul><ul><li>Direct Mail (NREMT, NAEMT, NAEMSD) </li></ul></ul><ul><ul><li>Target other regions, not just state EMS </li></ul></ul><ul><li>Welcome future invitation for involvement </li></ul><ul><ul><li>[email_address] </li></ul></ul><ul><ul><li>(415) 254-5821 </li></ul></ul>by Nikiah Nudell, NREMTP

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