Community Paramedics: Redefining EMS

Michael T. Hilton, MD, MPH


February 07, 2018

Challenges to Pushing the Envelope

EMS regulations and legislation were originally developed to provide an emergency medical care system that could stabilize patients and transport them to emergency departments. Community paramedics push the envelope of the current framework of EMS, and regulation and legislation have lagged behind.[13] States allow community paramedicine leaders varying levels of freedom to craft community paramedicine programs.[33] Fifteen states have provided legislative authority for community paramedicine programs.[34]

Reimbursement for these services is another challenge, because there is no dedicated funding mechanism for community paramedicine.[13] Some programs, such as the Connect Community Paramedicine program in Pittsburgh, Pennsylvania, have created partnerships with insurance companies to provide funding for community paramedic programs to prevent readmissions.[35]

Without a unified model of community paramedicine, training and education for this expanded role are not standardized, nor is there a standard scope of practice.[13,24,33] This differs from the standardized roles and scopes of practice defined by NHTSA through the National EMS Core Content, National EMS Scope of Practice, and National EMS Education Standards documents.[3,4] There is concern about the risk for undertriage of patients to the emergency department, even with additional training for paramedics, which may worsen patient outcomes.[36] We also lack data about the safety and efficacy of community paramedic programs.[24]

Finally, other healthcare providers work in the home care industry, including visiting nurses and innovative telemedicine[37] and hospital-at-home programs,[38] are being developed by healthcare systems to address healthcare quality and prevent unnecessary admissions. Community paramedicine is just one approach of many to address healthcare quality and the social determinants of health. Of note, the American Nurses Association supports community paramedic programs.[39]

Community paramedicine is an exciting and growing branch of EMS. Despite the challenges these programs face, they are likely to continue to develop. In the future, many emergency medicine physicians will probably be able to use this resource to help keep patients at home and prevent unnecessary 911 EMS transports, repeat emergency department visits, and hospital readmissions.

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