Is Community Paramedicine the Next Step for EMS?

Healthcare continues to be a significant point of discussion in Washington, D.C. and state capitols around the country. Emergency medical services, which for the last decade has been a technologically driven field, has now begun to look at how it fits, or better yet integrates into the existing and changing healthcare landscape. Over the last 10+ years we have seen EMS expand in the area of critical care transport (CCT), industrial healthcare—often in remote or isolated areas—and disaster response. More recently, some EMS systems have begun to look at the feasibility and cost savings of “community paramedics.”

Community Paramedics

When community paramedics (CP) are first mentioned, many citizens say they already have paramedics where they live. So, what is a community paramedic? A CP is a paramedic or an EMT who already operates in their service area and/or community, and who has taken advanced didactic and clinical education in a number of areas enabling them to identify the healthcare needs in underserved communities such as the homeless, elderly or those living in rural or remote areas.These areas can include:

• Health and wellness
• Health screening assessments
• Health teaching
• Administering immunizations
• Monitoring of diabetic patients
• Monitoring of post-MI patients
• Advanced mental health issues and referral
• Wound care
• Safety programs.

The CP will work with other healthcare providers as a team to provide health teaching and disease management, and monitoring of the diabetic, congestive heart patient (CHF) or post-myocardial infarction (MI) patient in their home¹. Other areas of involvement would be determined or identified by the needs of the community and healthcare organizations/providers within the community.

A CP program in one county might address significantly different healthcare needs than a program in another county based upon demographics, social-economic issues or distance to medical facilities. For example, the CP might staff a fast-response unit (FRU) working with a physician in a clinic, but be available to respond with basic life support units in a rural county to bring advanced life support to areas that otherwise could not support ALS in their community. In a suburban area, the CP might be trained in advanced procedures and respond on only critical calls while performing their regular CP duties between those calls. For example, the CP might respond in a FRU to a cardiac arrest and two weeks later when the patient is discharged perform an in-home follow-up.

The options and potential use of CPs are limited only by the creativity of the EMS provider, healthcare organizations and other healthcare providers in a community. The biggest misconception is that CPs are designed to replace other healthcare providers in a community. They are not! The role of the CP is to supplement and/or enhance the current organizations and providers in a community, in cases such as when a severe influenza outbreak sickens a significant number of home healthcare providers in a rural community; following a natural disaster when health screenings, immunizations, etc. are needed; and when a rural county is exploring the feasibility of providing ALS to an aging population in their community.

Existing Programs

The CP program is based off of similar existing and highly successful programs in both the U.S. and around the world. In the U.S., Alaska has utilized community health aides (CHA)² since the 1950s in response to a number of healthcare concerns, including the tuberculosis epidemic, rural trauma and high infant death rates. Nova Scotia’s CP program centered on remote (small population) and isolated islands requiring 50 minutes of travel to the mainland via two ferries. The focus has been on diabetic patient management and in-home wound care. The program has resulted in a 23% decrease in emergency department visits by those living on the island³ with a substantial cost savings to both patient and provider. Australia’s Rural and Remote Paramedic (RRP) program looks at the RRP as an integral part of their rural and remote primary healthcare program which consists of physicians, nurses and indigenous health workers⁴.