Community Paramedics

OUTLINE
Community Paramedics
For The Future

By

Nikiah G. Nudell
Glacier County EMS
Cut Bank, Montana
2002

RUNNING HEADER: Community Paramedics

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Question: Are Paramedics capable of providing a role in healthcare as physician extenders

with an expanded scope of practice in hospitals and in the community.
Hypothesis: Paramedics are the most appropriate personnel to provide care as physician
extenders using an expanded scope of practice in hospitals and in the community then
Registered Nurses or Mid-level providers.
Thank you for your interest in this project! I eagerly look forward the results of the paper and await your
valuable input. When I began this project 8 months ago, I did not realize the implications or the extent of
interest I would find in the subject. I created the survey after my hospital employer began asking about
other facilities that employ Paramedics. My employer was unable to get satisfactory answers by informally
calling regional hospitals that employ Paramedics or EMTs. The questions I have included in the survey
are a compilation of those that have surfaced due to my employment in the local small rural hospital.
After many responses by voluntary participants via electronic media including both web page and emailbased questions, I realized the potential implications of the results. It was then that I wrote the question
and hypothesis for this paper. I also understood that as my first research project, I would need the
assistance of those that have previously published research, have some knowledge of the subject matter,
and have an interest in the EMS profession.
It became clear with many responses that those EMS providers in many different facilities, have come
under fire by the nursing profession. A consistent theme can be seen with these responses, and it would
appear that EMS providers, particularly Paramedics, have a natural (apparently so) competition in the
nursing profession. Some responses did not indicate this to be the case, and it is not the case for myself.
In my employment, the Paramedics are very highly respected by both medical and nursing staff and are
very complimentary in nature.
In this time of nursing shortages, low EMS provider incomes, managed care, and reduced funding, we
will all benefit from working together towards a common goal. Perhaps this common goal should be to
provide superior patient care, in an appropriate time frame, with a minimal cost while providing for
adequate training, job satisfaction, professional accreditation, and adequate incomes for all healthcare
providers.
In July of 1999, ACEP contracted a survey that was mailed to Paramedics working in Emergency Rooms
across the US. Beginning in the fall of 2001, I began requesting participation on several EMS email lists
and two popular EMS websites in my survey on Paramedics working inside hospitals. Over the course of 8
months, I have received well over 50 responses from EMTs, Paramedics, and Nurses. With strong
participation, many pertinent questions have been answered. The survey I developed and the ACEP
survey are complimentary in nature.
The questions in my survey address the issues surrounding this subject, such as What is the role of
Paramedics in the ER (i.e. physician extender, nursing aid, ward clerk, etc.)? and What political issues
have been encountered and how were they handled?. The responses have been phenomenal and
appear to represent a wide variety situations and environments in the US. Participants in later versions of
the survey were requested also provide information to the location pertaining to the information. With
daily responses still coming in, I have not yet closed the survey.
Gene Gandy has suggested that the particulars of this paper remained focused on one particular state
and its regulations regarding the nursing practice act and standard of care issues, which in my opinion is
a good point. Perhaps the state of Texas would be the most appropriate state to utilize in for this
purpose, while still allowing for a national perspective.

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There are many issues that need to be addressed for this paper to avoid an incomplete or one-sided
perspective of this potentially contentious issue. Some of these are/may be:
Are nursing skills the same as Paramedic skills for purposes of legislation?
Are Paramedics capable of providing no-transport care to the community?
Are Paramedics the most appropriate technicians to be trained for this?
Are todays nurses really trained to a higher level of care in the acute setting?
Can medical staff accept Paramedics as Para-professionals inside the hospital?
Can Paramedics handle this increased level of expectation?
Can Paramedics work in the hospital within their standard of care without threatening the
nursing profession?
How can these services be justified and billed for?
How much can a physician delegate to a Paramedic?
How much should Paramedics be paid?
How will this impact the current model of Paramedics?
Is the Agenda For The Future feasible?
Is the nursing shortage detrimental to patient care?
Should there be a new level of curriculum for Community Paramedics?
What additional training programs should be developed for national standardization?
What do the NAEMT and other professional organizations need to do for this to happen?
What expanded skills are needed by the community, or in acute care settings?
What should the Standard Of Care be based on?
Who has the authority to allow Paramedics to work in the hospital?
I am considering the use the Utstein Style of reporting to produce the results of my survey, to compare
the scope of practice of nurses, paramedics, medical technicians, and mid-level providers. I am not a
mathematician nor statistician, so if you have a particular expertise in this area or know of someone who
does, any assistance will be greatly appreciated! In addition, the use of the Community Paramedics
term has begun recently and in my research is being used in particular with expanded scope of practice
discussions. In an effort to promote EMS as an independent profession, I am attempting to avoid the
term physician-extender which is also used to describe mid-level providers such as Physician Assistants
and Nurse Practitioners.
I invite you to share with me what you think you might have to offer this particular project and how you
would like to participate. I would also appreciate your opinion on the subject and any negative bias you
may have for this subject. If you have suggestions pertaining to the questions that need to be
answered please share these. In addition, several different mediums have been suggested for the
publication of this paper, I would like your opinion on the most appropriate journal that you feel would
likely publish this work. For grammatical editing assistance I will be using an English curriculum manager
and instructor from Dallas, Texas.
In closing, thank you again for your interest and assistance. I would like to work together with a
teamwork approach, although we will probably primarily utilize this informal electronic medium for most
contacts. In a future communication I will happily provide my contact info and bio for your use.