Mobile Integrated Healthcare Technician, Community Paramedic, or Tactical CNA, whatever moniker you choose, the future of prehospital medicine is upon us.
There was a time when people called 911 for emergencies. True emergencies, life threatening, someone is bleeding to death. Now, we’re an industry mired in calls for sore throats, possible COVID symptoms, and persistent knee pain — due to a severe shortage of primary care providers.
Baby boomers are aging and our 911 teams are being eaten up with chronic health conditions that deteriorate to the point of emergency. ERs are overrun with people who could be treated under urgent care, if it were available, and the collective health care community is at its wit’s end like an NFL lineman who just ran 4 miles straight. The EMS industry needs to embrace a paradigm shift while we can still see the eight ball behind us.
Chronic health problems, such as congestive heart failure, diabetes, coronary heart disease, chronic obstructive pulmonary disease and hypertension, abound.
To make matters worse, Dr. Google is always ready to provide our patients with the latest “expert” advice on homeopathic remedies. Sometimes our patients are better informed thanks to the internet, but often they are unfortunately misinformed. Primary care physicians are overworked and understaffed across the country and don’t have the time to educate patients as they used to. Many patients don’t know what drugs to take, when to take them, or which ones they should have stopped three years ago. You all saw the patient taking digoxin prescribed 4 years ago.
Not the hero the industry wants, but the hero the industry needs
Unlike Batman, the job of an MIH technician or community paramedic may not seem sexy, glamorous, or even remotely desirable to those of us who grew up on adrenaline and bad coffee. However, MIH is the future of medicine. Why take the patient to medical care, when we can bring medical care to the patient? Just as Amazon pioneered the delivery of groceries to your living room, MIH is also bringing patient care to the home. The concept of mobile integrated healthcare is not new, with various programs across the country pioneering the concept to where we are today. The first widely cited community paramedicine program was the Red River Project in New Mexico, circa 1993. Twenty-five years later, we are still working to initiate the vision for this project.
How do we adapt to the changing EMS environment? It’s really simple. We need to move beyond our emergent response, lights and sirens, and Unit 51 mentality. The truth is, we are no longer responding to a large number of life-threatening or life-threatening emergencies. What we cater to are people who need help managing their chronic conditions, understanding their care plan, and staying on top of their health.
MIH is the answer, as we enter a world of connectivity, where we can bring a doctor to the patient’s home via telehealth, and an advanced practice paramedic can implement doctor’s orders on the spot. MIH programs using AIs and PCs can provide on-site laboratory analysis via any number of commercially available devices, and CLIA waivers, in-depth assessments, and real-time data transmission allow for conducting the full experience of home patient care in many cases. There will always be times when patients need to be transported to the emergency room, but much more often we can manage these patients from home.
Think about the possibilities
If EMS is to move beyond our position as the ginger son-in-law of the healthcare industry, we must be part of the overall solution. Far too often, as EMS clinicians, we live in our silo, our blinders firmly in place for the rest of the healthcare continuum.
MIH is our opportunity to partner with other aspects of the healthcare community and develop innovative solutions within our communities – solutions that solve real problems. Funding these programs is not easy at the moment, but reimbursement models have come a long way and there are methodologies for generating revenue streams that will support sustainable models. Although not as hot as Johnny and Roy, MIH is the future of the industry. We can fight change and stay in our silos, or we can embrace a new paradigm in an evolving healthcare landscape and take charge of our destiny as an industry. For the record, I hate the term tactical CNA, mobile integrated healthcare is much more than that.
More than a medicine
How to identify, integrate and manage community paramedics to succeed in their unique role in improving community health