Firefighter EMT and Community Paramedic Interview With Andrew Young

I see my careers as a firefighter EMT and community paramedic as being pretty similar. A lot of the care that I do on the firefighter EMT side is helping those in need during emergency situations. Many of these emergency situations involve people who are “falling through the cracks,” which is something that I see a lot of on the community paramedic side of things. Therefore, there is a lot of overlap between my two careers. 

 

Many people today do not have the ability to get preventative care, whether that is because of financial reasons or something else. This often results in people having an acute emergency or other issues, and the fire department or ambulance service has to respond and help that person. A. Community paramedics have truly embraced this side of medicine and do a lot of work with preventative care. In all of these career pathways, you truly get to be able to help others and improve their quality of life. 

 

When you go into a situation where there is significant trauma or an emergency that requires you to act quickly, you need to act as an EMT to stop bleeding, do CPR, and assist the patient in a variety of other ways. In other cases when 911 is called, however, you can slow down and provide resources and education to give the best care possible for the person in need. Oftentimes, these emergencies happen when people are not getting proper care to meet their needs, whether that is in their own home or a facility like a nursing home. An example of this is if someone is living in their home and cannot get up after falling down. There is always a reason why this person is on the ground needing assistance, and it is obvious that they are not being cared for in the way they need. In this case, we would go see the person, examine their living situation, call the person’s family or friends to help them, bring them to the Emergency Room (if needed), and help them to prevent future falls. 

 

As a community paramedic, I often see people who are at risk for rehospitalization. This means that they went to the hospital and were told by someone in their care team that they would likely struggle at home and not get the resources they need. Community paramedics get to meet with these patients and act as the link in the chain that helps them get the support they need. They examine reasons why patients are “falling through the cracks” and see how they can prevent emergencies from happening in the future. In general, the phrase to describe why some people are at a greater risk for rehospitalization is called the social drivers of health. These social drivers of health include things like socioeconomic status, where a person lives, resources in one’s community, substance use, mental health, age, and a variety of other factors. 

 

Although the EMS world is beginning to use community paramedics more, I think that this career has always been there. When I have talked to older paramedics and firefighters, I have always heard stories about how old fire departments and ambulance services cared for people in similar ways as community paramedics do now. For example, I have heard stories about how these workers used to help people in need with things like lawn mowing, picking up things from the store, bringing someone home, and a variety of other things that a good community member would do. Unfortunately, these acts of service have become less common because of new rules and regulations for EMS workers. However, there still are some instances where the community EMTs or fire department workers get to do these things. 

 

I truly think that the community paramedic program is amazing and I hope it expands. The reimbursement model in healthcare can sometimes be a challenge, and I think a lot of ambulance services and EMS agencies are only reimbursed if a person is transported to the hospital. It sounds like this might change in the next few years. But in the meantime, at least for the agency I work for, it is thought that if you are reducing readmission of a patient into the hospital for the same emergency or medical issue, then you are providing benefit to the organization. This is because there is less reimbursement that insurance will give if someone goes to the hospital for the same reason within a certain time period. For example, if I went to the hospital for a foot wound, but then after getting discharged I end up in the hospital two weeks later for the same injury, my insurance would not pay for my second stay in the hospital. This is why it is seen as a good thing for community paramedics to provide services that allow patients to not be rehospitalized. The only issue is that community paramedics are only subsidized when someone gets hospitalized. In the future, some are hoping that community paramedics could be funded by insurance to improve the current system of reimbursement.