Developing a Paramedicine System Model

Nationally we are seeing EMS services struggling from lack of funding, retention issues, recruiting failures, and being the second or third responsibility for some agencies, behind fire response, special operations response, etc.

We as a profession need to begin the process of moving from the current public safety system model to a paramedicine systems model. This paramedicine model must be a component of the healthcare/medicine process and must not be governed through fiefdoms, politicians, or unions. It must be governed by paramedicine professionals.

This paramedicine model would be the aegis for:

• EMS - 911 response
• Mobile integrated healthcare/community paramedics/primary care providers
• Mobile critical care (ground and air)
• Austere/wilderness environment medical care
• Tactical/Close protection medical care
• Wildfire medical care
• Medical special operations teams (marine, bike, etc.)
• Event medical care
• Disaster medical response
• Non-emergency medical transport
• Etc.

For this paramedicine system model to work several major changes need to occur.

As a profession, we will need to:

• Accept and expand the need for paramedicine-specific undergraduate and advanced practice graduate degrees.
• Require the establishment of state Paramedicine Boards to govern paramedicine education, certification/licensure, professional standards/conduct, and assurance of competent paramedical care.
• Require and establish federal recognition and financial support of paramedicine as a component of the healthcare/medicine process with proper representation in HHS, DHS, USPHS, FEMA, DOD, etc.
• Both the federal and state levels require and establish a fee-for-service paramedicine model to replace the current fee-for-transport model.
• Support the concepts of regionalization of paramedicine systems to assure that every citizen and community has comprehensive and competent paramedical care.
• Require and support full-time board-certified paramedicine physicians as medical directors for regional paramedicine systems.
• Support and finance academic, clinical, operational, and human resource paramedicine research.
• Support and finance academic, clinical operational, and human resource paramedicine data collection and effective utilization.

Although these changes are not all-inclusive, they would establish a strong cornerstone to build the paramedicine profession and to help assure that every citizen and every community receives comprehensive and competent healthcare outside of the typical hospital setting.