ASK THE DOCTOR
New York State, as a whole, does not employ the full concept of Community Paramedicine. There are some rural areas that have developed some practices which are reliant on local regional rules and protocols, there are no statewide standards. The advantage of a Community Paramedicine program would allow EMS crews to offer primary healthcare and preventive services to underserved populations in the community instead of just load and go even when the emergency room is not what is really needed. Under the Community Paramedicine concept, a patient can be assessed, and transport could be arranged to a healthcare facility specific to their needs including urgent care centers, psychiatric facilities, a doctor's office, or even a modicum of treatment at home with possible follow-up care.
Normally when an ambulance responds to a scene, the Paramedics and EMTs treat and transport to the closest hospital even if the patient requests another facility; some patients refuse (RMA) if they find they must go where they don't want to. Unless the local regulations and protocols allow for variances, the only true recourse that a crew has is to contact Medical Control (the person, usually a physician, who can make final decisions about the care provided to the patient by the EMS crew). After being contacted by the crew and given all the available information and assessment, the doctor can decide and provide instruction via radio or telephone — this is referred to as Online or Immediate Medical Control; offline medical control is care and treatment provided based on the local protocols of the specific region. Ideally following Online Medical Control helps to ensure that the treatment and facility (if transported) are specific to the patient's actual needs. Decisions to treat in place or transport to a different type of facility also helps to alleviate overcrowding at a busy hospital emergency room where the patient may not really receive the necessary treatment for their complaint.
When a hospital is on "diversion" it doesn't mean that the hospital is NOT accepting new patients, however it means that it can request ambulance services to bring patients to other facilities, and without permission, the crew must re-direct. However, there are times when the immediate level of care, or even the patient's insistence, seem to necessitate delivery to that specific hospital; calling Medical Control, or the hospital itself (if it is deemed a Medical Control) and explaining the need to bring the patient there may result in the necessary permission. If it is the patient's demand to go to that specific hospital or they will refuse transport, it might be a good idea to explain to that patient that there is liable to be a lengthy wait once in the ER until treatment is received.
Last year New York City initiated a specific behavioral response unit to answer calls in specific (test) neighborhoods made to 911 for mental health emergencies. Prior to this initiative, behavioral emergency patients were not always able to get the compassion and care they needed from a hospital's general ER. The units are trained to respond to suicide attempts, substance misuse, and serious mental illness, as well as physical health problems, and make the decision to transport patients to mental health facilities that offer counseling and treatment to meet their immediate needs. If there are reports of a weapon or immediate physical danger, police officers are dispatched along with the behavioral response units as a safeguard.
Community Paramedicine could allow for this type of mental health response, or other specific needs, elsewhere in New York State. "Community Paramedicine" is an umbrella term describing all the potential innovative and expanded roles that EMS can perform within our healthcare system. This is a concept that is currently being worked on by a small group of NYS agency leaders.