By Ashley Hannigan
Emergency medical services (EMS) fill the gap between home and hospital health care and are a critical but underappreciated part of the U.S. health care system. Today, EMS is a dynamic field of prehospital care with an ever-expanding scope of practice. As a student pharmacist who is also a certified emergency medical technician (EMT–B), I recognize the unmet need for pharmacist-provided patient care within EMS.
A crucial role can be played
The EMS team is often comprised of a paramedic and an EMT who work together to develop and execute a treatment plan. EMS providers have access to a large medication formulary to treat, on a rudimentary basis, any pathological presentation. However, EMS professionals are not extensively trained in the pharmacology, pharmacotherapeutic benefits, and adverse effects of many of these medications. Because of this, EMS providers are often hindered in their ability to treat patients and may find themselves in situations where they can only use unit dosed and prefilled medications.
More than ever, the EMS teams provide specialty care transports (SCT). During a SCT transfer, critically ill patients need to have medication therapy continued. Administration of medications is performed by the paramedics in the dynamic environment of an ambulance. Proper storage, preparation, dose calculations, and quick administration of medications are critical. Currently, the SCT protocols are developed by physicians, but given the importance of safe medication use during these transports, a pharmacist would be more adept to developing these protocols. Considering the importance of safety, efficacy, and stability of the medications, a pharmacist can play a crucial role in managing the use of medications during SCT transfers.
As reported in a January 2018 Pharmacy Today article, community paramedicine is on the forefront of innovation in the EMS system and has the potential to bridge gaps in patient health care. In this care model, a paramedic would respond to a patient’s house and treat minor conditions such as cuts and scrapes, sprains, and minor respiratory infections such as influenza, strep, and bronchitis. Moreover, the paramedics perform point of contact tests such as influenza, prescribe short treatments of medications such as antibiotics, recommend OTC products, or refer patients to a higher level of care. With the prescribing of antibiotics and other treatments, it is advisable to have a pharmacist involved to ensure that the medication therapy is appropriate and safe. Pharmacists could communicate in real time with a paramedic or respond on scene as well to perform an onsite medication utilization review and check for interactions, allergies, adverse effects, and comorbid conditions.
My experience as an EMT
For the aging population, community paramedicine would enable patients to stay at home longer and obtain the care they need without leaving their house. In my personal experience with EMS, many of our patients could avoid emergency hospitalization with a proper home care plan and medication management. As discussed in a Journal of Emergency Medical Services article, falls are one of the number one causes of hospitalization of senior patients. These falls can be caused by adverse drug reactions or by medical conditions such as a heart attack or stroke, and both scenarios would benefit from well-managed medication therapy by pharmacists.
A familiar scene I have experienced in EMS is arriving on scene to a patient who when asked about medication presents a large bag full of vials. As an EMT, it is our job to record as thoroughly as possible what medications that patient is taking at home, however, it is often difficult to ascertain what medications a patient has been taking regularly and which has simply been stored in the bag since its fill date. Pharmacists could play a role not only on scene, but community medicine could reduce the number of patients with “the bag” by providing frequent medication evaluations for at-risk individuals. Providing this care where the problems start, at home, would provide exponential benefits to patient outcome, reduce emergency department overcrowding, and take a huge burden off the medical system at large.
Pharmacists currently have a small to nonexistent role in EMS and their professional expertise and skills are underutilized in this field. Pharmacists are adequately trained and positioned to carve a niche in the prehospital health care system that would benefit patients and EMS providers alike. In the realm of team-based, patient-centered health care, a pharmacist could interface with members of the EMS team in a currently unprecedented role.