Community Paramedics: Redefining EMS

Michael T. Hilton, MD, MPH

Disclosures

February 07, 2018

Emergency medical service (EMS) systems were developed in the 1960s and 1970s to respond to traumatic and medical emergency conditions in the community and provide life-saving (stabilizing) care while en route to the hospital emergency department.[1,2] Over time, additional skills training and medical education were provided to prehospital care providers. What were initially ambulance attendants became emergency medical technicians (EMTs), which further diversified into today's EMTs, advanced EMTs, and paramedics.[3]

The different levels of paraprofessionals, particularly paramedics, receive highly sophisticated disease, pharmacology, anatomy, and pathophysiology education and medical skill training that is based on the National EMS Core Content, National EMS Scope of Practice, and National EMS Education Standards.[4] These documents are published by National Highway Traffic Safety Administration (NHTSA), the lead federal agency for EMS.[5]

The paramedic's advanced knowledge and skill set has not been matched by a more adaptable role in the healthcare system, however. Current healthcare policy is defined by the Affordable Care Act and calls for reducing healthcare costs and reining in emergency department visits and hospital readmissions, and studies show that it has succeeded.[6,7] Paramedics may be pivotal in achieving these goals by providing the right care, at the right place and the right time. EMS providers are among the few healthcare providers today who make house calls to address the acute decompensation of chronic conditions and who can be at the patient's house within minutes.

What Is Community Paramedicine?

Community paramedicine, also known as "mobile integrated healthcare," is a rapidly developing field at the intersection of EMS and public health.[8,9] The goals of community paramedicine programs have included more appropriate use of emergency services, increased access to primary care, and enhanced opportunities for skill development of EMS personnel.[10]

Community paramedicine has its roots in international EMS programs. One model of community paramedicine is RESPIGHT (Response to emergencies; Engaging with communities; Situated practice; Primary healthcare; Integration with health, aged care, and social services; Governance and leadership; Higher education; Treatment and transport options). RESPIGHT is based on an Australian rural paramedic model.[11] It covers many of the domains of existing domestic and international community paramedicine programs.

There are other definitions of a community paramedic and of community paramedicine. In one working definition, for example, a community paramedic is a paramedic with additional training in working within a community paramedicine program under local medical control as part of a community-based team of health providers. Community paramedicine in this case is defined as a community-based model of care that uses the skills of paramedics and EMS systems to address care gaps in the community.[10]

The American College of Emergency Physicians and other stakeholder organizations define mobile integrated healthcare and community paramedicine as follows[12]:

In its simplest definition, Mobile Integrated Healthcare (MIH) is the provision of healthcare using patient-centered, mobile resources in the out-of-hospital environment. It may include, but is not limited to, services such as providing telephone advice to 9-1-1 callers instead of resource dispatch; providing community paramedicine care, chronic disease management, preventive care or post-discharge follow-up visits; or transport or referral to a broad spectrum of appropriate care, not limited to hospital emergency departments.

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