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.


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