Community paramedicine is a relatively new and evolving healthcare model. It allows paramedics and emergency medical technicians (EMTs) to operate in expanded roles by assisting with public health and primary healthcare and preventive services to underserved populations in the community. The goal is to improve access to care and avoid duplicating existing services.
Though there are differences from program to program, a working definition of a community paramedic from the Joint Committee on Rural Emergency Care (JCREC) is:
…a state licensed EMS professional that has completed an appropriate educational program and has demonstrated competence in the provision of health education, monitoring and services beyond the roles of traditional emergency care and transport and in conjunction with medical direction. The specific roles and services are determined by community health needs and in collaboration with public health and medical direction.
There is currently no consensus on the definition for community paramedics, but the following definition proposed by the International Roundtable on Community Paramedicine (IRCP)6 has been widely cited:
“Community paramedicine is a model of care whereby paramedics apply their training and skills in ‘non-traditional’ community-based environments, often outside the usual emergency response and transportation model. The community paramedic practices within an ‘expanded scope’, which includes the application of specialized skills and protocols beyond the base paramedic training. The community paramedic engages in an ‘expanded role’ working in non-traditional roles using existing skills.”
Additional training could include patient assessment, clinical skills, and familiarity with other healthcare providers and social services available in a local community.
Community paramedicine provides a bridge between primary care and emergency care, representing a solution to address the need of those patients with low acuity but lack of access to primary care, elderly patients without mobility, or residents in rural/remote areas. Although out-of-hospital emergency care is central to paramedic practice, paramedics’ unique combination of skills and field experience (for example, assessment and treatment of patients at home) could also apply to a range of healthcare services that can be delivered in the community or the home.3 This allows such programs to be targeted to bridge healthcare gaps, and also to increase overall healthcare system effectiveness and efficiency. The need for healthcare services to come to mobility-challenged patients rather than vice versa suggests there is an opportunity to leverage paramedic expertise as part of “mobile integrated health units” through community paramedicine program.
The National Association of EMT’s now offers a mission statement for Mobile Integrated Health – Community Paramedicine programs.
“Recent changes in the healthcare finance system have created an unprecedented opportunity for EMS to evolve from a transportation service to a fully integrated component of our nation’s healthcare system,” the document states.
“Aligned financial incentives now focus stakeholder awareness on the value of EMS in providing either “patient navigation” throughout the healthcare system, efficiently and effectively directing each patient to the right care, in the right setting at the right time, or providing primary care in medically underserved areas.”
According to this mission statement, an effective MIH-CP program should be:
- Fully integrated – acts as a vital component of the existing healthcare system, with efficient bidirectional sharing of patient health information.
- Goal directed – is predicated on meeting a defined need of a specific patient population in a local community articulated by local stakeholders and supported by formal community health needs assessments (HNAs).
- Patient-centered – incorporates a holistic approach focused on the improvement of patient outcomes.
- Collaborative – works together with existing healthcare systems or resources and fills resource gaps within the local community.
- Consistent with the Triple Aim – improves the patient experience of care, improves the health of populations; and reduces the per capita cost of healthcare.
- Data-driven – leverages data to develop evidence-based performance measures, research and benchmarking opportunities.
- Physician-led – is overseen by engaged physicians and other practitioners, as well as the patient’s primary care network/patient-centered medical home, using telemedicine technology when appropriate and feasible.
- Team-based – integrates multiple providers, both clinical and non-clinical, in meeting the holistic needs of patients who are either enrolled in or referred to MIH-CP programs.
- Educationally appropriate – includes more specialized education of MIH-CP practitioners, with the approval of regulators or local stakeholders.
- Financially sustainable – includes proactive discussion and financial planning with federal payers, health systems, managed care organizations,, legislatures, ACOs, and other stakeholders to establish MIH-CP programs and component services as an element of Triple Aim approach.
- Legally compliant – meets all legal criteria through strong, legislated enablement of MIH-CP component services and programs at the federal, state and local levels
Community paramedicine is a facet of the evolving integrated health care system that proposes to expand the role of paramedics and emergency medical technicians (EMTs) beyond that of traditional emergency care. The uninsured, chronically ill, elderly, homeless, and disabled are often referred to the emergency department because there are no other options available for them to receive care. Community paramedicine can potentially address this gap by offering services such as management for chronic disease, substance abuse, and mental health, as well as support for hospice care, injury prevention outreach, medication reminders, and patient advocacy.
Paul Hudson, FACHE
Chief Operating Officer