Welcome!Kevin McGinnis, MPS, EMT-P

Community Paramedicine Coordinator

EMS in the FLEX Program:Community Paramedicine and Other

Considerations

EMS Opportunities in FLEX

TRAUMA• Support trauma and EMS systems (state, regional or community) development• Support trauma and EMS system (state, regional, or community)

assessments(s);– Employment of HRSA’s Benchmarks, Indicators, and Scoring (BIS)

approach– Facilitation of BIS processes for EMS at the local and regional level.

• Facilitated Trauma System Development• Support trauma center designation of CAHs• Conduct State strategic planning and systems development to address

weaknesses identified by the BIS assessment; other weaknesses• Support CAH Trauma Team Development• Rural Trauma Team Development (RTTD) courses

EMS Opportunities in FLEX

CLINICAL/OPERATIONAL TRAINING AND LEADERSHIP

• Comprehensive Advanced Life Support (CALS) courses• Support the improvement of EMS Medical Direction• Training courses for Medical Directors• Training in comprehensive EMS agency budget processes• Rural EMS Manager leadership and management training.

EMS Opportunities in FLEX

SERVICE/SYSTEM STAFFING AND OPERATIONS• Support the implementation of mechanisms to support EMS agencies in

efforts of recruitment/retention, reimbursement and restructuring including:• Recruitment & retention initiatives • Implement evidence-based recruitment and retention programs• Reimbursement• Participation of EMS agencies in group buying and billing programs• Restructuring• Development of Systems and Pilot programs to better utilize pre-hospital care

personnel in meeting the health care needs of rural communities in cooperation with State EMS offices.

Real World EMS Context

•Where We Are•Where We Want to Be•How To Get There•Recommendations

Development of Systems and Pilot programs to better utilize pre-hospital care personnel in meeting the health care needs of rural communities in

cooperation with State EMS offices.

Paramedic Paradox

The further one moves from an emergency medical facility

The more one needs a higher level of local EMS capability

And the less likely that that EMS capability will be available

Rural Paramedicine Paradox

• Financially Less Supportable– Fixed Cost of Paid Crew– Availability of Volunteer Paramedics

• Operationally Less Supportable– Skill Retention

Blueprints for the System of EMS

• EMS Systems Act of 1973

EMS Agenda for the Future (1996)The Vision

Emergency medical services (EMS) of the future:• Community-based health management …• Fully integrated with the overall health care system…• Able to identify and modify illness and injury risks..• Able to provide acute illness and injury care and

follow-up, and …• Able to contribute to treatment of chronic

conditions and community health monitoring…

Blueprints for the System of EMS

Blueprints for the System of EMS

Community Paramedicine

Adapting EMS resources to address community health care and public health

need not currently being met and embracing the “paramedicine paradox” as one of those

needs.

Rural/Frontier EMS Agenda for the Future• Community Paramedicine

– An organized system of services, based on local need, which are provided by EMTs and Paramedics integrated into the local or regional health care system, working with and in support of mid-level practitioner, nursing and other community health team colleagues and overseen by emergency and primary care physicians.

Rural/Frontier EMS Agenda for the Future• Community Paramedicine

– This not only provides resources to address gaps in primary care/public health services, but enables the presence of EMS personnel for emergency response in low call-volume areas by providing routine use of their clinical skills and additional financial support from these non-EMS activities.

Evolving Concept…..

• Community Paramedic– A state licensed Paramedic who is certified as

graduating from a recognized college program in community paramedicine and operates within the scope of practice for their licensure level as approved by the state under appropriate medical direction for the nature of their practice.

Community Paramedicine• IS

– A generic concept– A means to fill a temporary or on-going need– Expansion of EMS roles and services to assist community

health team colleagues (compliments primary role & enhances skills)

• IS NOT– An expansion of EMS scope of practice– Just for the Paramedic license level….– The same in every (or any) community– Competing for community health roles, but leverages the 24/7

presence and mobility of EMS resources in the community

CP Models in Practice

• Community Paramedic Model– Licensed Paramedic– 100-200 Hour College-Based Program– Primary Care Medical Oversight

• Extended Role/Services Model– Licensed Providers Within Their Scope – Limited/Selected Services

Statutory Approaches

• No Statutory Changes – Delegated Practice• No Statutory Change/Current Definitions

Work– Maine

• Statutory Changes Needed for Practice and/or Reimbursement– Minnesota– North Dakota

Maine CP Project• Collaboration:

– Maine EMS (DPS)– Maine Office of Rural Health (DHHS)

• Components (Over 3 Years)– Develop Task Force– Develop Detailed Plan and Implementation Models

• Health Gaps/ALS Gaps Assessment• Medical Direction/Quality Improvement Processes• Education Model and Mechanism• Prospective Research Methodology

Maine CP Project• Components (continued)

– Develop Pilot Program and Requirements• Current Paramedic Capacity• Relationship With Primary Care Practice Site• Willingness of Site To

– Provide Medical Oversight/QI– Access Data on Patient Population

– Solicit Pilot Sponsors– Assist Pilots to Establish Services– Evaluate Effectiveness of Pilots/Work With Payers

Maine CP Task Force

• Initial Planning Core:– Jay Bradshaw (State EMS Director)– Dr. Matt Sholl (State EMS Medical Director/MMC)– Dr. Steven Diaz (MGMC)– Dr. Timothy Pieh (Regional Medical Director/MGMC)– Dr. Amy Madden (Family Medicine Physician/HRN)– David Winslow (Maine Hospital Association)– Myra Broadway (Board of Nursing)– Kevin McGinnis

First Statewide CP Meeting• Invitees/Attendees

– EMS– Hospital Systems/Primary Care (ACO/PCMH Sites)– Association/Licensing Organizations:

• Physicians• PAs/NPs• Nursing• Home Health/Extended Care/Hospice

– Public Health– Third Party Payers

Maine CP Program

Kevin McGinnis, MPS, EMT-P 207-512-0975 mcginnis@nasemso.org

http://cpif.communityparamedic.org