@article{ref1,
title="Advanced practice providers in the field: implementation of the Los Angeles Fire Department advanced provider response unit",
journal="Prehospital emergency care",
year="2019",
author="Sanko, Stephen and Kashani, Saman and Ito, Terrance and Guggenheim, Aaron and Fei, Shangnon and Eckstein, Marc",
volume="ePub",
number="ePub",
pages="ePub-ePub",
abstract="<b>                         <i>Background:</i>                     </b> To address the growing number of low-acuity patients in the 911-EMS system, the Los Angeles Fire Department (LAFD) launched a pilot program placing an Advanced Provider Response Unit (APRU) in the field so that a prehospital nurse practitioner (NP) could offer patients treatment/release on scene, alternative destination transport, and linkage with social services. <b>                         <i>Objective:</i>                     </b> To describe the initial 18-month experience implementing this new APRU. <b>                         <i>Methods:</i>                     </b> This is a retrospective, descriptive review of all APRU-attended patients from January 2016 - June 2017. The APRU was an ambulance staffed by an NP and a Firefighter/Paramedic, equipped with basic point-of-care testing capability, and linked to incidents by either being summoned by on-scene first responders or by monitoring EMS radio traffic. Descriptive statistics were used and outcome measures included counts of clients attended, treat/release rates, impact on total time in service for other LAFD resources, patient need for subsequent re-use of 911 and self-reported experience of care. <b>                         <i>Results:</i>                     </b> During its first 18 months in service, the APRU attended 812 patients, including 792 911-patient incidents. 400 of these 911-patients (50.5%) were treated and released on scene or medically cleared and transported to an alternative site for specialty care. This included 76 patients with primary psychiatric complaints who were medically-cleared and transported directly to a mental health urgent care center. An additional 18 high utilizers of 911 were attended by the APRU and connected with a social work organization, and 12 of 18 (66.7%) decreased their use of EMS in the 90-days following APRU evaluation and referral. Of the 400 911-patietns that did not go to the emergency department (ED), 26 (6.5%) re-contacted 911 within 3 days: all were transported to the ED with normal vital signs and without prehospital intervention, and all were ultimately discharged home from the ED. As a result of APRU intervention, 458 other LAFD field resources were quickly placed back in service and made available for the next time-critical call. <b>                         <i>Conclusions:</i>                     </b> Advanced Practice Providers such as nurse practitioners can be incorporated into the prehospital setting to address a growing subset of 911-patients whose needs can be met outside of the ED.<p /> <p>Language: en</p>",
language="en",
issn="1090-3127",
doi="10.1080/10903127.2019.1666199",
url="http://dx.doi.org/10.1080/10903127.2019.1666199"
}