Defining Community Paramedicine
According to the Association of State and Territorial Health Officials (ASTHO), in most traditional
models, the primary
responsibility of emergency medical services (EMS) providers is to stabilize patients in crisis
and then transport them to emergency healthcare services for treatment. Community paramedicine
is an emerging model that enhances the role of EMS providers so they are partners in public health and
community healthcare delivery.
There are two primary types of EMS employees: paramedics and emergency medical technicians (EMTs).
Traditionally, paramedics and EMTs respond to emergency situations, conduct lifesaving measures, and
transfer patients to healthcare settings for more advanced care. Paramedics are trained to a higher
level and have a larger scope of practice than EMTs. The level of training for each role varies state
Community paramedicine programs build on the existing skills and community relationships of
paramedics and EMTs and provide additional skills to work in the community, such as motivational
interviewing. A community paramedic may perform health screenings, home inspections, suturing, and
other services while in the field or in the client's home. In their role, community paramedics
address one or both of two main goals:
Increasing access to primary care
Reducing use of emergency care resources
These programs can align with a broader, system-wide expansion toward mobile
integrated healthcare, a model of care in which healthcare professionals work in an expanded capacity
outside of the clinical setting.
The National Association of Emergency Medical Technicians (NAEMT) reported in 2018 that over
200 community paramedicine programs operate in the United States, and many of them are located in rural
areas. Some community paramedicine programs are focused on providing or connecting patients with primary care
The Centers for Disease Control and Prevention (CDC) explain that an individual may call 911 for help when it is
not a medical emergency for reasons like a lack of
access to other healthcare services or transportation. However, these calls can strain limited EMS
resources and fill the emergency department (ED) with patients who could be better served by a different level
of care. Nationally, an estimated
14%-27% of ED visits, according to a 2010 RAND Corporation report, are for non-emergency medical issues
that could be addressed at a health clinic, saving $4.4 billion per year in healthcare costs.
In many cases, insurers will only provide reimbursement
for emergency care and services to the EMS provider when a patient has been transported to a hospital.
As a result, people who do not need to visit the hospital for higher-level or more comprehensive care —
and could be treated effectively by paramedics at their current location — may be transported to the ED
unnecessarily so the cost of their treatment is billable to insurance. This adds both burden to the
healthcare system and stress for patients and their families.
Emergency Medical Services in Communities
EMS providers are front-line healthcare workers who are the first responders when emergency medical care is
Medical Services: At the Crossroads, a book from the National Academies of Sciences,
Engineering, and Medicine, explains how the EMS system
developed quickly in the U.S. in the 1960s and 1970s following research into clinical advances like
cardiopulmonary resuscitation (CPR). This research provided proof of the life-saving potential of rapid response
medical care, which stabilizes patients long enough to transport them to a location like a hospital with more
sophisticated or comprehensive resources.
In the 1980s, federal funding for EMS programs declined,
and local jurisdictions needed to develop their own systems for providing emergency medical care. As a result,
there are several types of EMS agencies that provide services in different parts of the country.
Fire departments. EMS programs are most often affiliated with a fire department. Fire
department-based EMS programs accounted for 40% of all EMS programs in
the U.S. in 2011. This affiliation is common in rural areas because having a standalone EMS program may be too
costly to maintain.
Standalone or third-party EMS. Some EMS programs are privately organized and not associated
with a hospital. They may be run as nonprofit or for-profit entities. These programs accounted for 25% of all
EMS services in the U.S. in 2011.
Government. Some local jurisdictions, like counties, have an EMS service that is separate from
the fire department but still managed by government organizations. These agencies represented 21% of U.S. EMS
services, with tribal EMS representing an additional 1% in 2011.
Hospitals. EMS programs affiliated with a hospital accounted for 6% of all EMS programs in the
U.S. in 2011.
Rural areas rely heavily on a volunteer workforce. In a 2013 survey from the National Highway Traffic Safety
Administration, which represents the best available national data, 43.8% of calls to rural EMS systems were
managed by volunteers.
Types of Community Paramedicine Services
Community paramedics can receive training and provide a variety of different services depending on community
needs and gaps in existing services.
Generally, a community paramedicine encounter will involve the community paramedic driving to a patient's home
in a fleet vehicle, not an ambulance, dressed in their EMS uniform. Their activities while in the home may vary
based on the patient's needs and health status. Programs typically have a
set of protocols to navigate the health issues they are targeting in their patient population. After
initial contact with the patient, community paramedics may continue to conduct in-home visits or may check in by
phone or telehealth visit, depending on the program's protocols.
California's Office of Statewide Health Planning and Development piloted
different community paramedicine programs through the California Emergency Medical Services Authority
(EMSA) that demonstrate how these services could be offered to different patient populations. The populations
and services provided in these pilots included:
Post-discharge. Community paramedics visited patients with chronic conditions who were recently
discharged from a hospital. These visits can provide an opportunity to introduce patients to techniques to
manage their health conditions and reduce hospital readmission.
Frequent emergency medical services users. Individuals who frequently call 911 or use emergency
services for non-emergent issues were provided case management to connect them with more appropriate services
including primary care, behavioral health, housing, and social services.
Directly observed TB therapy. In an attempt to prevent the spread of tuberculosis (TB),
patients with TB were given directly observed therapy (DOT) by community paramedics and local public health
officials who provided patients with medication and monitored the patients to ensure they took their medication
Hospice. Community paramedics provided services to hospice patients in their homes to decrease
their need to call emergency services and avoid difficult or unwanted hospital stays.
Alternate destination – mental health. Community paramedics identified and evaluated
patients who needed mental health services rather than emergency medical care and transported them directly to a
mental health crisis center rather than to the hospital emergency room.
Alternate destination – sobering center. Community paramedics transported 911 callers
with acute alcohol intoxication who did not need emergency medical or mental health services to a sobering
More information about different types of community paramedicine programs implemented in rural communities can
be found in Module 2.
Mobile Integrated Healthcare
integrated healthcare (MIH) is a term that is often used to describe community paramedicine programs but
also refers more broadly to the practice of providing patient-centered healthcare services outside of the
hospital or traditional clinical environment. NAEMT explains that a variety of organizations and providers can
participate in MIH and are administratively
or clinically linked with local EMS services, while community paramedicine is a service provided by EMS
agencies that are administratively and clinically linked with the broader healthcare system. This relationship
can allow MIH providers to offer services like chronic disease management, referrals to other care providers,
and telephone advice instead of immediate dispatch of EMS services to 911 callers. Some agencies may also prefer
to use the term “mobile integrated healthcare” to describe their program, particularly if their
providers have not been required to complete advanced community paramedic training.
Resources to Learn More
911: State and Community Strategies for Expanding the Primary Care Role of First Responders
Examines the emerging roles of emergency medical technicians (EMTs) and paramedics in community
paramedicine. Discusses the challenges and opportunities regarding this transformation and includes
federal, state, and local activities related to the expansion of the primary care role for emergency
Organization(s): National Conference of State Legislatures
Provides guidance for healthcare organizations developing or expanding a community paramedic program
in Minnesota. Includes information on education and training, program planning, models of care,
hiring, financing, quality measurement, and evaluation.
Organization(s): Minnesota Department of Health
Community Paramedicine in
Provides information on a series of community paramedicine pilot programs conducted in California.
Includes information about implementation and evaluation of the pilots, along with a report on the
impact of the pilots on the state budget.
Organization(s): California Health Care Foundation
Handbook on Mobile
Provides information and resources for fire department chiefs wanting to develop a mobile integrated
healthcare (MIH) program in their department. Includes information about the organizational benefits,
reimbursement mechanisms, working with policymakers, and financial sustainability. Offers
considerations for volunteer departments relating to the implementation of an MIH program.
Organization(s): International Association of Fire Chiefs
Integrated Healthcare and Community Paramedicine (MIH-CP): A National Survey
Reports the results of a 2014 survey on the development, characteristics, and status of mobile
integrated healthcare and community paramedicine (MIH-CP) programs operating in the U.S. Includes
information about clinical services, funding and payment mechanisms, evaluation and quality measures,
and lessons learned.
Author(s): Zavadsky, M., Hagen, T., Hinchey, P., McGinnis, K., Bourn, S., & Myers, B.
Organization(s): National Association of Emergency Medical Technicians (NAEMT)
Integrated Healthcare/Community Paramedicine (MIH/CP) Primer
An introduction to the mobile integrated healthcare and community paramedicine (MIH-CP) models of
coordinated, community-based care for people working in emergency medicine. Includes the history,
organizational variability, state regulations, medical direction authority, scope of practice issues,
specialized training, and financing or reimbursement considerations related to the MIH-CP program of
Organization(s): American College of Emergency Physicians, Mobile Integrated
Healthcare/Community Paramedicine Task Force
Statement on Mobile Integrated Healthcare (MIH) & Community Paramedicine (CP)
Outlines how emergency medical services (EMS) agencies can convert to a mobile integrated healthcare
(MIH) system. Includes a list of key components useful for the development of MIH programs and services.
Organization(s): American College of Emergency Physicians