Community Paramedicine Model

Community Paramedicine model has two components: 1) primary care services,

ordered by a physician and conducted in a patient’s home, and 2) community-based

prevention services planned and provided in concert with the local

public health department.

Primary Care Services

As a way to increase availability and continuity of health care for vulnerable

populations, specially-trained paramedics provide specific primary care services

in the patient’s home, working through a physician’s order. The services are

within the paramedic’s legal scope of practice, and the paramedics have been

trained and evaluated on their ability to provide such care. This type of care is

not of an ongoing nature, such as that of a home health agency, but rather

each visit necessitates a discreet order with instructions for that one visit. If the

provider believes the patient requires additional follow up by the Community

Paramedic, they must issue another order.

In-home care that is delivered by a Community Paramedic is not of an ongoing

nature, but rather each visit requires a discreet order from the patient’s

physician.

While in the home, the Community Paramedic takes a patient history, assesses

the chief complaint, and then confers with the treating provider on next steps.

The paramedic may also conduct a home safety check and assess the need for

referral to a social service agency or other community resource. A patient care

report is developed and faxed to the ordering provider to be placed in the

patient’s chart. This in-home type of care is perfect for many vulnerable

populations including:

ü The chronically ill who have a hard time getting to their medical provider’s

office and frequently cancel appointments.

ü Patients recently hospitalized that would benefit from a few in-home

monitoring sessions to prevent complications.

ü Patients in need of social supports who frequently call 9-1-1.

Community-Based Prevention Services

Community Paramedics also assist the local public health department with

community-based services such as immunizations, disease investigations, blood

draws at health fairs, mass vaccination clinics, and fluoride varnish applications

to children. This assistance helps to increase the capacity of the department. In

this two-way partnership, public health personnel also play a role in linking

uninsured patients to a primary care provider, thus assisting with the physician

order process described above.

The Global View

Community paramedicine is a relatively new field with local programs emerging

as a response to the health care crisis. The CP model increases access to basic

health care services through the use of specially trained Emergency Medical

Service (EMS) personnel in an expanded role. These so-called Community

Paramedics provide care in a non-urgent setting, consistent with the Medical

Home Model (defined as patient-centered medical care led by a physician

coordinating all aspects of preventive, acute and chronic care, using the best

available evidence and technology), and under the supervision of an ordering

physician or advance practice provider.

Community Paramedics expand the reach of primary care services by using a

paramedic to perform procedures already in their skill set, such as: assessment

(vital signs, blood pressure, labs: glucose levels, medication compliance),

treatment (wound care, medication reconciliation), prevention (immunizations,

fall assessment), and referral (medical and social services). Specific roles and

services are determined by each community’s unique health needs, within the

paramedic’s legal scope of practice, and consistent with medical direction.

International programs have had success in reducing emergency transports and

hospital readmissions by using the paramedic in this expanded role.

History

The term “community paramedicine” was first described in the U.S. in 2001, as a

means of improving rural EMS and community healthcare; however, it is not a

new concept in practice.1 Increasingly EMS personnel are caring for patients

with non-emergent medical problems in their day-to-day role as emergency

responder. For example, studies place the number of low-acuity transports (e.g.,

sprains or

1 Joint Committee on Rural Emergency Care (JCREC): National Association of State Emergency

Medical Services Officials & National Organization of State Offices of Rural Health, “State

Perspectives Discussion Paper on Development of Community Paramedic Programs,” (2010).