The Community Paramedic - Essay Example

COMMUNITY PARAMEDICS al Affiliation Community Paramedics A paramedic is a healthcare official working mainly in the pre hospital or out of hospital setting they act as a form of complementary/support to the existent healthcare system. They often act as first responders to emergency scenes and therefore aid in the support of the patients before the can be admitted to a hospital. In Australia, the paramedics have evolved to take up new tasks or assist in the performance of services that were previously provided by home healthcare providers such as family physicians. Jason Busch (2013) noted the roles of SJAWA’s (St. Johns Ambulance of Western Australia) community paramedics are described as follows by The Council of Ambulance Authorities (CAA) report from the year 2009: Providing support in the local community to maximize the number of volunteer ambulance officers Responding to ambulance calls as necessary as a compliment to the volunteer operations Providing an extended scope of practice to assist the community and Department of Health in areas where the provision of such services is not viable through the traditional health model The advantages of this new development are numerous and community focused. First, is that there is better access to healthcare services for isolated patients. Paramedics are often trained to reach remote locations and deal with diverse situations whether acute, emergency or chronic. This need is further exacerbated by the fact that physicians have been unwilling to attend to patients at home level (Money) due to matters of violence, cost and other issues (Magin P) (J). This therefore makes it possible for patients to access better healthcare in these remote areas. They, also provide an alternative to crowding of local health facilities that may be small or inadequately equipped. This is because facilities are known to be less equipped due to the reduced populous of the rural areas. The paramedics though, have adequate training and access to facilities such as life support that can be utilized in certain settings to enhance survival odds of patients before they get access to larger more equipped hospitals. Another advantage of the community paramedics is the reduction of load on the national emergency system 911, as they attend to the repeat cases and cases such as those of prank callers, drug abusers, chronically ill and mentally ill patients. This has a subtle advantage as it allows the 911 service to be more effective as an emergency tool for the truly deserving cases. This, though, is not to imply that the minor cases are less deserving. This also reduces the total budget cost on the state thus diverting the resources to provision of healthcare on other levels. Another advantage of this new venture is the fact that chronically ill patients, elderly patients and patients in need of frequent checkup can be catered for this is a service previously hard to come by, but highly essential for this cohort of patients. With the onset of WHO’s universal coverage and service delivery reforms, community paramedics have become absolved in the aim to improve equity of access and contribute to health equity. This comes as universal coverage to health services through Medicare aims to improve equity of access and contribute to health equity. However, one clear and ongoing trend across all health service sectors, outlined in the National Health Performance Framework, is the discrepancies in health between Indigenous and non-Indigenous populations and those living in rural and remote areas. There are also strong inequities in the health status between low and high socioeconomic groups. For example, Indigenous Australians have a life expectancy 10 to 12 years lower than non-Indigenous Australians, more disability and a lower quality of life. Country people have higher levels of disease risk factors than those living in cities, and disadvantaged Australians are more likely to have shorter lives compared with those who have social and economic advantages. Factors for this include availability and access to services, cultural appropriateness of health services, and affordability (Australia Health Service Delivery Profile, 2012, p.7). There is an initiative taken by the Commonwealth to close any gaps between life expectancy and health outcomes between indigenous and non-indigenous Australians in a generation. The following are targets set apart for action by the Commonwealth and State and Territory Governments through The National Healthcare Agreement. to narrow down the gap in life expectancy within a generation; to halve the hiatus in mortality rates for Indigenous children under five within a decade; to ensure all Indigenous four year olds in remote communities have access to early childhood education within five years; to halve the gap in literacy achievements for Indigenous children within a decade; to halve the gap for Indigenous students in year 12 attainment or equal attainment rates by 2020; and to halve the gap in employment results between Indigenous and non-Indigenous Australians within a period of ten years. If the above targets are met within the assigned period of ten years, then there is hope for the new Community Paramedic initiative and the Australian populace at large. What professional and legislative framework will you need to be aware of as an advanced clinical practitioner? What competency standards will govern your practice? The emergence of this new crop of paramedics has put a new spin on the way the health sector governs and regulates practitioners. First, there is the conflict between medical doctors and paramedics on the matter of patient care. Medical practitioners believe that it is their function to provide expert consultation and care to patients, while the role of paramedics is to be the support staff. This creates conflict between the EMS providers and medics as the EMS providers find themselves having to cater for the need in places where physicians neglect. The legislative framework present for the protection and maintenance of professionalism amongst the two individual practitioner groups include clinical governance systems and occupational registration requirements. Clinical governance systems/standards are a set of guidelines set to ensure that healthcare providers work together efficiently for the common good of the patients. It has been developed by the Australian government for this purpose. The purpose of the systems is to increase organizational awareness of clinical governance and contribute to the development and implementation of clinical governance systems and processes; assist clinicians and health service management to embed clinical governance within their organizational culture; and assist Health Services to demonstrate improved accountability for the delivery of safe, high quality health care services through the implementation of clinical governance systems and processes (Fong) It comprises four key pillars that ensure proper adherence to the standards. The occupation registration ensures that the practitioners that are under the paramedical service are well vetted and without questionable background. This ensures that they provide high quality care without risk of questionable behavior or tendencies such as theft, violence, or murder. The competency standards that will govern the practice will be based on the pillars of clinical governance standards. CONSUMER VALUE This is the first pillar of the governance systems, which pushes for health services to involve their communities and stakeholders in maintaining and bettering the performance of their Health services. It also aids in the planning of the organization’s future. Effective consumer participation needs proper leadership to ensure that the involvement is of value, effective and leads to positive outcome for the health of the populous. The two key features of Consumer Value are Consumer Liaison and Consumer Participation. Consumer liaison basically means providing avenues for two way communication between consumers and HCPs. Some strategies include use of informed consent, complaint management strategies, taking patient satisfaction surveys and providing adequate information about services to the patients, their families and care givers. Consumer participation is a strategy that involves the clients in the health service planning, development of policies and making of decisions (WAu). CLINICAL PERFORMANCE AND EVALUATION This is the second pillar that aims to guarantee the continued introduction, monitoring and evaluation of evidence-based standards. The outcome will foster a culture where vetting of organizational and clinical performance, including audit of clinical practice and files, is common place and expected in every clinical service. The three main tools that will greatly assist in achieving this outcome are the Clinical Standards, Clinical Indicators and Clinical Audit. Clinical standards These standards aim to incorporate clinical guidelines, pathways and local practice manuals. Clinical indicators These are measures or bench-marks that assist health services in comparing themselves to similar health services. To foster health system improvement, they must be meaningful and reflect clinical practice standards. Clinical audits These are methods of evaluating and bettering practice. They can be defined as ‘the systematic measurement and evaluation of the efficiency and effectiveness of organizational systems and processes’. They analyze the outcome of patient clinical care, thus including the procedures used for diagnosis and treatment, the continued use of clinical resources and patient quality of life. CLINICAL RISK This is the third pillar that concentrates on reducing clinical risk and overall improvement of safety. This is achieved by the identification and reduction of potential risks. It also focusses on examination of serious incidents for evaluation of the causative and contributing factors. It also checks for trends within and across the clinical services. To increase learning opportunities, the lessons should be shared at a basic/local, state and nationwide level. Some aspects of clinical risk management include: Incident and serious events documenting, monitor and trend analysis. These aim to incorporate activities such as learning from local incidents. Including near incidences and management of serious events and keeping a risk register. It also does monitoring medico-legal cases. Sentinel event reporting, monitoring and clinical investigation: this defines the process for spotting, reporting and investigation of events in line with the Health policies set by the government. The Risk profile analysis: this includes the identifying, investigating and analysis plus evaluation of risks. Afterward, there is follow up with the most appropriate way of correcting, eliminating or mitigating risk. What are the barriers you have found in the literature and your own experience to the success of the role? What can you suggest will overcome these barriers? Some of the barriers that affect the growth of this field are the education, legal constraints, and conflicts with medical practitioners. The educational constraints come about where the paramedical personnel lack adequate training in the management of diseases and conditions. Some of these are acute scenarios such as those that require surgery or intervention of a specialist. These include severe trauma or most obstetric complications. This can be overcome by educating the paramedical personnel on such procedures. For the legal and medico legal constraints that prevent paramedics from carrying out these tasks, certain laws can be amended to incorporate or allow them to carry out the practices without risk of lawsuits. This is for example assisting of birth in complicated setting. Conflicts between the paramedical officers and the medical personnel may be reduced by ensuring that the paramedical officers are made part of the conventional healthcare system. This will mainly be done by creating a niche for their functions, and/or making sure that the personnel work together. Furthermore, medical practitioners can also be tasked to accompany and assist the paramedical officers in their activities. This way, they can work together to ensure proper patient care and cooperation. References Money, S. (n.d.). No carrot home visits. Retrieved March 8, 2015. Mclntyre D, Ataguba J. How to do (or not to do)… a benefit incidence analysis. Health Policy and Planning 2010;26: 174-82 Magin P, Adams J, Sibbritt D, Joy E, Experiences of occupational violence in Australian urban general practice: A cross - sectional study of GPs. (2005). Medical Journal of Australia, 183(7), 352-356. J, R. (2010). The Patient Journey Through Emergency Care in Nova Scotia: A Prescription for New Medicine. In: Department of Health. Nova Scotia Govt. Fong, N. (n.d.). Retrieved March 9, 2015, from http://www.safetyandquality.health.wa.gov.au/docs/clinical_gov/1.4 Clinical Governance Standards.pdf (n.d.). Retrieved March 9, 2015, from http://www.safetyandquality.health.wa.gov.au/initiatives/clinical_governance_pillars.cfm Read More