202791 Utilizing paramedics to provide in-hospital, critical care surge capacity

Wednesday, November 11, 2009: 8:45 AM

Michael J. Reilly, DrPH, MPH, NREMT-P , Center for Disaster Medicine, New York Medical College, Valhalla, NY
David S. Markenson, MD , Center for Disaster Medicine, New York Medical College, School of Public Health, Valhalla, NY
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.

Learning Objectives:
Discuss the significance of the nursing shortage in the United States when combined with the anticipated reduction in health care workforce immediately during and following a major disaster or public health emergency. Identify potential solutions to increase the surge capacity of critical care nurses during a disaster, pandemic, or public health emergency. Describe the clinical scope of practice of a paramedic or critical care paramedic, and the potential in-hospital role these providers may have in extending critical care nursing capacity during a disaster, pandemic or public health emergency.

Keywords: Emergency, EMS/Trauma

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have supervised this research as senior faculty and physician expert on this project.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.