Community Healthcare Integrated Paramedicine Program (CHIPP)
- Need: To reduce 911 use and improve older adults' health in rural Santa Cruz County, Arizona.
- Intervention: Community paramedics made scheduled visits to patients and connected them to other community resources.
- Results: CHIPP assisted over 150 people, and 911 calls decreased.
Arizona's rural Santa Cruz County is a Health
Professional Shortage Area in primary care. This lack of
primary care providers can lead some people to utilize
emergency medical services for non-emergencies, which is
expensive and might take emergency medical technicians
(EMTs) away from other calls.
In addition, many older adults in this county live by
themselves and don't have family nearby. Some of these
adults have Alzheimer's or other forms of dementia but
can't afford memory care or assisted living. Others
aren't able to leave the house to buy food or see the
911 use for non-emergencies and improve older adults'
health, the Rio Rico Medical & Fire District created the
Community Healthcare Integrated Paramedicine Program
(CHIPP), in which firefighters and EMTs received
community paramedicine training and provided in-home
care to older patients.
The Rio Rico Medical & Fire District partnered with the
Tubac Fire District, Sonoita-Elgin Fire District, Nogales
Fire Department, Arizona Poison and Drug Information
Center, and healthcare facilities and organizations. The
Rio Rico Medical & Fire District received a
2015-2018 Federal Office of Rural Health Policy (FORHP)
Rural Health Care Services Outreach Grant to support
this program. CHIPP is currently inactive, but program
coordinators are looking to relaunch it in 2023.
This KOLD News 13 video contains more information about
Clinicians, primary care offices and hospital staff, and
home health agencies referred super-utilizing older
patients (55 or older) with chronic conditions to CHIPP.
Eligible conditions included:
- Alzheimer's or other dementias
- Behavioral health issues
- Congestive heart failure
- Post-myocardial infarction
CHIPP paramedics then made scheduled home visits to
community members and provided the following free
- Checking and tracking of vital signs, like weight and
- Chronic disease education
- Delivery of medications
- Home inspections, to check for fall risks and other
- Medication management support
- Referrals to community resources
like home repair and social services
All providers were trained in community paramedicine,
which taught them to see the larger issue instead of the
specific reason a patient called. For example, a patient
may call with a specific health concern like anxiety, but
the provider notices that the house is unkempt or there
are tripping hazards like unsecured rugs. That provider
can call CHIPP and get the patient connected with any
needed resources or care.
For medication management support, CHIPP partnered with
the Arizona Poison and Drug Information Center. CHIPP
staff documented their patients' medications and sent the
information to the center's pharmacist. The pharmacist
reviewed the list and contacted CHIPP with any concerns
(for example, if a dosage seems too high or if certain
medications will negatively interact with others). CHIPP
staff then communicated these concerns to the patient and
their primary care provider.
CHIPP assisted over 150 people, and 911 calls decreased.
In addition, Rio Rico Medical & Fire District was
recognized as a
Treat and Refer provider, which allows EMS staff
responding to 911 calls in which patients don't need an
ambulance to assess and refer patients to more
appropriate care, like urgent care or behavioral health.
Resources are available in some communities but not
others, which can limit how some residents are helped.
For example, public transportation and Meals on Wheels
are available in Nogales but not in Rio Rico.
Complete a needs
assessment. CHIPP staff completed a formal assessment,
but informal assessments work too. Ask community agencies
and first responders what resources are available and
what services are needed. First responders and 911
operators can also ask patients and other community
members what services they need.
Network within the county to identify where you can send
those residents who need help. Through its grant, CHIPP
started a collaborative focus group with other agencies
in the county.
Chronic disease management
December 18, 2018
Date updated or reviewed
January 7, 2022
Suggested citation: Rural Health Information Hub,
Community Healthcare Integrated Paramedicine Program (CHIPP) [online]. Rural Health Information Hub. Available at:
[Accessed 30 January 2023]
Please contact the models and innovations contact directly for the most complete and current information
about this program. Summaries of models and innovations are provided by RHIhub for your convenience. The
programs described are not endorsed by RHIhub or by the Federal Office of Rural Health Policy. Each rural
community should consider whether a particular project or approach is a good match for their community’s
needs and capacity. While it is sometimes possible to adapt program components to match your resources, keep
in mind that changes to the program design may impact results.