Community Paramedicine: Planning to Protect, Acting to Save
By Gary E. Seidel, fire chief, retired
Learn More About our EMS DegreesCommunity paramedicine is a simple concept that provides healthcare services to communities where access to medical facilities and physicians are non-existent. This program was originally founded to meet the needs of those living in rural or frontier areas where their healthcare needs were outnumbered by the limited amount of healthcare options. In 2004, the Rural and Frontier EMS Agenda for the Future defined community paramedicine as “an organized system of services, based on local need, which are provided by EMT’s and paramedics integrated into the local or regional healthcare system and overseen by emergency primary care physicians.” A degree in emergency medical services administration is ideal preparation for someone interested in community paramedicine.
Communities considering starting a community paramedicine program should also consider using the Community Paramedicine Evaluation Tool produced by the United States Department of Health and Human Services (HHS), Health Resources and Services Administration (HRSA) and Office of Rural Health Policy (ORHP). This document provides a self-assessment tool enabling communities to evaluate the current status of their community paramedicine program. It also provides guidance for communities wishing to establish a community paramedicine program. The Community Paramedicine Evaluation Tool utilizes the three core functions and 10 essential services of public health, which are:
Communities considering starting a community paramedicine program should also consider using the Community Paramedicine Evaluation Tool...
- Monitor Health
- Diagnose and Investigate
- Policy Development
- Inform, Educate and Empower
- Mobilize Community Partnerships
- Develop Policies
- Enforce Laws
- Link to Provide Care
- Ensure Competent Workforce
The evaluation tool above is based on current literature on community paramedicine program development, interviews with existing community paramedicine programs and public health systems. Each of the bullets has a series of benchmarks and performance indicators used to identify compliance and progress in a community’s paramedicine program. Each community is different and will need to adapt their program goals and resources to that of their community’s needs. Some examples of program goals are:
- Blood pressure monitoring
- Diabetic monitoring
- Reduction in abuse of the 911 system
- Wound care, etc.
Established Community Paramedic Programs
Here are four established community paramedic programs across the U.S.:
MedStar Community Health Program, Fort Worth Texas
This program’s goal was to reduce unnecessary 911 calls and emergency transports. To date, the program has saved more than $1.3 million in emergency room charges and reduced the unnecessary 911 calls by 50 percent, saving approximately $1 million in EMS charges.
San Francisco Fire/EMS Homeless Outreach and Medical Emergency (HOME) Team, San Francisco, California
This program’s goal was to stop sending expensive EMS resources to repetitive non-emergency calls. Through psychosocial assessment and assisting the patients’ perceived needs, the program was making a difference. However, due to lack of funding the program was eliminated.
Scott County Community Paramedicine, Scott County, Minnesota
Its goal was to free up fixed and mobile clinics by reducing inappropriate use of 911 resources. This program underwent a hiatus in the absence of funding, but recently, the state passed legislation to allow community paramedicine programs to bill for their services.
Emed Health, University of Pittsburg, Pennsylvania
Promotion of disease prevention and management through the use of EMS resources for home-based services was the goal for this program. More than 50,000 citizens have been immunized with this program and 30,000-40,000 have received biometric screening.
The majority of the programs have met their goals, but several to date have had problems in acquiring funding and/or establishing legislation to ensure the program can continue to operate. There is also the barrier of acquiring sufficient data to prove the viability of the program. Lastly, there has been opposition of individuals in the healthcare system.
Most programs to date have either met or exceeded their goals. This includes a reduction in unnecessary requests, allowing better service that meet resident’s needs, increased revenue billing and better collaboration among the community’s healthcare providers. The greatest success in these programs is the ability to reach the citizens who don’t have access to needed healthcare.
Community paramedicine programs are continuing to emerge and must keep focusing on the revolving healthcare needs of the community. Paramedics and EMTs are respected in their communities. The public welcomes these healthcare professionals into their homes without hesitation. Expanding the scope of practice for these individuals provides a win-win for the total community healthcare system in underserved communities.
Bio: Gary Seidel, EFOP, CFO, MPA; is a retired Fire Chief from Hillsboro Fire Department in Oregon and a retired Assistant Chief from Los Angeles Fire Department in California.