Governor opens door to changes in how emergencies are handled

Thursday, July 25, 2013

Nevada Daily Mail

When Missouri's Gov. Jay Nixon signed House Bill 307 on June 25, he opened the door to potentially sweeping changes in the way emergency medical care is delivered to Missourians.

Several changes are covered in the bill, but Vernon County Ambulance District Director James McKenzie is especially concerned with the section that lays groundwork for a community paramedicine form of emergency services.

McKenzie said community paramedicine is the newest "buzzword" used to describe an emergency health care model designed to increase efficiency, while reducing cost of by eliminating so-called non-essential transports and other inefficient practices.

The model is based on the premise that 15 percent of calls for transport by ambulance are preventable, McKenzie said. The problem lies in determining which calls are part of the 15 percent.

Some say the solution is in the community paramedicine model.

Under that model, specifically trained personnel, coordinating their efforts with hospitals and other agencies, would respond to some emergency calls before an ambulance is dispatched. On the scene, the paramedic would make a diagnosis and recommend an appropriate action whether it meant giving the patient an aspirin, calling for ambulance or referring the patient to an urgent care clinic, a physician's office or specialist.

One problem with that, McKenzie said is that in rural areas such as Vernon County, it may be 25 miles to the scene. A lot can change while a paramedic is en route and while waiting on an ambulance if one is needed.

That wait, McKenzie said, could mean the difference between life and death.

The whole notion makes McKenzie nervous, he said, although he acknowledged being able to see pros and cons to the idea.

It might even work very well in urban areas where several transport options exist.

There are no other options in Vernon County, and McKenzie said this system could open up liability issues that now don't exist. The cost savings could be very significant, but only if the system functions properly.

Under current Missouri law, anyone who requests transport must be transported to a hospital, regardless of his or her condition.

Any paramedic authorized to work under the umbrella of House Bill 307 will be required to attain 600 more hours of training above and beyond what is currently needed for certification. The increased training could create a financial burden for smaller service providers who may have to hire new people to fit the model.

All of that cost will have to be passed on, McKenzie said.

The groundwork laid by bill 307 is not mandatory. McKenzie said he hopes it remains strictly voluntary.

"They're poking their noses in our business." he said, acknowledging he is not sure what direction the bill will take once budget cuts and Obamacare take effect next year. A couple of states are already trying to work some of these types of measures in and McKenzie expects more.

"There are some rogue outfits out there," he said. "It's spreading like a firestorm."

More on House Bill 307 can be found at http://open states.org/mo/bills/2013/HB307/documents/MOD00008508/

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