Maine has its share of rural places, and plenty of communities where what you call community paramedics might be of value. It’s about to find out just how valuable they might be.
A bill signed into law in March by Governor Paul LePage gives the formal green light to a dozen community paramedicine pilot projects that will be overseen by the state EMS office. In fact, Maine recently became the first state with a state-level CP coordinator to shepherd such efforts: Kevin McGinnis, chief of Scarborough-based North East Mobile Health Services, the state’s EMS chief from 1986–96, author of the 2004 Rural and Frontier Emergency Medical Services Agenda for the Future and, by the way, the guy who coined the term community paramedicine.
The office and forthcoming programs mark another step forward for the concept, which, in this era of doing more with less, now seems to have arrived in the U.S. in a big way.
“Ten years ago the idea of community paramedicine didn’t even have a name. Now it’s being cited in grant guidance by the Center for Medicare & Medicaid Innovation,” says McGinnis, who spoke on the concept at the NAEMSP show in January. “It’s definitely gained momentum. But the fact is, people have been doing this type of practice—mixing primary care and EMS response—for many years. Once it had a name and people could talk about it as a concept, we started to discover where it was being practiced and look at those practices, and the people doing them started to improve upon them based on the attention.”
Across North America and elsewhere, the idea has taken a few different forms. Community paramedics are often associated with home visits—making housecalls in underserved areas or to underserved populations for things like simple procedures and follow-ups and wellness checks. They may also work in settings like clinics or hospitals alongside or in the absence of higher-level providers. There’s not a single template. The general idea is to leverage EMS resources, including its mobility and 24/7 availability, to address healthcare and public health needs not being met. That requires special education for participating providers and linkages to other healthcare and social services for coordination of care. It’s traditionally associated with rural and frontier areas.
Maine’s projects are likely to take a variety of shapes, as communities’ circumstances dictate. In addition to home visits, its CPs will likely deliver care in places like nursing homes, community centers and rural health facilities.
“Every community’s needs are different,” says McGinnis. “But one commonality is, they all have or need advanced life support EMS. We have places where there is simply no advanced life support in a rural setting that needs advanced life support, and also needs primary care services of some sort or another. So the concept of providing one by providing the other, and having a kind of critical mass that might be fundable, and achieving advanced life support and primary care that didn’t exist as a result, would be really a good thing.”
Another benefit in rural systems (most of the Maine communities interested in doing CP pilot projects are rural) is keeping medics’ underused skills sharp. But many of the ideas also translate to more urban settings, as efforts in places like Pittsburgh and San Francisco have shown. “We haven’t seen that evolve to any great degree in Maine yet,” says McGinnis, “but there are urban areas that have used the principles to great success.”
Whatever their nature, CP programs can reduce strain on healthcare systems by preventing unnecessary transports and ED visits and bringing appropriate care to those who otherwise might not get it. But that doesn’t happen for free. Funding is always a challenge.