Paramedics Providing Physicals? Decreasing Healthcare Costs and Improving Care – EMS 2.0

Sitting down at your station one night finishing paperwork, you’re startled from your daydreaming by a knock at the door. You get up, and answer it to find one of the off-duty firemen from the town standing there at the door. He looks like heck warmed-over. He’s pale, sweaty, and his respiratory rate is elevated. He says He’s “Glad it’s you on tonight” and that he feels worse than he looks. He asks if you can “Check him out” since you’re “all medical and stuff”.

Treating this like a walk-in medical call, you help the guy walk into the back of the ambulance and have him sit on the bench seat. Your fire and EMS departments aren’t connected so you’re not really on a first name basis with the guy, but you know him from sight and know him from seeing him around the town on calls and social things and such. He just looks sick, he says that he’s having a bit of trouble breathing and that he feels like he’s freezing one minute and hot the next. He also says that he’s been coughing up “all kinds of stuff” for the last few days.

Putting on your best caring EMS provider face, you begin your assessment. He’s a 26yo Male patient in generally good health and with good appearance other than for right now. His skin is very warm and moist to the touch and he seems to have a fever. His pulse is rapid and bounding at around 120bpm, but that decreases after a few minutes of rest as does his respirations. He states that for the last few days he’s been sick. It started with a sore throat and some sinus gook and now has “gotten into his chest”. You listen to his lungs and hear some diminished sounds in the bases bilaterally with diffuse rhonchi throughout.  His abdomen is soft and non-tender but says that he’s had some mild bouts of diarrhea. He complains of exertional dyspnea and his BP is way high at 184/98. His temperature is 101.4 degrees F taken at the tympanic membrane.

So based upon the assessment, you’re thinking that he’s got a respiratory infection, probably bronchitis. Just because you can, you run a 12-lead EKG which is otherwise normal other than for the sinus tachycardia. His pulse ox is 94% on room air. He says that he doesn’t have insurance and that he can’t afford the emergency room, but that he’s willing to pay for a visit to the urgent care doctor if you think he should go in.

Now, faced with the above, as I have been a few times in my career, you have a few options here. You could do what we’re supposed to do by the book and recommend transport to the ER even though you know the guy’s condition probably isn’t life threatening right now. You could also tell him that you think that he may have a respiratory infection and that while he should see the doctor as soon as he can, that he probably doesn’t need the emergency room.

(Remember, we’re talking about today’s protocols, not the ones I want that I posted in “The Current US Economy and EMS – An In-depth look at how this mess will affect 911 in your community”)

Usually, I choose to tell my buddies that they should consult their regular doctors or go to an urgent care clinic instead of going to the ER. Sure, in cases where I thought they had a life threat or needed immediate care above the level of the local Urgent Care, I’ve transported my friends a few times. However, most of the time I give them my assessment findings written down on a piece of paper, hand them a copy of their EKG if I took one, and send them on their way to the non-ER doctor.

The last time I did this, it hit me: I’m conducting a physical when I do this. Sure, in the above case and in the cases where I’ve done this before it is a complaint-based assessment, but a patient examination is a physical exam. When I write my assessment findings on a sheet to give to the doctor, I’m writing them on a physical examination form. While my assessment isn’t as in depth as that of a physician, it certainly is better than not being examined, and a paramedic has specific training in detecting disease processes that may go undetected by a patient and their families.

(Note: In all of the cases where I did not transport the patient to the hospital, I did obtain a proper refusal form after educating the patient about their condition as best I could. They made the decision, not me.)

If you type “Annual Physical Exam” into Google, you’ll see quite a few articles about the topic, including a study published in the Archives of Internal Medicine and this article published in US News and World Report basically, they say that Preventative Health Exams account for approximately 8.0% of all ambulatory care visits costing approximately $7.8 billion in health care costs. They also say that the cost of providing these services may outweigh the benefits of receiving them. In 2005, a survey of 800 Primary Care Physicians reported that 65% of them recommended an annual physical, that 74% felt that it improved early detection of illness, and that 94% felt that it improved patient-physician relationships, there is currently “No major North-American clinical medical association” that “currently recommends that health adults get a physical each year.”

So there’s a debate being held in healthcare circles. On one hand, patients probably perceive a benefit to the annual physical exam, and certainly the people who have disease processes detected and stopped with early intervention see a very tangible benefit. There are also a majority of physicians that when questioned individually state that they see a benefit to the exam. However, there is also the fact that the costs probably outweigh the benefit of the exam, even though “preventative care” is batted about in the current healthcare debate quite a bit and most organizations and physicians recommend health screenings for specific disease processes that benefit most from early detection.

My opinion is that when the cost outweighs a benefit, there is the choice to either forgo the benefit or find a way to decrease the cost. I am suggesting that we can decrease the cost to the overall healthcare system as well as increase the availability of preventive care by introducing paramedics into the debate. I believe that paramedics could provide a more than adequate annual physical examination in most cases for a large subset of the population. In fact, most of us probably already do without thinking about it. The articles state that 80% of preventive health care is provided within the context of complaint-based ambulatory care visits. I would say that paramedics in ambulances provide this care to the rest of the population. I’d also say that we provide a lot more patient education on chronic health issues to a larger segment of the underserved population than any other healthcare provider. Think about it, how many times have you personally attended to a patient who called you for a complaint such as a “fall” and upon assessment found evidence of an undiagnosed chronic condition? I have, and I like to think that with a thorough assessment on every patient, I can improve their overall health more so than just helping them with their current complaint.

To implement this plan, I would think that functionally, paramedic training already gives us a strong background to provide a detailed physical exam. We would, however, have to undergo more intensive training in examination skills and pathophysiology to be able to detect subtle underlying signs and symptoms of disease processes, mental health and substance abuse issues, and sexual health problems. I would envision that there would be a detailed and formalized set of procedures, tests, and paperwork that would be completed in full that should be pre-agreed upon with the Primary Care Physicians in an ambulance service’s wider sphere of influence. Tests such as a random fingerstick glucose, a monitor strip, and a baseline 12-lead EKG could be obtained as well as a review of the patient’s social and other risk-factors. These findings would then be forwarded to the patient’s personal physician, or could be given to the patient to bring to a physician of their choosing.

This is an easily implemented service that we could be providing our communities with tomorrow with the right planning. The chance to improve the overall health of our patients exists coupled with a chance to decrease overall healthcare costs. It’s also another potential revenue source for ambulance services, which is sorely needed in order to implement EMS 2.0 and improve the EMS profession for tomorrow. Imagine the revenue boost to your service’s and your bottom line if every crew started performing ten physicals a day for $50 a pop. It’s a bargain for the patient, but would be a boon for us.

Paramedics are underutilized for our skill sets and education, this is a way that we can further contribute to the health of our communities while improving our profession overall.

References:

US News and World ReportDo You Actually Need a Physical Exam”http://health.usnews.com/articles/health/2007/09/24/do-you-actually-need-a-physical-exam.html

Archives of Internal Medicine “Preventive Health Examinations and Preventive Gynecological Examinations in the United States” – http://archinte.ama-assn.org/cgi/content/abstract/167/17/1876

  • mr618

    Dammit, CK, with thoughtful, common-sense proposals like that, how on earth do you expect EMS to remain right where it is? Do you realize that what you are suggesting could lead to the following dire consequences:
    a. better healthcare for underserved populations
    b. better return on investment for municipalities and private EMS companies
    c. furthering the transition of paramedics from a trade to a profession
    d. additional improvement in paramedic skills through additional training and experience

    My God, man, wake up and smell the coffee!

    Obviously, I think it's a great idea, one that should (but probably won't) meet with wide acceptance through the governing bodies. Perhaps, with the visibility you've achieved through The Project, you and some of the other leading medical bloggers might be able to give this idea some traction.

  • mr618

    BTW, I didn't mean to imply that The Project was solely your baby (I know that was Happy Medic and Medic999)… I was looking for more of a “collective” you, the medical bloggers that have raised public awareness of what paramedic-level EMS has to offer.

  • mr618

    Dammit, CK, with thoughtful, common-sense proposals like that, how on earth do you expect EMS to remain right where it is? Do you realize that what you are suggesting could lead to the following dire consequences:
    a. better healthcare for underserved populations
    b. better return on investment for municipalities and private EMS companies
    c. furthering the transition of paramedics from a trade to a profession
    d. additional improvement in paramedic skills through additional training and experience

    My God, man, wake up and smell the coffee!

    Obviously, I think it's a great idea, one that should (but probably won't) meet with wide acceptance through the governing bodies. Perhaps, with the visibility you've achieved through The Project, you and some of the other leading medical bloggers might be able to give this idea some traction.

  • mr618

    BTW, I didn't mean to imply that The Project was solely your baby (I know that was Happy Medic and Medic999)… I was looking for more of a “collective” you, the medical bloggers that have raised public awareness of what paramedic-level EMS has to offer.

  • http://www.lifeunderthelights.com Ckemtp

    Aww! I thought I was gonna get full Chronicles of EMS cred.. but it wouldn't be right. I went to San Fran to get my butt kicked by a limey but I wasn't a STAR.

    There's a “collective me”? Wow, yesterday I heard that I was a “premium EMS blog” by someone, and now I'm me… collectively.

    A good day!

  • http://www.lifeunderthelights.com Ckemtp

    Aww! I thought I was gonna get full Chronicles of EMS cred.. but it wouldn't be right. I went to San Fran to get my butt kicked by a limey but I wasn't a STAR.

    There's a “collective me”? Wow, yesterday I heard that I was a “premium EMS blog” by someone, and now I'm me… collectively.

    A good day!

  • mr618

    One question: I notice you mention the patient is an off-duty fire fighter from your town. Should we assume he is a volunteer, or is the town too cheap to provide insurance for town employees?

    And I meant you “premium EMS blogs.” Sheesh.

  • totwtytr

    Chris, you seem to be intent on finding more for paramedics to do. I'm not sure why, when there is a “shortage” of paramedics we need a heavier work load or “expanded scope”. We're also likely intruding into someone else's work space in the process.

    Nor can I say that giving more for the same amount of money of benefit to the profession. In fact, I'd opine that it will have the opposite effect.

  • http://www.lifeunderthelights.com Ckemtp

    That's twice! Twice I've been called a “premium” something. I've gotta get my wife to read this.

    “See, honey?”

    Oh, the town in cheap… but on my posts I use an “anytown” scenario and am not really commenting on anywhere I work now. The setting in my head is an amalgamation of everywhere I've ever worked.

    And yea, the amalgamation is cheap too.

    For this one, it's a volunteer department.

  • http://www.lifeunderthelights.com Ckemtp

    There's a few ways to look at this. If you were to think that I am intent on adding to paramedics' collective workload without changing anything else about the profession, or if you were to think that I wanted to add yet another unfunded mandate, I could see how you would think that way. However, I'm not.

    I've often said that our profession's current funding model, the “fee for transport” model has failed. I believe that the new evolution of EMS is going to need new revenue sources to supplement our operations… and salaries. Adding a service that would improve the overall health of the community while simultaneously adding a new billable service and solving a cost vs. benefit issue in the overall healthcare system seems like a good idea to me.

    Would this be a good fit if we added this to your service right now? Maybe not. It would work at both of mine very well. The added education and responsibilities of this would also add to our professional growth overall and would work towards achieving our future goals.

    Do I want paramedics to do more? Yes. We need to evolve past what we do now and grow to achieve our optimal professional benefit to society.

  • Josh

    Alright, I get that Paramedics want to do more and to expand their profession (and I'm all for it!), but I just think this is the wrong battle to fight. As I wrote on the facebook page about this article, performing medical physicals takes more than just being able to perform a physical exam. You have to be able to manage multiple disease states, their sequellae, give recommendations on diet and medication manipulation…all of which would require more training. Also, are you going to be drawing blood, sending it off to a lab and evaluating their lab values and manipulating their medications? That is also part of a physical.

    Like I said on the other discussion, if this is what you want to do you should have become a PA or NP. To become a paramedic, you need ~2 years of school (I know there are faster routes) and a PA goes through ~3 years of school and they can perform said physicals. They have a greater understanding of the above.

    Also, I just don't see the time in which paramedics are going to do these physicals. The Paramedics I know do not have time between calls to perform physicals (they should take around 45 min each) and if you are going to ask them to come in on their off days, good luck! They are already over tasked by mandatory overtime!

    Lastly, I just don't think this is where you want to expand yourselves as a profession. You are an Emergency Medical Technician, not a family medicine tech. Routine physicals just seems like a poor move. Something like suturing (like they do in the military) or something else would be a better move.

  • http://www.lifeunderthelights.com Ckemtp

    There's a few ways to look at this. If you were to think that I am intent on adding to paramedics' collective workload without changing anything else about the profession, or if you were to think that I wanted to add yet another unfunded mandate, I could see how you would think that way. However, I'm not.

    I've often said that our profession's current funding model, the “fee for transport” model has failed. I believe that the new evolution of EMS is going to need new revenue sources to supplement our operations… and salaries. Adding a service that would improve the overall health of the community while simultaneously adding a new billable service and solving a cost vs. benefit issue in the overall healthcare system seems like a good idea to me.

    Would this be a good fit if we added this to your service right now? Maybe not. It would work at both of mine very well. The added education and responsibilities of this would also add to our professional growth overall and would work towards achieving our future goals.

    Do I want paramedics to do more? Yes. We need to evolve past what we do now and grow to achieve our optimal professional benefit to society.

  • Josh

    Alright, I get that Paramedics want to do more and to expand their profession (and I'm all for it!), but I just think this is the wrong battle to fight. As I wrote on the facebook page about this article, performing medical physicals takes more than just being able to perform a physical exam. You have to be able to manage multiple disease states, their sequellae, give recommendations on diet and medication manipulation…all of which would require more training. Also, are you going to be drawing blood, sending it off to a lab and evaluating their lab values and manipulating their medications? That is also part of a physical.

    Like I said on the other discussion, if this is what you want to do you should have become a PA or NP. To become a paramedic, you need ~2 years of school (I know there are faster routes) and a PA goes through ~3 years of school and they can perform said physicals. They have a greater understanding of the above.

    Also, I just don't see the time in which paramedics are going to do these physicals. The Paramedics I know do not have time between calls to perform physicals (they should take around 45 min each) and if you are going to ask them to come in on their off days, good luck! They are already over tasked by mandatory overtime!

    Lastly, I just don't think this is where you want to expand yourselves as a profession. You are an Emergency Medical Technician, not a family medicine tech. Routine physicals just seems like a poor move. Something like suturing (like they do in the military) or something else would be a better move.

  • http://www.lifeunderthelights.com Ckemtp

    Howdy Josh! Thanks for coming by the site and commenting. I love comments and really think that the whole profession needs the discourse, whether anyone agrees with me or not. (and I didn't know if I made a Facebook fail by posting on there)

    If I can make an overarching statement here, I believe in something called the “Battlefield of Ideas” and think that in the course of discussion, research, and exploration, ideas are the currency on which we will build and rebuild everything. They always have been. Through discourse and debate, the best ideas will rise to the top.

    So when you say that this is the “Wrong battle to fight” I, very respectfully, disagree. I can fight my battles using my idea currency and if they work, they work. I encourage you and everyone else reading this to intellegently fight for what they believe in… and if they find they don't know what they believe in, to explore until they find something.

    In EMS as in everything, “If you always do what you've always done, you'll always get what you've always got”. Perhaps what we are doing in EMS is all wrong? Perhaps this industry that has evolved because of the mentality that we have had isn't the best possible incarnation of what we should be?

    In the first part of your comment you speak of paramedics being ill-equipped, education wise, to manage the complex patient presentations encountered in family medicine. You mention lab draws and their interpretation. You also mention taking action on those results.

    Here's what I think on that. We already do most of those things. I carry around 40 different medications that I have authorizations to use and the breadth of confidence from my medical director to exercise judicious use of. To use them judiciously, I have to consider all of the things that you speak of above. Since I personally take that as a huge responsibility (and it is), I self educate as much as possible to prepare for it. Every possible edition to our repitoire will be bought with education.

    Also, in the above scenario, I never mentioned that the paramedic would be the ultimate clinician charged with interpreting the results and making recommendations to the patient. Sure, for a lot of these cases with generally healthy patients, this probably should be done. However, in complex cases of patients that are very unwell our findings should be forwarded to the patient's Primary Care Physician… just like in everything we do.

    I want to expand the profession through education and research, not through just adding skill sets and cool toys. Sure, I love cool toys as much as the next guy, but I caution people on viewing the EMT and paramedic as simply a skill set.

    I don't view EMS as a skill set. I view us as a remarkably untapped resource whose potential is ripe to be fully explored.

    Hope to see you back, buddy. Stop by anytime.

    ]

  • http://www.lifeunderthelights.com Ckemtp

    Howdy Josh! Thanks for coming by the site and commenting. I love comments and really think that the whole profession needs the discourse, whether anyone agrees with me or not. (and I didn't know if I made a Facebook fail by posting on there)

    If I can make an overarching statement here, I believe in something called the “Battlefield of Ideas” and think that in the course of discussion, research, and exploration, ideas are the currency on which we will build and rebuild everything. They always have been. Through discourse and debate, the best ideas will rise to the top.

    So when you say that this is the “Wrong battle to fight” I, very respectfully, disagree. I can fight my battles using my idea currency and if they work, they work. I encourage you and everyone else reading this to intellegently fight for what they believe in… and if they find they don't know what they believe in, to explore until they find something.

    In EMS as in everything, “If you always do what you've always done, you'll always get what you've always got”. Perhaps what we are doing in EMS is all wrong? Perhaps this industry that has evolved because of the mentality that we have had isn't the best possible incarnation of what we should be?

    In the first part of your comment you speak of paramedics being ill-equipped, education wise, to manage the complex patient presentations encountered in family medicine. You mention lab draws and their interpretation. You also mention taking action on those results.

    Here's what I think on that. We already do most of those things. I carry around 40 different medications that I have authorizations to use and the breadth of confidence from my medical director to exercise judicious use of. To use them judiciously, I have to consider all of the things that you speak of above. Since I personally take that as a huge responsibility (and it is), I self educate as much as possible to prepare for it. Every possible edition to our repitoire will be bought with education.

    Also, in the above scenario, I never mentioned that the paramedic would be the ultimate clinician charged with interpreting the results and making recommendations to the patient. Sure, for a lot of these cases with generally healthy patients, this probably should be done. However, in complex cases of patients that are very unwell our findings should be forwarded to the patient's Primary Care Physician… just like in everything we do.

    I want to expand the profession through education and research, not through just adding skill sets and cool toys. Sure, I love cool toys as much as the next guy, but I caution people on viewing the EMT and paramedic as simply a skill set.

    I don't view EMS as a skill set. I view us as a remarkably untapped resource whose potential is ripe to be fully explored.

    Hope to see you back, buddy. Stop by anytime.

    ]

  • applmedic

    Please tell me we are gonna get a huge raise for expanding our scope to include physicals.

  • applmedic

    Please tell me we are gonna get a huge raise for expanding our scope to include physicals.

  • http://www.lifeunderthelights.com Ckemtp

    Howdy Josh! Thanks for coming by the site and commenting. I love comments and really think that the whole profession needs the discourse, whether anyone agrees with me or not. (and I didn't know if I made a Facebook fail by posting on there)

    If I can make an overarching statement here, I believe in something called the “Battlefield of Ideas” and think that in the course of discussion, research, and exploration, ideas are the currency on which we will build and rebuild everything. They always have been. Through discourse and debate, the best ideas will rise to the top.

    So when you say that this is the “Wrong battle to fight” I, very respectfully, disagree. I can fight my battles using my idea currency and if they work, they work. I encourage you and everyone else reading this to intellegently fight for what they believe in… and if they find they don't know what they believe in, to explore until they find something.

    In EMS as in everything, “If you always do what you've always done, you'll always get what you've always got”. Perhaps what we are doing in EMS is all wrong? Perhaps this industry that has evolved because of the mentality that we have had isn't the best possible incarnation of what we should be?

    In the first part of your comment you speak of paramedics being ill-equipped, education wise, to manage the complex patient presentations encountered in family medicine. You mention lab draws and their interpretation. You also mention taking action on those results.

    Here's what I think on that. We already do most of those things. I carry around 40 different medications that I have authorizations to use and the breadth of confidence from my medical director to exercise judicious use of. To use them judiciously, I have to consider all of the things that you speak of above. Since I personally take that as a huge responsibility (and it is), I self educate as much as possible to prepare for it. Every possible edition to our repitoire will be bought with education.

    Also, in the above scenario, I never mentioned that the paramedic would be the ultimate clinician charged with interpreting the results and making recommendations to the patient. Sure, for a lot of these cases with generally healthy patients, this probably should be done. However, in complex cases of patients that are very unwell our findings should be forwarded to the patient's Primary Care Physician… just like in everything we do.

    I want to expand the profession through education and research, not through just adding skill sets and cool toys. Sure, I love cool toys as much as the next guy, but I caution people on viewing the EMT and paramedic as simply a skill set.

    I don't view EMS as a skill set. I view us as a remarkably untapped resource whose potential is ripe to be fully explored.

    Hope to see you back, buddy. Stop by anytime.

    ]

  • applmedic

    Please tell me we are gonna get a huge raise for expanding our scope to include physicals.

  • http://www.lifeunderthelights.com Ckemtp

    There's a few ways to look at this. If you were to think that I am intent on adding to paramedics' collective workload without changing anything else about the profession, or if you were to think that I wanted to add yet another unfunded mandate, I could see how you would think that way. However, I'm not.

    I've often said that our profession's current funding model, the “fee for transport” model has failed. I believe that the new evolution of EMS is going to need new revenue sources to supplement our operations… and salaries. Adding a service that would improve the overall health of the community while simultaneously adding a new billable service and solving a cost vs. benefit issue in the overall healthcare system seems like a good idea to me.

    Would this be a good fit if we added this to your service right now? Maybe not. It would work at both of mine very well. The added education and responsibilities of this would also add to our professional growth overall and would work towards achieving our future goals.

    Do I want paramedics to do more? Yes. We need to evolve past what we do now and grow to achieve our optimal professional benefit to society.

  • Josh

    Alright, I get that Paramedics want to do more and to expand their profession (and I'm all for it!), but I just think this is the wrong battle to fight. As I wrote on the facebook page about this article, performing medical physicals takes more than just being able to perform a physical exam. You have to be able to manage multiple disease states, their sequellae, give recommendations on diet and medication manipulation…all of which would require more training. Also, are you going to be drawing blood, sending it off to a lab and evaluating their lab values and manipulating their medications? That is also part of a physical.

    Like I said on the other discussion, if this is what you want to do you should have become a PA or NP. To become a paramedic, you need ~2 years of school (I know there are faster routes) and a PA goes through ~3 years of school and they can perform said physicals. They have a greater understanding of the above.

    Also, I just don't see the time in which paramedics are going to do these physicals. The Paramedics I know do not have time between calls to perform physicals (they should take around 45 min each) and if you are going to ask them to come in on their off days, good luck! They are already over tasked by mandatory overtime!

    Lastly, I just don't think this is where you want to expand yourselves as a profession. You are an Emergency Medical Technician, not a family medicine tech. Routine physicals just seems like a poor move. Something like suturing (like they do in the military) or something else would be a better move.

  • http://www.lifeunderthelights.com Ckemtp

    Howdy Josh! Thanks for coming by the site and commenting. I love comments and really think that the whole profession needs the discourse, whether anyone agrees with me or not. (and I didn't know if I made a Facebook fail by posting on there)

    If I can make an overarching statement here, I believe in something called the “Battlefield of Ideas” and think that in the course of discussion, research, and exploration, ideas are the currency on which we will build and rebuild everything. They always have been. Through discourse and debate, the best ideas will rise to the top.

    So when you say that this is the “Wrong battle to fight” I, very respectfully, disagree. I can fight my battles using my idea currency and if they work, they work. I encourage you and everyone else reading this to intellegently fight for what they believe in… and if they find they don't know what they believe in, to explore until they find something.

    In EMS as in everything, “If you always do what you've always done, you'll always get what you've always got”. Perhaps what we are doing in EMS is all wrong? Perhaps this industry that has evolved because of the mentality that we have had isn't the best possible incarnation of what we should be?

    In the first part of your comment you speak of paramedics being ill-equipped, education wise, to manage the complex patient presentations encountered in family medicine. You mention lab draws and their interpretation. You also mention taking action on those results.

    Here's what I think on that. We already do most of those things. I carry around 40 different medications that I have authorizations to use and the breadth of confidence from my medical director to exercise judicious use of. To use them judiciously, I have to consider all of the things that you speak of above. Since I personally take that as a huge responsibility (and it is), I self educate as much as possible to prepare for it. Every possible edition to our repitoire will be bought with education.

    Also, in the above scenario, I never mentioned that the paramedic would be the ultimate clinician charged with interpreting the results and making recommendations to the patient. Sure, for a lot of these cases with generally healthy patients, this probably should be done. However, in complex cases of patients that are very unwell our findings should be forwarded to the patient's Primary Care Physician… just like in everything we do.

    I want to expand the profession through education and research, not through just adding skill sets and cool toys. Sure, I love cool toys as much as the next guy, but I caution people on viewing the EMT and paramedic as simply a skill set.

    I don't view EMS as a skill set. I view us as a remarkably untapped resource whose potential is ripe to be fully explored.

    Hope to see you back, buddy. Stop by anytime.

    ]

  • applmedic

    Please tell me we are gonna get a huge raise for expanding our scope to include physicals.

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Chris Kaiser aka "Ckemtp"

I am a paramedic trying to advance the idea that the Emergency Medical Services can be made into the profession that we all want it, need it, and know it deserves to be.

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