Paramedics In Healthcare

A visit to the emergency department (ED) is usually associated with negative thoughts by most people. It creates preconceived images of overcrowded waiting rooms and routine long waits for treatment (Jarousse, 2011). From 1996 to 2006, ED visits increased annually from 90.3 million to 119.2 million (32% increase). During this same time period, the number of EDs has declined by 186 facilities creating the age old lower supply and greater demand concept (Crane & Noon, 2011). There are many contributing factors that have led to an increase in ED visits. A few of these key drivers include lack of primary care access, rising of the uninsured population, dwindling mental health services, and the growing elderly

One of the contributors to the rising cost of Healthcare can be attributed to the over use of emergency departments (EDs) for non-emergency needs. In the greater Capitol/First/Beacon Hill area there are three major hospitals (Virginia Mason, Harborview, and Swedish) with emergency rooms and no urgent care centers with the exception of Group Health which is restricted to Group Health insurance members.

I am currently employed in the Veteran’s Affairs Loma Linda HCS in the Emergency Department. Our target population are adults, mainly male, with multiple on-going health conditions. In our ED, we see a huge volume of veterans who have chronic illnesses and conditions. I noticed that many re-peat ED visits that could have been easily avoided and prevented. Some are legitimate emergencies and urgencies, but unfortunately the great majority are the result of non-compliance, lack of adequate knowledge in managing illness and failure to partner with their care provider to promote better overall health.

They have improved access to health care for populations in rural, inner city and other medically underserviced areas. With their training modified as needed to integrate with local health systems, PAs are considered a viable adjunct to physicians in areas with shortages of

I am currently employed in the Veteran’s Affairs Loma Linda HCS in the Emergency Department. Our target population are adults, mainly male, with multiple on-going health conditions. In our ED, we see a huge volume of veterans who have chronic illnesses and conditions. I noticed that many re-peat ED visits that could have been easily avoided and prevented. Some are legitimate emergencies and urgencies, but unfortunately the great majority are the result of non-compliance, lack of adequate knowledge in managing illness and failure to partner with their care provider to promote better overall health.

The study population for this research is patients for EMS hospitals for observation that provide different shift patterns. This group will mainly include emergency room physicians, and emergency patients. Any doctor who is a medical director for an EMS service will be excluded from the survey to disregard any potential bias(Bowen, 2009).

One of the primary goals of the Affordable Care Act (ACA) was to provide affordable health care coverage and increase access to affordable health care to the community. Unfortunately, since the passage of the ACA, while there has been an increase in the number of people with health care coverage, those same people do not necessarily have access to affordable health care. Currently, the public views the Emergency Department (ED) as a safety net by the community it serves; as demonstrated by the increasing number of people who continue to seek treatment in the ED for non-urgent problems. Utilization of the ED for non-urgent care contributes to the rising costs of healthcare as treatment in this setting can be upwards of three times the cost

There were three types of home-based care encounters: one with a VA registered nurse (RN), one with a contract RN, and one with a VA nurse or doctor at an SCI clinic via the LifeView machine. Nurse wages in the VA are not unusually high, but the costs for VA nurses were more than five times those for contract nurses (Table 3). We conclude that the difference stems from overhead costs in the SCI service of VA medical centers. Finally, we assumed that using a digital camera would not lengthen the time it takes to examine a patient for PUs, and thus did not account separately for the cost of using a digital camera.

“A considerable amount of a GPs time is taken up by home visits and much of that time is non-clinical, spent travelling from house to house,” Dr Spencer observes, “but, for paramedics that's their bread and butter.” At his own practice in Fleetwood Lancashire, they benefit from a paramedic practitioner who carries out the majority of home visits, something he notes frees up a phenomenal amount of GP time, reduces the stress a GP might be under and can provide a much quicker response to patients’ needs.

Thus, emergency physicians cannot rely on earned trust or on prior knowledge of the patient's condition, values, or wishes regarding medical treatment. The patient's willingness to seek emergency care and to trust the physician is based on institutional and professional assurances rather than on an established personal relationship. Fourth, emergency physicians practice in an institutional setting, the hospital emergency department, and in close working relationships with other physicians, nurses, emergency medical technicians, and other health care professionals. Thus, emergency physicians must understand and respect institutional regulations and inter-professional norms of conduct. Fifth, in the United States, emergency physicians have been given a unique social role and responsibility to act as health care providers of last resort for many patients who have no other feasible access to care. Sixth, emergency physicians have a societal duty to render emergency aid outside their normal health care setting when such intervention may save life or limb. Finally, by virtue of their broad expertise and training, emergency physicians are expected to be a resource for the community in pre-hospital care, disaster management, toxicology, cardiopulmonary resuscitation, public health, injury control, and related areas. All of these special circumstances shape the

The medical home concept is not new, as it is built on health care practice innovations that have arisen over the past 40 years (Kilo & Wasson, 2010). From these principles, a multitude of medical home projects and demonstrations across the United States have grown (PCPCC, 2011). Given the unique characteristics of each of the numerous projects promoting the PCMH model, it is difficult to obtain generalizable evidence of the effectiveness of the model (van Hasselt, et. al., 2015). However, the most fundamental aspect of the medical home model—the primary care provider – can be the source of the effective functioning of the model, and its direct benefit to the Medicare-eligible population. The role of primary care within a health care system has been tied to health services’ costs, with some evidence supporting the idea that health care delivery systems that place an emphasis on primary care have lower overall health costs (Starfield & Shi, 2004). Although the medical home model is not just about primary care, it places a priority on this type of care as a critical aspect of patient care. As a result, evidence of the success of primary care can carry through to the PCMH model.

According to Community Paramedic Taskforce Results 7/1/15-12/31/15 (2016), the average patient age was 71 years old, and 61% of these patients were female (n=247). This data is consistent with Rittner and Kirk’s study (1995) relating to age and gender distribution. In 2015 there were more people in this age group than in 1995, which increases reliance on EMS for services that do not always fall into the emergent category, yet do need intervention of some sort. To reduce burdening the EMS system with addressing non-emergent needs MIH/CP programs seek to connect the right patient, with the right care, at the right time. However, some of these patients are limited in mobility and cannot travel to a primary care provider to receive care.

“Hospitals are not only required to care for emergency patients, but they also are required to do so in a timely fashion” (Pozgar, 2010, p. 272). “Hospitals are expected to notify specialty on-call physicians when their particular skills are required in the emergency department. An on-call physician who fails to respond to a request to attend a patient can be liable for injuries suffered by the patient because of his or her failure to respond” (Pozgar, 2010, p. 271). Under the doctrine of Respondeat Superior, hospitals are also liable for the actions of physicians working or on-call in their emergency department.

The emergency room has become the new primary care facility for the millions of uninsured in the United States. Thanks to an “unfunded mandate passed into law in 1986,” hospitals that participate in the Medicare program must “screen and treat anyone with an emergency medical condition” (Stephens & Ledlow, 2010). This unfortunately leads to emergency rooms full of people who may have something as simple as a sinus infection which then makes it really difficult for someone with a real emergency that did not require ambulatory transport to be seen in a timely manner. Another unfortunate result of this is that “over 1,100 emergency departments closed over the past decade” (Stephens & Ledlow, 2010).

My brother John is my primary inspiration of pursuing a career in Healthcare Management. It is my vision to administer a health care system that provides world-class affordable health care so that patients don’t have to travel further away for better care. According to the article “Emergency Department Visits and Proximity to Patients’ Residences” by the Center of