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National Ems Scope Of Practice Model
 

National Ems Scope Of Practice Model

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

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 National Ems Scope Of Practice Model Presentation Transcript

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