Like most states, including the State of Maine, the Medical Director uses state statutes to implement protocols that we all follow. Of course, many internal and external stake-holders are involved with the governance process including the State Board as well as practicing providers. Many states are now adopting the National EMS Scope of Practice which states Emergency Medical Services (EMS) of the future will be community based health management that is fully integrated with the overall health care system. The future model will have the ability to identify and modify illness and injury risks, provide acute illness and injury care and follow-up, and contribute to treatment of chronic conditions and community health monitoring. This new entity will be developed from redistribution of existing health care resources and it will be integrated with other health care providers and public health and safety agencies. It will improve community health and result in a more appropriate use of acute health care resources. EMS will remain the public’s emergency medical safety net. If you read between the lines of the full document, community paramedicine will play a very important and vital role in the future of health care.

With that being said, providers currently use and follow state mandated protocols that guide and govern pre-hospital treatment. Slight variation exists in regards to inter-facility, PIFT, and critical care transfers.

In comparison with our current scope of practice, CP Expanded role will provide a much broader focus on primary health, public health, disease management, prevention and wellness. This will allow paramedics to focus on the “root cause” and focus on the larger issue which is chronic disease. Currently, most Paramedics focus on dealing with acute issues so this will be a major change in how business is done and will modify our current culture. This expanded scope will allow our medics to apply specialized skills, work in non-traditional roles while using existing and new skill sets, and will allow for new protocol development specific to the community’s needs.

Our medical director will be our biggest supporter and is a proponent to the community paramedicine model. The medical director and I both understand the importance of this concept and more importantly I have been afforded the opportunity to help establish a program in Florida. In addition, I would be working closely with our visiting nurses, social services, and local hospitals to ensure proper communication is established which will help reduce redundancy and losing folks in the cracks. The network will ensure the best possible outcomes and service for our patients.

Although our biggest allies can be the visiting nurses, I also feel that that until they become properly educated, they can become a threat to the success of the program. Ensuring that they are educated and that proper communication exists is paramount to the success of the program. Visiting nurses and other allied health professionals have been very vocal against CP programs in other states. The competition for healthcare dollars is always the major reason despite agencies coming forward to state that claim. In addition, there is a sense of ignorance from some visiting nurses as they truly do not understand the education, training, and scope of a paramedic.

Communication and education – these are the two MAJOR areas that need to be focused on to ensure program success. The lack of communication and education will be the major deterrent to the success of any CP program.

As states adopt the National EMS Scope of Practice model, EMS providers, whether they work at an EMT or Paramedic level will play a pivotal role in the success of any CP program especially in the early stages of development and implementation. With that said, a health care system relies upon teamwork. Without teamwork, failure can always occur. With that being said, without teamwork, operation effectiveness and efficiency reduce, patient outcomes are negatively affected, and finances suffer. These providers will be instrumental in assisting in history taking, assessment, and treatment of our patients. As the system evolves, their roles will only increase and they too will have expanded roles within the CP program. In fact, I think the community pamamedicine will change names to something that reflects a total EMS approach to community healthcare.

Integration of any successful Community Paramedic care model into an Accountable Care Organization will requires partnerships with almost every other healthcare entity to include visiting nurses, Maine EMS, Maine CDC, pharmacies, physicians (both PCP and specialty physicians), hospitals, urgent care centers, physical therapists, occupational therapist, fire departments, police departments, social services, and the insurers (Medicare, MaineCare, commercial payers) and the list goes on. Most of these are self-explanatory however all of these will help link patients to the CP program and more importantly to ensure our patients are getting the resources and treatment they need. I will hit on a few of the key personnel that I believe will help ensure long term program sustainability.