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Bill to bridge rural health care disparities in Nebraska

Bill to bridge rural health care disparities in Nebraska
Courtesy/ Legislature. Sen. Bruce Bostelman.

 

LINCOLN–A bill to change emergency care provider provisions and regulate critical care paramedics and community paramedicine was discussed by the Legislature’s Health and Human Services Committee Feb. 13.

“Nebraska is a geographically rural state and it relies on our paramedics and critical care specialists,” said Sen. Bruce Bostelman of Brainard who introduced the bill.

Implementing Legislative Bill 893 would help reduce health disparities in rural communities in Nebraska where there are shortages of visiting nurses due to the far distances from their offices and also prevent unnecessary visits to the hospital emergency rooms for patients whose needs could be taken care of at home with a community health provider, according to Bostelman.

The critical care paramedics and community paramedics would be educated, certified and trained to assist in a number of health services.

Dr. James Smith, a board-certified emergency medicine physician in North Platte who testified for the bill on Feb. 13, discussed the need for critical care paramedics with the proper education and training to identify patients that may require an expedited visit to their health care provider’s office or referral to a higher level of in-home care.

“How wonderful it would be if someone who actually lives in that community could travel just a few miles or even a few blocks to bridge this gap,” Smith said.

Through these services, patients would be taken to an appropriate health care destination such as urgent care or primary care, instead of the emergency room. With this new regulation, services for people with chronic diseases or post-hospital discharge follow-ups to prevent readmissions would be more accessible.

It would also provide assistance to non-emergency 911 callers by using telemedicine practice to connect patients with at-home health care providers.

“Critical care transportation has developed over the last few decades to involve a larger scope of practice for paramedics but there are still gaps,” Bostelman said.

Research by the Nebraska Department of Health & Human Services shows that paramedics currently deliver medical care using equipment and medications at a level above their education qualifications and for which they are not certified.

The current paramedic education does not include the necessary knowledge and skills to manage patients in need of critical care. This leads to patients being potentially at risk due to a lack of oversight and minimum certification.

This bill recognizes and provides for that needed oversight of critical care paramedic practice and requires completion of a certification application with the Medical Service Board.

To begin community paramedic practice, emergency medical services would be required to obtain approval from the Nebraska Department of Human Services through an application to demonstrate the need for health care in their territory.

Nearby states such as Colorado, Iowa, Kentucky, Montana, Oklahoma and Wisconsin recognize critical care paramedics. Nebraska does not.

“Make no mistake, people are dying in Nebraska due to lack of critical care transport,” Smith said.

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