Telehealth in Home-Based Primary Care May Expand Career Paths for Emergency Medical Technicians

Authors

DOI:

https://doi.org/10.30953/tmt.v7.283

Keywords:

emergency medical technicians, EMT career, EMS role expansion, home based primary care, older adults, telehealth, HBPC

Abstract

Objective: A growing body of literature supports emergency medical services (EMS) personnel acting in expanded roles to address acute conditions in the prehospital setting. While paramedic-based programs have shown great promise, emergency medical technicians (EMTs), who make up a larger percentage of the total number of nationally certified EMS personnel, are far less utilized. In this paper, a telehealth care delivery model utilizing emergency medical technicians (EMTs) as a primary care provider (PCP) extender is used as a case study to investigate EMT perceptions of this expanded role as an additional career avenue by assessing the participating EMTs’ feedback on current EMT career outlook and their experience with the MTT program.

Design: Two semi-structured focus groups were conducted. A deductive thematic analysis approach was used to analyze the focus group transcripts.

Setting: A home-based primary care program and Emergency Medicine Service agency in New York.

Participants: Four EMTs.

Intervention: The model, called Mobile Telemedicine Technician (MTT), used EMTs with additional training as telehealth facilitators who examined patients in the home and connected them with their remotely located PCPs.

Main Outcome Measure: Qualitative data from focus groups.

Results: The EMTs’ sentiments from the focus groups were majority positive in regards to program structure, EMT responsibilities as physician extenders, and having an expanded role in HBPC. Three themes emerged from the focus groups: 1) Perceptions of the MTT model, 2) EMT Career Mobility, and 3) Considerations for Future iterations and Similar Programs.

Conclusions: This analysis of the EMTs perceptions of the Mobile Telemedicine Technician (MTT) program demonstrates its potentiality as an additional EMS career path. This model provided a less physically and emotionally demanding option that encouraged building clinical expertise and relationships with patients. The results also elucidate the desire for expanding models of this kind and opportunities to learn new concepts like palliative care medicine. Models such as the MTT program could increase HBPC workforce and help retain a wealth of knowledge. However, continued and permanent regulatory changes will be necessary for long-term sustainability of this and other innovative EMT-based models.

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References

Hagland M. IOM report: ‘the path to continuously learning healthcare in America’. Healthc Inform 2012; 29(9): 30–3. PMID: 23193684

Figueroa JF, Maddox KE, Beaulieu N, Wild RC, Jha AK. Concentration of potentially preventable spending among high-cost Medicare subpopulations. Ann Intern Med 2017; 167(10): 706–13. https://doi.org/10.7326/m17-0767

Beck E, Beeson J, Bourn S, Goodloe J, Moy HP, Meyers B, et al. Mobile integrated healthcare practice: a healthcare delivery strategy to improve access, outcomes, and value. 2012. Available from: http://www.ramseyfoundation.org/wp-content/uploads/2014/02/Modern-Healthcare-supplement-MIHP-2013-3.pdf [cited 24 July 2020].

Alpert A, Morganti KG, Margolis GS, Wasserman J, Kellermann AL. Giving EMS flexibility in transporting low-acuity patients could generate substantial Medicare savings. Health Affairs 2013; 32(12): 2142–8. https://doi.org/10.1377/hlthaff.2013.0741

Millin MG, Brown LH, Schwartz B. EMS provider determinations of necessity for transport and reimbursement for EMS response, medical care, and transport: combined resource document for the National Association of EMS Physicians position statements. Prehosp Emerg Care 2011; 15(4): 562–9. https://doi.org/10.3109/10903127.2011.598625

Department of Health and Human Services, Office of Inspector General. Medicare payments for ambulance transports. 2006. Available from: https://oig.hhs.gov/oei/reports/oei-05-02-00590.pdf [cited 24 July 24 2020].

The IHI Triple Aim Initiative. Institute for healthcare improvement, Available from: http://www.ihi.org/Engage/Initiatives/TripleAim/Pages/default.aspx [cited 8 September 2020].

Carter AJE, Arab M, Harrison M, Goldstein J, Stewart B, Lecours M, et al. Paramedics providing palliative care at home: a mixed-methods exploration of patient and family satisfaction and paramedic comfort and confidence. CJEM. 2019; 21(4): 513–22. https://doi.org/10.1017/cem.2018.497. PMID: 30739628.

Snooks HA, Anthony R, Chatters R, Dale J, Fothergill RT, Gaze S, et al. Paramedic assessment of older adults after falls, including community care referral pathway: cluster randomized trial. Ann Emerg Med 2017; 70(4): 495–505.e28. https://doi.org/10.1016/j.annemergmed.2017.01.006. PMID: 28302422.

Bigham BL, Kennedy SM, Drennan I, Morrison LJ. Expanding paramedic scope of practice in the community: a systematic review of the literature. Prehosp Emerg Care. 2013; 17(3): 361–72. https://doi.org/10.3109/10903127.2013.792890. PMID: 23734989.

The National Registry Data Dashboard. The National Registry of Emergency Medical Technicians. Available from: https://www.nremt.org/rwd/public/data/maps [cited 24 July 2020].

Avesta System, American Ambulance Association. AAA/Avesta 2019 Ambulance Industry Employee Turnover Study. 2019. Available from: https://ambulance.org/wp-content/uploads/2019/07/AAA-Avesta-2019-EMS-Employee-Turnover-Study-Final.pdf [cited 24 July 2020].

Abrashkin KA, McBride AC, Slaboda, JC, Kurliand, M, Abel-Bey A, Turkistani A, et al. Emergency medical technician-facilitated telehealth visits: a ew model to expand home-based primary care for homebound seniors. Telehealth Med Today 2020; 5(3). https://doi.org/10.30953/tmt.v5.180

Abrashkin KA, Washko J, Zhang J, Poku A, Kim H, Smith KL. Providing acute care at home: community paramedics enhance an advanced illness management program-preliminary data. J Am Geriatr Soc 2016; 64(12): 2572–6. https://doi.org/10.1111/jgs.14484. PMID: 27575363.

Abrashkin KA, Poku A, Ramjit A, Washko J, Zhang J, Guttenberg M, et al. Community paramedics treat high acuity conditions in the home: a prospective observational study. BMJ Support Palliat Care 2019. https://doi.org/10.1136/bmjspcare-2018-001746. PMID: 30948443.

Abrashkin KA, Washko JD, Li T, Berkowitz J, Poku A, Zhang J, et al. Video or telephone? A natural experiment on the added value of video communication in community paramedic responses. Ann Emerg Med 2021; 77(1): 103–9. https://doi.org/10.1016/j.annemergmed.2020.04.026. PMID: 32534834.

Langabeer JR 2nd, Gonzalez M, Alqusairi D, et al. Telehealth-enabled emergency medical services program reduces ambulance transport to urban emergency departments. West J Emerg Med. 2016; 17(6): 713–20. https://doi.org/10.5811/westjem.2016.8.30660.

Kim Y, Groombridge C, Romero L, Clare S, Fitzgerald MC. Decision support capabilities of telemedicine in emergency prehospital care: systematic review. J Med Internet Res. 2020; 22(12): e18959. https://doi.org/10.2196/18959

Amadi-Obi A, Gilligan P, Owens N, O’Donnell C. Telemedicine in pre-hospital care: a review of telemedicine applications in the pre-hospital environment. Int J Emerg Med 2014; 7: 29. https://doi.org/10.1186/s12245-014-0029-0

Medicare Benefit Policy Manual. Available from: https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/bp102c10.pdf [cited 30 October 2021].

Emergency Triage, Treat, and Transport (ET3) Model. Available from: https://innovation.cms.gov/innovation-models/et3 [cited 30 October 2021].

Published

2022-01-31

How to Cite

Abrashkin, K., McBride, A. C., Latus-Olaifa, O., Washko, J., Berkowitz, J., Slaboda, J., Ball, T., & Abel-Bey, A. (2022). Telehealth in Home-Based Primary Care May Expand Career Paths for Emergency Medical Technicians. Telehealth and Medicine Today, 7(1). https://doi.org/10.30953/tmt.v7.283

Issue

Section

Use Cases, Pilots

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