All in

I am tired of waiting, wanting and hoping. I am tired of trying to figure out what career path to take after my EMS job (nursing, PA, Public Health). I want to be a Paramedic. Why is this not an option for a career? I am going to advocate in my state for a Community Paramedic Program.

I live in the state of Kentucky. We are mostly known for our Appalachian region and the stereotypes that go along with the hills. We are not known for our EMS system, or our healthcare system. Like in many areas of the country Kentucky is mostly rural. Many people are under-insured, uninsured and have no primary health care provider except for the 911 system. The state agency that regulates ambulance providers is understaffed, and the legislation is out dated. I believe that EMS in Kentucky is ten years behind the rest of the country. We are still arguing over allowing EMT-Bs to check blood glucose levels. Kentucky needs to be a leader.

Let’s look at a hypothetical EMS agency in Kentucky. The agency is a public service, special taxing district. They receive funding from personal property taxes and from billing for transports. We will call this service KYEMS. KYEMS has three ambulances staffed with two EMT-Bs, Two Ambulances staffed with EMT-P and EMT-B and two response vehicles staffed with paramedics. They serve a population of 60,000 in 200 square miles. KYEMS averages 5,000 calls a year. They are the sole provider for 911 medical service and they provide inter-facility transports. KYEMS has had the same response tier for the past ten years. The local fire departments provide assistance at the first responder level, with two departments having EMT-Bs. KYEMS is not a bad service, they have good retention and the best pay in the state.

I propose that KYEMS makes a few changes. Let’s staff every ambulance with a paramedic and an EMT-B. Take the two response vehicles and staff them with Community Paramedics (or Advanced Practice Paramedics). I want to create the first service in Kentucky with the Community Paramedic model or something similar. There are only two agencies that provide this service in the country now, Wake County EMS in North Carolina and one in Minnesota . Western Eagle County Ambulance in Colorado has just started a Community Paramedic program, they will be the third that I know of in the US. Even the largest publicly owned ambulance company, American Medical Response, has started an asthma program in Alameda County, CA.

The 1996 National Highway Traffic Safety Administration EMS Agenda for the Future stated

  • Expand the role of EMS in public health
  • Involve EMS in community health monitoring activities
  • Integrate EMS with other health care providers and provider networks
  • Advocate for legislation that potentially results in injury and illness prevention
  • Develop and maintain a prevention-oriented atmosphere within EMS systems
  • Include the principles of prevention and its role in improving community health as part of EMS education core contents

That was fourteen years ago. The time has arrived that we moved EMS into the public health sector and maintain our position in public safety. We are both.

I’m putting all my chips in the game, drinking the kool-aid and looking for an agency in Kentucky that wants to be on the leading edge of EMS. Be the change you want to see. EMS 2.0 must begin with me, you and our colleagues.


About Joel

I am a paramedic, firefighter and I work for an organ procurement organization. All stories related to work have been altered to HIPPA standards and for the protection of those involved. The personal stories are different. Photography, flying, aviation, hiking, camping, travel, geocaching, amateur radio are a few of my hobbies.
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3 Responses to All in

  1. Pingback: EMS Blog Rounds Edition 36

  2. Warm Southern Breeze says:

    I perceive that much of the foot-dragging is part and parcel of the general political miasma that infects much of America today. It’s not visionary. It’s not reactive. It’s not proactive. It’s status quo. However, the greatest and most significant problem with that attitude & behavior is that “status quo” is not genuinely static. Stasis leads to greater problems, and eventual death. Even that is not a status quo. Things in life are in a constant state of flux. We must acknowledge that, and become adaptive. We must also become accustomed to the notion & idea that we must continually grow in all areas, or else we know the results will harm ourselves and our posterity. It’s no longer sufficient to “just say no.” We’re long overdue for some “yes we can.”

  3. Joel says:

    Yes, we need some leaders who are willing to say “yes”. We need more support from health care practitioners. We need a campaign, PR and educational effort to inform everyone. The question is who is willing to step up and lead EMS in to the future?

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