Building a Community: Part 1

I came to EMS via a rather circuitous route, having worked for years in public health. As a result, I'm always thinking of how public health entities can interact in any situation. When I came to work at Ada County (ID) Paramedics four years ago, it seemed like there had to be some aspect of EMS connected to public health. When I started Googling "EMS and public health," one term kept appearing: community paramedic. Then our agency’s director, Troy Hagen, started talking about community paramedics. Almost three years later, we have four community paramedics in place who will start making house calls by early summer.

This series describes how to build a community paramedic program from the ground up. It is going to be a diary as to how Ada County Paramedics has designed and implemented a community paramedic program. The series will also be a real-time report of how we are rolling out the program.

Phase 1 – The History of Community Paramedicine

The first thing we wanted to know was who has started community paramedic programs and what are their results? The same names came up again and again, including Long and Brier Islands in Nova Scotia, Alaska Community Health Aide Program, MedStar in Texas, the SPHERE Program in Seattle and Wake County in North Carolina. More recently, Western Eagle County in Colorado and the state of Minnesota are deploying community paramedic programs.

We can attribute much about the community paramedic concept to the EMS Agenda for the Future, which was published in 1996. This document made it clear that EMS will be integrated into the overall healthcare system in the future.

After the initial information gathering, the department was able to budget for two full-time positions for 2012. It was decided that these positions would be staffed by four paramedics hired from within the department, working half-time in the new community paramedic position and half-time as a field paramedic. This was done for two reasons: to have four distinct voices sharing ideas in the planning stages, while also maintaining the field skills of those paramedics.

A position description was created, which proved challenging as the CP program and its functional position description were to be created by those hired. Twelve experienced ACP paramedics applied for the positions, a testament to the interest surrounding this new concept in paramedicine. We were starting our journey!

After hiring the four community paramedics, a community stakeholder meeting was held at our headquarters to introduce the program. Invitees were selected from the large pool of contacts within the community who we determined would be most interested in the program and those we would be most likely contacting for assistance in the coming months. Seventy-five people attended the meeting, with guest speakers Chris Montera and Anne Robinson from WECAD and Dan Swayze from E-Med in Pittsburgh. Their advice and support bolstered the confidence of the new community paramedics who were, admittedly, a little overwhelmed with the task ahead of them.

One month later, the community paramedics, EMS Director Troy Hagen and I met for a week-long brain storming session. Ideas, protocols and planning strategies from existing programs were reviewed and discussed. As was oft-repeated that week, we saw no reason to "reinvent the wheel." We recognized and appreciated those who had gone before us, and began cobbling together those pieces we felt might best apply to our community.

During that week, each of the four community paramedics was assigned to contact various stakeholders. We felt it was imperative to maintain a consistent contact person throughout the planning process, presenting an educated and informed face to the program. We continue to maintain these relationships as we begin considering an implementation date. Continually updating stakeholders on the process is important to maintain the interest surrounding the program.

Various lessons we have learned so far: