Monthly Archives: January 2009

Advanced Practice Paramedics (APP) to Make a Difference in Wake County North Carolina

Wake County EMS System implements new program to maximize paramedic response in the community.

The Advanced Paramedic Program consists of personnel who have an extensive background in field care and critical calls. In addition the EMS related functions, they have been trained to evaluate patients for referral to special medical and social service agencies. The program will augment existing home health programs to chronic medical areas that lead to emergency department visits when preventive actions or alternative referrals can better triage the patients and reduce last resort emergency department visits.

APP’s have three major objectives:
-High acuity calls: to insure that additional, experienced paramedics are available on the most critical calls. APP’s will also be providing some on-line medical direction and advice for those unique situations we sometimes find ourselves in – including difficult or unusual refusals.

-Follow up on frequent users of the EMS service and patients identified in the community who have certain chronic conditions in order to help patients manage their conditions and potentially prevent a crisis that will result in an ED visit. Initially these will focus on falls prevention, pediatric asthma, CHF and diabetes. We have researched these areas and found evidence that these conditions can be better managed with some education and assistance with management and recognition of warning signs in order to prevent crisis.

-Alternative destinations for the mentally ill and those who have substance abuse problems. These patients are often not served well by the ED since they do not typically have a medical emergency. APP’s have received some specialized training that will allow them to assess these patients a little better and direct them to the appropriate services to meet their needs.

This is the first of a three year program. In the first year, five APP units will be staffed (2 available overnight) to cover high acuity calls and manage home visits.


Wake EMS enters into a new chapter in Emergency Medical Service – Advanced Practice Paramedics

Tuesday, January 6 2009 will go down in EMS history as a new day. Wake County EMS System will initiate one of the first in the country community paramedic models – Advanced Practice Paramedic.

This unique and innovative program will match specially-trained paramedics with the most acute patients, prevent emergencies in certain high-risk patient populations, and ensure that patients receive the treatment they need at facilities other than emergency rooms.

Late last fall the County’s EMS Department began training 17 experienced paramedics for APP. Participants received intense classroom and clinical training to prepare them to operate as single paramedics in cars equipped with EMS equipment.

“Important efforts like the launch of Advanced Practice Paramedics are never done alone,” said Harold Webb, Chair of the Wake County Board of Commissioners.

“Advanced Practice Paramedics is the culmination of a lot of partners working together seamlessly to improve the level of care available to the citizens of Wake County,” said Webb. “In these times its more important than ever to find the most efficient way to deliver service while maintaining the quality and value that our citizens need, expect and deserve.”

The program will ensure that at least one additional, experienced paramedic is assigned to each high-acuity EMS call, which often requires multiple paramedics to perform time-sensitive procedures in a short period of time. In the past, the system sometimes used two ambulances to provide the necessary number of paramedics. APP will allow many of those patients to be treated while allowing the second ambulance to remain in service.

APP’s will also evaluate, educate and provide preventive care for selected patient populations; including senior citizens at high-risk for falls, those with certain diseases or a history of substance abuse. By improving the health and well-being of these patients, many medical emergencies will be prevented.

Advanced Practice Paramedics will also seek alternative destinations for EMS patients that would be better served somewhere other than emergency rooms. In certain situations, APP’s will identify and arrange transportation to substance abuse treatment centers or mental health care facilities. This will free up the ambulance for other calls.

“We have a shortage of paramedics, both nationally and in the state of North Carolina,” says Dr. Brent Myers, Wake County EMS Director. “This program allows us to make more efficient use of the paramedics that we do have, not only by getting the paramedics where we need them the most, but also by investing their time in prevention with the most acute patient populations that we see.

“We spend a lot of time and resources responding to emergencies. With the APP program, we begin to also spend time and resources preventing some of those emergencies.”

The Advanced Practice Paramedics will work staggered shift start times that will provide five APPs on duty across Wake County through the busiest parts of the day, and two APPs on duty overnight.