title: Insights into the implementation and operation of a novel paramedic long-term care program.
abstract: OBJECTIVE
  An extended-care paramedic (ECP) program was implemented to provide emergency assessment and care on site to long-term care (LTC) residents suffering acute illness or injury. A single paramedic works collaboratively with physicians, LTC staff, patient, and family to develop care plans to address acute situations, often avoiding the need to transport the resident to hospital. We sought to identify insights gained and lessons learned during implementation and operation of this novel program.
  
  
  METHODS
  The perceptions and experiences of various stakeholders were explored in focus groups, using a semi-structured interview guide. Two investigators independently conducted thematic analysis and identified emerging themes and related codes. Congruence and differences were discussed to achieve consensus.
  
  
  RESULTS
  Twenty-one participants took part in four homogeneous focus groups: paramedics and dispatchers, ECPs, ECP oversight physicians, and decision-makers. The key themes identified were (1) program implementation, (2) ECP process of care, (3) communications, and (4) end-of-life care.
  
  
  CONCLUSIONS
  The ECP program has positive implications for the relationship between EMS and LTC, requires additional paramedic training, and can positively affect LTC patient experiences during acute medical events. ECPs have a novel role to play in end-of-life care and find this new role rewarding.
authors.affiliation: From Emergency Health Services, Dalhousie University Division of EMS , Halifax, Nova Scotia , Canada .
authors.forename: Jan L
authors.initials: JL
authors.lastname: Jensen
authors.forename: Andrew H
authors.initials: AH
authors.lastname: Travers
authors.forename: Emily G
authors.initials: EG
authors.lastname: Marshall
authors.forename: Ed
authors.initials: E
authors.lastname: Cain
authors.forename: Stephen
authors.initials: S
authors.lastname: Leadlay
authors.forename: Alix J E
authors.initials: AJ
authors.lastname: Carter
mesh_terms: D000488:Allied Health Personnel; D003142:Communication; D003657:Decision Making; D004632:Emergency Medical Services / Q000458:organization & administration*; D017144:Focus Groups; D006801:Humans; D007407:Interviews as Topic; D008134:Long-Term Care / Q000458:organization & administration*; D010348:Patient Care Team / Q000458:organization & administration*; D015397:Program Evaluation