As we explore the possible structures for assigning shifts to block paramedics, it is useful to examine what the “givens” are in this new deployment of health professionals, and what our options might be.
Definition: a “paramedic” can be any of the four levels of paramedic EMR, PCP, ACP or CCP.
The first thing to consider here is that a Canadian paramedic makes about twice the income of an American paramedic ($74,000 vs $37,000 in CDN funds). So we’ll take the approach that if we can make this work financially in Canada, it will be financially feasible in the US as well, and hopefully provide a good living wage in both countries.
Hours of work
Coverage is provided 7 days a week from 7am to midnight, with the following considerations in mind:
- Most commercial towers and businesses will be closed after midnight
- The paramedics must register and contact people within their waking hours, and other agencies working within community health
- Conventional EMS is least busy overnight and streets are not crowded, so it is possible to respond with just lights and no sirens
There are thus two shifts, from 7am-3:30pm and 3:30pm-midnight 7 days a week.
Wage and Supervisory Structure
Here’s where we need to sharpen our pencils. We needn’t be paying three paramedics with full union wages, when we’re actually running a school…and what a valuable educational resource that adds!
In order to complete their education and be certified, paramedics must participate in a practicum, and thereafter treat a regular number of ‘patient contacts’ to maintain their license. The median hourly wage of a paramedic in Canada is cited as $25/hour, but we’re going to offer $20/hour because the EMR is doing a slower-paced practicum (than riding in an ambulance) and is accumulating patient contacts to qualify – so in effect we are indeed training paramedics, and hopefully in big numbers – as paramedicine and its variations are emerging as the likely drivers of telemedicine and remote patient care.
This key mentoring aspect is envisioned in the outlined Hurry Kings model, whereby experienced paramedics act within a teaching Society, offering working venues for senior students in paramedicine schools, where they can ‘earn and learn’ their way through. This approach can be strongly supported via online courses in the initial stages, to provide a defined credentialing pathway for young healthcare industry students, right through to their becoming a licensed health professional.
A 1 Paramedic, 2 EMR Structure
Our next given is that a veteran paramedic supervises this team, and works from 7am-3:30pm, Monday to Friday, so that he/she can take care of outside matters when government and business offices are open. This provides a stable daytime alternative to paramedics as a late career option, where their experience, system knowledge and street wisdom can be passed on.
The supervising paramedic is paid $6000/mo or $72,000 annually, as linked to above. This leaves two FTEs to cover a regular afternoon shift from 3:30pm-midnight Monday to Friday, and weekends from 7am-midnight, a total of nine shifts and 76.5 hours. Each is paid $20/hour and scheduled by the supervising paramedic. This is ideal part time work for graduating students, so two full time equivalents could be staffed by 3-4 students.
So the expected wage costs will be $72,000 for the paramedic and 52 weeks x 76.5 hours x $20/hr = $79,560, for an annual wage total of $151,560.
Working Bases shared with health care workers
Field Stations A small studio apartment would be appropriate within the central block as a home base for the team; a place to keep their paramedic bags, medical supplies, and a closet for uniforms or street clothes, with a washroom and shower etc. They’ll need a desk and computer for delivering secure telemedicine, and a kitchenette for paid breaks and lunches that will have to be taken onsite.
The studio can also be a base for health care aides looking after recent hospital discharges, chronic and monitored patients that require periodic medical care in their homes. For a city with plans for implementing paramedicine and telehealth, this overhead can be shared, and at the same time help bind together EMS and home care workers into a lean team.
This is not to say that this little apartment will become a drop-in or medical treatment site, as that is outside the EMS team’s scope of practice and there is no guarantee that anyone will be there, as they must continually make their rounds and respond to all calls within their block(s) immediately.
As a comfortable retreat for the paramedics, a place to get off their feet, freshen up after a difficult procedure, to grab a bite to eat – where an ambulance driver or crew could drop by while awaiting calls – EMS is a stressful career, and some small comforts are their due.
Being posted there during waking hours around the city might significantly reduce the number of dedicated ambulance stations needed, once these bases are set up across the city.
The cost of the apartment would have to negotiated with the property managers of the central building. Having the paramedics based in their building would be a considerable bonus, whether it saves them having to pay a first aid attendant (large facilities) or because the paramedics do provide some onsite security functions, formal or not, thereby displacing a basic security guard. This is one reason male paramedics would be a preferred choice for this calling – they must largely work alone except for neighboring paramedics in adjacent blocks, and occasionally will face patient-lifting challenges and aggressive behaviour.
A reasonable estimate for the studio apartment, with some supplies, insurance and utilities might be $2,370 per month, which with the above wages adds up to $15,000/mo or $15 for each of 1000+ protected citizens.
Against these costs are improved security, the presence of a technician who can enable telemedicine or remote patient monitoring and offer a triage function that relieves 911 and emergency vehicles of unwarranted traffic. They can be called by EMS instead of vice-versa, and dispatchers will conserve and assign their resources for acute incidents with improved safety and efficiency.
The biggest bargain is for the patient who did not go blind from an overdose incident, or the father who came home from work alive, after successful defibrillation following a sudden cardiac arrest. The child who didn’t choke to death.
If the health authority overseeing these services looks closely, they may discover that the net costs involved in block EMS for heavily populated city areas arise from delaying its implementation – especially if they are ultimately responsible as well for the occupants’ health care bills, as is the case with Canada’s universal healthcare programs. With spiralling boomer health care costs – citizens must ask “If not now, when?”
A later benefit is the value of the cloud databases these practitioners will assemble, whether from registering all the building occupants, with their confessed frailties and bad habits, or the treatment trials initiated in this neatly defined demographic around their specialty – early intervention. This data and its outcomes will be an ongoing scientific gold mine – which might be monetized as externally-funded research.
Regardless of any balance sheet differences, when patient safety can be upgraded to the unprecedented standard that true early intervention alone can provide, then replacing fire crews with onsite paramedics where population density permits rationalizes EMS.
Health authorities can utilize block EMS as a physical template to spearhead the coming telehealth and paramedicine revolution, and give clinics and local health practitioners the integrated security and EMS connector they will need to succeed.
Patient-oriented, data-driven and team based within mobile integrated healthcare – block EMS is the field infrastructure that will anchor community health.