Paramedics Could Play Larger Part in Rural Medicine

By Amy Schweitzer, The Independent

June 21, 2010

For the elderly Nebraskan in a rural town having severe pain in the middle of the night, there are few options other than calling an ambulance to take them to the emergency room.

In the future, instead of sending an ambulance, a paramedic may be able to visit the person, make an assessment and possibly save the cost of an ambulance trip.

Health care professionals from across the state gathered in Grand Island Monday to learn about "Community Paramedics," a pilot program in Minnesota that could change the role of rural paramedics.

"One of our big concerns is that our state is aging. With us baby boomers getting older, it's putting a stress on the system," said Dean Cole, program administrator for Emergency Medical Services/Trauma Program with the Nebraska Department of Health and Human Services.

The paramedic program would add to what volunteer paramedics currently are able to do. It prepares them to provide expanded health services in areas short on other health-care practitioners, particularly in rural areas.

In Minnesota, the paramedics chosen for the program spent time in emergency rooms, family practice clinics, pediatrics and a simulation lab. They were taught aspects of health care beyond emergency first aid, such as stitching up a wound, said Mike Wilcox, EMS medical director in Mdewakanton, Minn.

Besides primary care, the first responders would be trained to serve communities in public health, disease management, prevention and wellness, mental health and even dental care.

Cole said he foresees the paramedic as an advocate with local health departments possibly recommending patients for educational visits.

"This person would be the eyes and ears for the community," he said.

He envisions full-time paramedics backing up the volunteer paramedics with 911 calls that aren't true emergencies. 

Cole said that in the past many people had family close by or a neighbor at home during the day who could check on them. But as small towns become bedroom communities, "there's really not those caregivers that there were in the past," he said.

That is why they looked toward the EMS system.

"We already had this resource of caregivers out there that know their community and are a part of their community," Cole said. "They could be handling welfare checks on people, doing blood pressures, diabetic checks, wound care, all that follow-up."

He explained that many 911 calls now are elderly people who were sent home early from the hospital.

"They get home and they aren't feeling well, they panic and they call for transport," he said. "A lot of them are not emergencies."

Cole said the paid paramedic could help relieve the stress of the volunteers by helping with 911 calls. In the meantime, he or she could be doing assessments of these people, help relieve the load on calls that may not be an emergency, but were called in as a 911 call."

One question that several participants kept going back to was how the program could be funded. Currently, the Minnesota program is funded through grants, but Cole admitted it would take an educational effort to convince insurance companies that such a program could pay for itself by saving money in ambulance trips and emergency room visits.

"This is going to be an educational effort," he said. "It must be something that is sustainable."

Cole anticipated that communities would cooperate to provide the service of one to three paramedics serving the rural communities.

He and Wilcox noted that emergency paramedics in rural areas often have a high burnout rate and this could be another career option for them.

"We invest so much money into the training of these paramedics," Cole said. "It could be a great opportunity to keep these people with all these skill sets in the community and in the system instead of losing them."