In a trauma situation, every second an injury goes untreated is vital, and time can tick away when the victim is in an isolated, rural area. One Wisconsin health care system, however, is aiming to alleviate that problem, by transporting physicians directly to patients, rather than the other way around.
Three-hospital Mercy Health System in Janesville, Wis., recently started sending emergency department doctors out into Rock County to provide care at the scene. The physicians use a special vehicle dubbed an MD1 — equipped with everything needed to tackle trauma, from chest tubes to tourniquets, field amputation equipment and extrication tools.
Such an approach to emergency medicine is rare, experts say, with a scarce number of doctors available to take on such duty, and lack of a clear path to reimbursement. But President and CEO Javon Bea says Mercy has found physicians who are willing to jump into the role. Clinicians and administrators view the program as a way to help patients and take a bite out of Mercy’s charity care costs, which hit $40 million last year.
It’s too early in the program to determine exactly how much of an impact it’s made, says Jay MacNeal, M.D., medical director of Mercy’s Emergency Medical Services Training Center. But as one sign of progress, Mercy added a second MD1 vehicle and hired two physicians to staff it, covering neighboring Walworth County.
Some experts were unsure how widespread the approach would become. Finding volunteers who are willing to serve as emergency medical technicians in rural areas can be challenging, says Gary Wingrove, president of the Paramedic Foundation and chair of the International Roundtable on Community Paramedicine. It’s possible that having ED docs and equipment along in the field could help with recruitment and training. However, he wonders if other hospitals could find the physicians to re-create the program. “This seems like a wonderful, innovative approach to emergency medicine, but I worry if it’s replicable,” Wingrove says.
A lack of a clear funding stream is another challenge, says Jim DeTienne, president of the National Association of State EMS Officials and section superviser of EMS and trauma for the Montana Department of Public Health and Human Services. The concept of “community paramedicine” is becoming much more prevalent, he notes. Community paramedics address less-urgent conditions, working to keep patients out of the hospital before they call 911. Mercy’s approach to emergency care makes sense if it frees up paramedics to perform more of those duties, DeTienne says.