Rugby Community Paramedic Program
- Need: Low patient volumes, a shortage of EMS volunteers, and an aging population in a 5-county North Dakota region required a change in the way the Rugby EMS team delivered care.
- Intervention: Through the Rugby Community Paramedic Program, EMS staff brought medical care to patients transitioning back into their homes, including hospice patients and those with chronic conditions.
- Results: The program's early intervention methods helped reduce the number of emergency room admissions and the escalation of medical conditions. Patient satisfaction improved, and the program gained the trust of patients and medical staff in Rugby and surrounding areas.
The Rugby Community Paramedic Program was based out of
Emergency Medical Service (EMS) at the Heart of America Medical
Center, a Critical Access Hospital. It was started as
pilot project of the North Dakota Department of
Health Community Paramedic Program in order to fill
healthcare delivery gaps in Rugby and its surrounding 5
counties: Pierce, Benson, McHenry, Rolette, and
Bottineau. Low patient volume, a shortage of EMS
volunteers, and an aging population in this region were
some of the reasons Rugby's EMS took on this project.
Through the program, the team's 7 full-time paramedics
and 3 full-time emergency medical technicians (EMTs) made
non-emergent house calls to patients enrolled in the
program's transitional care or chronic care programs.
Medical services were brought to the patient's home in an
effort to reduce hospital readmissions and catch medical
problems before they escalated. Since 2016, the Rugby
Community Paramedic team also assisted as primary hospice
care providers, regularly visiting and offering
palliative care to home-bound patients within their
This program was financially supported by the Heart of America Medical
Center's Accountable Care Organization and received
in-kind donations from the hospital. The program also
worked in partnership with the counties' public health
units, making and accepting patient referrals. As of
2018, the program is no longer in operation.
Paramedics and EMTs provided the following services to
patients in their homes consistent with their authorized
scope of practice:
- Wound care
- Vital sign monitoring
- Medication administration
- Blood glucose monitoring
- Laboratory draws
- Medication reconciliation and compliance
- Home safety inspections
Patients enrolled in 1 of 2 Community Paramedic programs
administered by the EMS staff:
- Transitional care:
- Primary care medical services
were administered in a patient's home.
- Telephone follow-up calls were made after each
- The goal was to prevent hospital readmissions.
- Chronic care:
- Included evaluations,
screenings, and care for patients with chronic
diseases. EMS staff also made referrals for
adjustments to the patient's home environment to
better accommodate their medical situation.
- Telephone follow-up calls were made after each
EMS staff, providers, and nurses at the Heart of America
Medical Center identified patients to enroll in these 2
programs. The hospital's care coordinators scheduled
visits, monitored, and evaluated the care given to each
patient. Patients were enrolled until their medical issue
was resolved or until they moved into assisted living.
In addition to these services, the Paramedic Program
offered transitional and follow-up care for patients who
were being transferred to another facility.
Overall, this program saw a reduction in the number of
emergency room and hospital admissions. Because of the
paramedic's regular presence with these patients,
potential medical problems were detected early. For
instance, wounds were treated before becoming septic, and
chronic respiratory disease patients received early
Patient satisfaction improved, and the Rugby Community
Paramedic Program gained trust of patients and medical
staff in Rugby and surrounding service areas.
Because the program was a pilot project, there were some
initial challenges the Rugby Community Paramedic team
- Adjustments involving the Heart of America Medical
Center staff and the Rugby EMS team had to be made to
accommodate the new model of EMS staff providing clinical
services in patients' homes that had traditionally only
been offered in a medical facility.
- Patient care plans created by the paramedics and the
care coordinator sometimes clashed with patients' wishes
and had to be adjusted appropriately.
- Hospice regulations stating that patients needed to
be within a 60-mile radius of
a hospice provider disqualified some of the patients
within Rugby's EMS service area from receiving hospice
care from the Rugby Community Paramedic Program.
- Because the Centers for Medicare and Medicaid
Services does not offer reimbursements for community
paramedic programs in North Dakota, the program needed to
find other funding sources. They worked with the Heart of
America Medical Center, who designated funds to pay
full-time and part-time EMS staff. They also use
"off-production time" when EMS staff is not on a call to
help in the emergency room and screen incoming 911 calls.
- A necessity for any rural EMS program is to be
adaptive and open to incorporating multiple patient
scenarios into the program's scope.
- A community paramedic program may not work as
effectively without existing as a part of an established
structure like a healthcare system or public health unit.
- Have a champion within your
healthcare system. Support from a clinician or
administrative advocate can help your program capitalize
on resources, navigate the healthcare system, and gain
Rugby's Community Paramedic Program adapted key
principles of California's
Community Paramedic Project model. Rugby EMS offers
training for new and current EMTs, but because North
Dakota doesn't have a formal licensure for community
paramedic programs, the EMS staff was trained for the
Community Paramedic Program through Hennepin Technical
Chronic disease management
Hospice and palliative care
November 16, 2017
Date updated or reviewed
December 14, 2018
Suggested citation: Rural Health Information Hub,
Rugby Community Paramedic Program [online]. Rural Health Information Hub. Available at:
[Accessed 28 September 2022]
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.