Monday, June 9, 2014

How Advanced Practice Paramedic Training Can Improve Emergency Services

By Sally Delacruz


In most large urban areas people pay little attention to the constant background noise of ambulance sirens until they actually need an emergency service. Acute medical situations happen at all hours, and citizens have come to rely on well-trained personnel to treat them on site, as well as en route to the hospital. The people who make this service possible save hundreds of lives each year, making a strong case for advanced practice paramedic programs.

In the not-very-distant past there were no actual teams dealing with field emergencies. Less than fifty years ago, only a handful of states actually had written descriptions of the standards and practices for this kind of care, and prior to cell phones many ambulances did not even enjoy basic communications. Response personnel usually had certification from the Red Cross, but little formal medical training.

That was an era when car wrecks killed more people than wars, making the need for expanding those services seem obvious. When funding began in the 1970s, it laid the groundwork for the current network response structure. At that time, the goal was formally stated as being a speedy response to a crisis, care as needed for those who are affected, and medical support while en route to a hospital emergency room.

Today, the same front lines are manned by two different levels of personnel. Emergency medical technicians (EMTs) are considered to be entry level workers, and comprise the largest group of responders. Training for this position is extensive and comprehensive, and they are often the first to arrive at the scene. Both basic and intermediate level EMT technicians, however, are prevented from taking certain actions.

Paramedics perform similar tasks, but their scope of practice is far less restricted. Although not actually doctors, they have received additional training in cardiology, physiology and anatomy, in addition to the latest field emergency medical procedures used to resuscitate heart attack victims. They are authorized to clear airways, administer intravenous solutions, and inject drugs. Many began as EMTs.

Many of them got their start as an EMT. While the current system is far ahead of the old in terms of capability, technology, and lives saved, the need for an additional level of expertise has been noted since the beginning. Many consider it to be the most logical next step. When additional instruction was first seriously proposed, however, it was shelved, largely due to bureaucratic and hierarchical concerns.

More education and higher certification levels can prevent many emergencies before they happen. Besides answering crisis calls, these upper-level paramedics would also visit patients in their homes, assist in educating people about their conditions, and helping to monitor the diseases that most often need acute care, such as heart failure, diabetes, and asthma. This practice also frees additional workers for actual emergency response.

Additional training would help fill the gaps that currently exist in emergency services, and opens the door for job advancement. Many valuable paramedics have abandoned field care in favor of in-hospital positions because they want to further their medical careers. Making these improvements will not only help patients, but will also help keep the most talented workers where they are crucially needed.




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