Health Services Committee Meeting

Health Services Committee Meeting Community Paramedic Study 07/31/2013

Tom Nehring, Director, Division of Emergency Medical Services & Trauma was first to testify about the paramedic study. Senator Lee and others took questions.

Rep. Fehr - Still on call while providing services? If they're at a school working, they still have the capability to stop and respond with ambulance services?

Tom Nehring: EMS will take call while working secondary site (such as a school) and respond to the emergency. They would later return back to school.

Sen. Lee - give example of people who are "frequent flyers" who don't necessarily need EMS. What if they sent community paramedic when there was an actual emergency.

Tom Nehring: Urban model, as we move forward with affordable care act ambulance may respond and separate vehicle with community paramedic would also respond to assess situation.

Sen. Anderson: How are you anticipating services will be billed? Tom Nehring: Reimbursement has not been decided yet.

Sen Lee: How long did it take other states to determine scope of practice and licensing, and reimbursement from third parties?

Tom Nehring: Now 17 programs across US, potential for 44 in short period of time. Some states have not increased scope of practice. First state that got going with reimbursement was MN with medicaid reimbursement. Took 2 yrs to determine reimbursement.

Sen. Heckeman: Do paramedics have specific training with those who have autism, other disabilities or even Alzheimer?

Tom Nehring: Do not believe most EMS curriculums have comprehensive programs for autism.

Rep. Holeman: What is training and certification for EMS providers? Tom Nehring: Ambulance services have two designations: basic life support and advanced life support. Basic has to have a national reg EMT and driver trained in CPR. Advanced life support requires a Registered paramedic and EMT. Some communities have people who offer basic life support with advanced capabilities but are licensed as basic life support. Sen. Anderson: If someone calls 911, do community paramedics respond first, assess situation, and call necessary backup (police, ambulance, etc)?

Tom Nehring: Varies in different areas in ND. Emergency side, things will go as they always have. Community paramedic will show up on scene and provide services at location. Nurse Practitioners are essential to this formula.

Health Services Testimony - will scan in testimony. No questions asked.

Sen. Mathern: Mobile crisis team implemented in FM area for mental health. Is DHS making connections between community paramedics and mobile mental health unit, duplicate across the ND?

Tom Nehring: Find common ground but most of these services are higher level mental health provided by specialists such as councilors, social workers, etc.

ND Nurse Practitioners Cheryl Rising, American Association of Nurse Practitioners

Been looking at this program, have lots of discussion about this. Anything we can do to work with paramedics to bring additional health care we highly support. If there's any language being put out that the language is mutual language and specific including nurse practitioners to not be left out. Many nurse practitioners in communities across state. Just completed survey, there are seven plus independent nurse practitioners who have businesses in ND including in Washburn, Watford City, Dickinson, three for psychiatric care (one in Minot). There is a program in Mesa, AZ to add Nurse Practitioner in ambulance services - something ND could consider (add nurse practitioner to their program). Might be a good team to add nurse practitioner. They support this concept but want to add to it. Adding nurse practitioners to 911 team.

Sen. Lee - how does this tie in to programs that have school nurses or without?

Tom Nehring: We see in some of these areas (small communities) that do not have a school nurse, that perhaps they could provide services there (community paramedic). Some may be educational in nature, others might be wellness surveys, ergonomic assessments.

Sen. Lee - I hope that there would be some really good advice for committee, we will be relying on DHS for recommendations for committee to consider. Provide us with guidance see this evolving. May be a gradual thing, may have issues with liability, etc. May expand to other areas. Help us to see what the right approach is. Mathern made motion: Under #1, add behavioral after clinical?

Include information about liability, behavioral. (approved - motion carried).