ET3: Perspectives of a Paramedic and PA


As both a Paramedic and an Emergency Medicine Physician Assistant I commend those who made the announcement of the Emergency Triage, Treat and Transport (ET3) payment model a possibility.  This is by far, one of the biggest steps in the advancement of modern EMS.  This historic payment model could finally bring an end to the “you call, we haul” motto that has plagued EMS since its inception.  One of the most beneficial sections of this new payment model is that it allows current EMS providers the option to transport to hospitals, urgent cares, primary care offices, or, when necessary, to “stay and play”, allowing EMS professionals to provide treatment in place with qualified healthcare providers, via telehealth when necessary.  While I feel this is beneficial to the EMS community as a whole, it begs the question what does this mean for the day to day provider?

As a paramedic, I am thrilled that this may curve the overwhelming amount of calls that do not require trips to the emergency room.  I can recall many trips for simple requests, such as  prescription refills, cast removal, cold and cough symptoms, or suture removal that would be placed in triage and often still be sitting in the same seat when I returned with the next patient.   I often thought to myself that there has to be another way – that trips to the ED were not always the answer, but if only we could take them to their primary care office, or utilize technology to communicate with their provider.  Then there were the many calls I would run that would end without any transport at all.  Often there would be treatment provided on scene, but then would come the refusal of transport.  For paramedics, these are also some of the highest risk refusals, but that’s another topic on good documentation.  I feel that the lack of access to healthcare was the basis of many non-transport calls, people whose only reliable way to see a provider was to call 911.  A perfect example is the underinsured patient with diabetes.  Patients who needed their blood sugar checked, were hypoglycemic, received treatment and when alert again, would sign the refusal of transportation form.  These trips would often end with a call to a medical control provider but would yield no payment to the EMS service.

For years, we have fought to be recognized as a valued part of the medical team, and this new service model has the possibility of being a giant leap for EMS kind.  Not only does this require the implementation of quality metrics for EMS service but provides paramedics a platform to shine.  EMS providers are now able to highlight their mastery of pre-hospital medicine, human pathology, knowledge of medical protocols, and dedication to patient care, no matter where that care may be delivered.  This is our chance to prove to the world that paramedics and EMTs are capable of quality, evidence based prehospital medical care, and not just basic transport.  With increased power comes greater responsibility and thus the responsibility of advanced education now falls onto the shoulders of my EMS family.  Advanced education, in the form of college degrees or specialty certification, is paramount for providers making definitive decisions for patients, and as professional healthcare providers, we should not fear this change.  At this time, paramedics are faced with the ability to be valued members of the medical community, it is time we seize this moment to bear the responsibility, to ourselves, our patients and our communities.

 As a PA, the ability of alternative (more appropriate) destinations brings the obvious benefit of a decompressed ED waiting room.  Many of my patients are there because they have no other avenues to see a provider.  This new payment model is a way to allow for a more efficient and effective pre hospital triage, and subsequently improved treatment of the 911 patient.  Paramedics in the field would now be able to utilize urgent cares and primary care providers to facilitate the most appropriate level of care, while having the ability to be paid for the services they provide.  It also allows for a closer collaboration opportunity between in-hospital providers and pre-hospital providers via additional resource utilization, such as telehealth.

 Overall I think this is a great leap in the right direction for EMS and the future of our profession.

This new reimbursement model creates standardized benchmarks for the EMS providers.  The goal of which is to improve the quality of care, while decrease the overall cost of healthcare.  It is our responsibility as EMS providers to show that we are worthy of this opportunity and seize it with overwhelming care, compassion, and efficient care for our patients.  It is also our responsibility to make assure we have the education, knowledge and the skills to advance the EMS profession and allow ET3 to be the giant leap forward EMS so desperately needs.  This may also allow for new relationships between EMS providers and hospitals in the region to be formed. It is my hope and belief that this announcement will improve the effectiveness and efficiency of prehospital medical care and allow the continued growth of MIH programs nationwide.




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