Utilizing paramedics to provide in-hospital, critical care surge capacity

Introduction: The emergency medical services (EMS) system is one of the key components in disaster, terrorism and public health emergency response. In the United States the Paramedic is the most highly trained prehospital medical provider, and directs patient care as part of the emergency medical services system. These highly trained practitioners of advanced life support and critical care are supervised by emergency physicians and trained to operate independently in austere conditions with little supervision, and to perform highly skilled medical procedures.

Purpose: It has been show in the literature that up to one-third of the hospital work force may not report to work during a disaster or public health emergency. Not all types of disasters may require Paramedics to perform their typical functions, leaving them available to perform additional duties. Large-scale studies have shown that the majority of Paramedics would be willing to perform additional duties during disasters when EMS services are not required. Utilizing these providers in acute-care hospitals can serve as “force multipliers” by allowing limited nurses and physicians to care for a larger numbers of patients with reduced staff.

Conclusion: Models of the utilization of Paramedics in emergency departments, on hospital “Code” teams, and rapid response teams within a hospital will be discussed as well as the medical and legal issues concerning paramedics operating within a hospital. Examples of Paramedics operating within medical clinics during Hurricane Katrina in 2005 will be presented. Proposed expanded scope of practice models along with supplemental educational modules for altered standards of care will be discussed.