Читать книгу Emergency Medical Services - Группа авторов - Страница 51

There has been growing interest in the United States in expanding the role of paramedics to include the management of non‐urgent and urgent low‐acuity illnesses, monitoring patients with chronic illnesses at home, and performing other functions that do not involve the traditional EMS role of treating and transporting patients to emergency departments. While scientific evidence of the safety and effectiveness of such expanded roles is limited, the success of programs in Canada, England, and Australia has drawn the attention of governments and others interested in innovative models of health care delivery and incorporating non‐physician personnel, who are sometimes viewed as underused, into these models [80]. Legislation passed in Minnesota in 2011 (2011 Minn. Laws, Chap. #12) defines community paramedics and establishes a process for educating and certifying them. In 2012, a law was passed to enable reimbursement for community paramedic services under the medical assistance program and to study the cost and quality of the program (2012 Minn. Laws, Chap. #169). Also in 2012, the Maine legislature passed a law to establish pilot community paramedic projects (Chapter 562, Sec. 1 §84). Community paramedic programs also function in many areas of the United States. The National Association of EMTs has established an EMS 3.0 initiative to further promote the potential capabilities of EMS clinicians in providing appropriate care to support the national health care needs [81].

In further recognition of the potential services that EMS systems can appropriately provide, the Centers for Medicare and Medicaid Innovation Center recently initiated an Emergency Triage, Treatment and Transport (ET3) pilot program. Using nearly 200 pilot sites, the program is designed to investigate, over a 5‐year study period, the appropriateness and financial considerations of several models: treat in place (without transport), treat and referral for follow‐up, and transport to alternative destinations (other than an emergency department) [82].