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
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
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.
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.,
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).