key: cord-0780698-ig0d0hbi authors: Boehronger, Brad; O'Meara, Peter; Wingrove, Gary; Nudell, Nikiah G. title: An Emergency Amendment to the National Scope of Practice for Paramedics in the Setting of a Global Pandemic date: 2020-04-11 journal: J Rural Health DOI: 10.1111/jrh.12441 sha: 8960ad5968685327d909bbe01d61d84e70746e61 doc_id: 780698 cord_uid: ig0d0hbi nan This article is protected by copyright. All rights reserved. 2 Unprecedented events force us to look at "the way we've always done it" and reconsider how we might better leverage underutilized resources. This could not be truer of our paramedic services as we embark into unchartered territory around the COVID-19 pandemic. Surge prediction models for pandemic response and global experiences to date indicate that tens of thousands of ventilators are needed in the coming weeks and months. While governments and corporations can fund and mass-produce the equipment required, the supply of a professional and competent workforce needed to operate the equipment is of equal concern. Critical care concepts should be applied as part of the continuum of care and not just as a resource offered within the walls of a hospital. Multiple studies have demonstrated that the earlier low-volume ventilation is initiated, the more likely it is to be maintained through to the ICU. [9] [10] [11] Known as ventilator inertia, paramedics could have a real impact on the care and management of critically ill patients by initiating these principles on the first contact. While the complexity of critical care patients requires the resources and knowledge that a highly experienced interdisciplinary critical care team brings to the bedside, experienced paramedics could be better utilized as members of these teams in both the out-of-hospital and hospital settings. In the out-of-hospital setting, from a resource management standpoint, utilizing a ventilator could free up valuable human assets during transports. 12 Transport is one of the most dangerous times in patient care and particularly important to those in rural America that have limited critical care resources. Adverse events have been reported to occur in 68% of in-hospital transports with This article is protected by copyright. All rights reserved. 4 serious adverse events occurring in 4.2% to 8.9% of cases. 13, 14 Reducing the drain on limited rural hospital resources and minimizing the risk of moving intubated patients to tertiary care centers is a significant value of paramedic ventilator management. Ventilator use in the out-of-hospital environment has generally been limited to the realm of interfacility transfers, with many already managed by nationally registered paramedics who may not have had specialized critical care training. 15 In other cases, critical care paramedics and certified flight paramedics with additional training play critical roles in managing the critically ill patients as members of interdisciplinary transport teams. 16 With a robust training and quality assurance program, non-critical-care paramedics could be trained to safely initiate and manage ventilators in the transport and non-transport settings. As such, paramedics would become valuable team members and experienced resources within hospitals 17 during times of extreme need, such as the current global pandemic. The need for specific changes to the paramedic Scope of Practice is urgent as the ability of in-hospital staff to manage vented patients is becoming overwhelmed through exponential growth in demand and an increasingly stressed workforce. 18 Now is time that we must reconsider the restrictions on paramedic scope of practice related to ventilator management. While the standard paramedic is not a replacement for highly trained critical care health professionals (doctors, respiratory therapists, nurses, and paramedics), there is utility in widening practice capacity-both in hospital and out-of ventilator use by paramedics during the current pandemic. Creative and nimble solutions should be embraced to leverage the paramedic profession in these difficult times. Our health care system(s) are bursting at the seams, and paramedics are an untapped resource. National Registry of Emergency Medical Technicians Patchwork of scope-of-practice regulations prevent allied health professionals from fully participating in patient care Comparison of blood gases of ventilated patients during transport Can you deliver accurate tidal volume by manual resuscitator? Oxygen outflow delivered by manually operated selfinflating resuscitation bags in patients breathing spontaneously Peak pressures during manual ventilation Staffing level: a determinant of late-onset ventilatorassociated pneumonia Patient to nurse ratio and risk of ventilator-associated pneumonia in critically ill patients Mechanical Ventilation and ARDS in the ED: A Multicenter, Observational, Prospective, Cross-sectional Study Mechanical ventilation and acute lung injury in emergency department patients with severe sepsis and septic shock: an observational study Prehospital tidal volume influences hospital tidal volume: A cohort study Automatic Transport Ventilator Versus Bag Valve In The EMS Setting: A Prospective, Randomized Trial Unexpected events during the intrahospital transport of critically ill patients Incidence of complications in intrahospital transport of critically ill patients: experience in an Austrian university hospital Critical care transportation by paramedics: a cross-sectional survey The role of Critical Care Paramedics Mechanical ventilator weaning protocols driven by nonphysician healthcare professionals: evidence-based clinical practice guidelines United-States-Resource-Availability-for-COVID-19/United-States-Resource-Availability-for-COVID-19.pdf?lang=en-US This article is protected by copyright. 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