Community Paramedicine Models for Prevention and Health Education
Prevention and health education represent one significant role for community paramedics in the healthcare
system. Through home visits, telehealth appointments, and telephone check-ins, community paramedics can identify
medication errors, environmental risks, or problems with durable medical equipment that are not often identified
in a traditional clinical or healthcare setting.
People with complex chronic conditions often have many prescriptions, each with their own dosing schedules,
warnings, and instructions. This complexity can make
it challenging for patients to take their medication safely and correctly each day. In addition, because
these prescriptions often come from multiple providers, patients may not have support managing their medication
lists. There may be contraindications, errors in dosage, drug type, or patient usage, resulting in adverse drug events that can be harmful or even
One important role for community paramedics is to help patients manage medications. Community paramedics can
help set up reminders, explain dosing instructions, identify medication management issues like improper storage,
and uncover errors in their medication list. Medication reconciliation has three steps:
Verification: Developing a comprehensive list of all current prescriptions
Clarification: Confirming medications and dosage are appropriate
Reconciliation: Making necessary adjustments to the list to ensure no errors, duplications, or omissions
Community paramedics can work with patients and other healthcare providers to conduct all three steps of this
process. Using the Medication
Management Strategy from the Agency for Healthcare Research and Quality (AHRQ) or another method,
community paramedics can help patients develop a comprehensive list of their current prescriptions.
Once the list is correct, the community paramedic confirms its contents with the patient's providers, ensuring
that all dosages are correct and all medications are still currently needed to manage their health. Then, either
on their own or with support from a community pharmacist, the community paramedic conducts a medication
reconciliation process, which will ensure there are no contraindications, drug-drug interactions, or
drug-disease interactions that may cause harm.
A final responsibility of medication management is to provide patient education.
The community paramedic can work with the patient and their family or caregiver to ensure they understand how and when to
take each medication, along with any potential warning signs of adverse drug events that should be shared with
their primary care provider.
Community paramedics conducting home visits are well-positioned to observe any issues in the patient's home that
may pose safety risks. Particularly for elderly or frail patients, tripping hazards like throw rugs, broken
stairs, ill-fitting slippers, or electrical cords may pose a risk for falls. Up to
half of falls may be caused by these environmental risk factors. Home safety checks can help identify
modifications that make it easier and safer for patients to age in place, including installing grab bars,
adequate lighting, and non-slip surfaces.
By identifying these issues early, community paramedics can prevent accidents that may later result in a 911
call or emergency room visit.
Community paramedicine programs can also conduct safety checks of home durable medical equipment (DME) like
nebulizers, wheelchairs, or continuous positive airway pressure (CPAP) machines. They can also help manage
maintenance and distribution of DME for community
lending closets that provide access to patients who are otherwise unable to obtain DME on their own.
Chronic Disease Management
People living in rural communities are more likely to have
multiple chronic conditions, which has a significant impact on quality of life. With the right tools,
including patient education, people can often manage their condition at home. This results in better long-term
outcomes and saves both time and money for the patient and the health system.
Community paramedicine programs focus on a range of chronic conditions including diabetes, chronic obstructive
pulmonary disease (COPD), congestive heart failure (CHF), and asthma, depending on the needs of their patient
population. Their activities include checking and counseling patients on blood glucose levels, conducting
regular weigh-ins with patients living with CHF, checking blood oxygen levels, and discussing the patient's
current disease management strategies so they can be modified as needed.
As described by EMS
World, a community paramedic engages the patient in an iterative process to ensure they understand how
best to manage their disease. This includes education about symptoms, lifestyle modifications, warning signs for
worsening health, and proper use of medication or equipment. The patient also works with the community paramedic
to practice their self-monitoring and disease management techniques and teaches-back
their medical plan to the paramedic.
Examples of Rural Prevention and Health Education Programs using Community Paramedics
The Help for Seniors program in Livingston County, New York, works with
older adults in the community to identify unmet health needs. It also educates emergency medical services (EMS)
providers on geriatric health issues. The program includes in-home screening for falls risk, medication
management needs, and depression. Of program participants, 91% had identified needs that were then
referred to case managers for a follow-up home visit.
ThedaCare and Gold Cross Ambulance in northeastern Wisconsin have partnered to develop a community paramedicine program
that serves a variety of patients referred from hospital and primary care settings. Through funding from the
Moore Foundation's Community Management of Medication Complexity Innovation Lab, the team was able to expand its program to
focus on patients whose complex prescription regimens put them at increased risk of hospitalization. By
developing a Medication
Risk Score, community paramedics were better able to assess which patients needed extra support to
improve their health.
Considerations for Implementation
Community paramedics may rely on the services of other health professionals to deliver prevention services or
education messages to their patients. For example, a pharmacist may be needed to review medication lists to
identify potential drug interactions or incorrect dosages. However, they may be unable to attend the home visit
in person due to distance or competing priorities. Telehealth can be a valuable tool to facilitate participation
in the visit.
If programs are using telehealth to deliver services, access to high-speed internet is often necessary. For
patients without high-speed internet in their home or who live in places without high-quality cell phone
service, this can be a key limitation. Some community paramedicine programs have installed hot spots in their
vehicles or have provided signal boosters to patients in order to better facilitate communication with other
healthcare providers. For more information about broadband access, see Module 4: Implementation Considerations.
Program Clearinghouse Examples
Resources to Learn More
Always Use Teach-Back! Training Toolkit
Teaches healthcare providers how to use the teach-back method when providing education or coaching to patients.
Includes an online learning module offering opportunities to practice the teach-back method in hospital, home
health, and primary care settings.
Organization(s): Institute for Healthcare Advancement
Disease Management for the Community Paramedic
Identifies several components important to include when integrating chronic disease management into a community
paramedicine program. Discusses the social determinants of health model and the factors that influence a
patient's ability to manage their condition at home.
Author(s): Dan Swayze
Organization(s): EMS World
Safety Assessment Checklist
Offers a comprehensive list of safety features to be assessed during patient home visits to identify problems or
issues that may increase their risk of falls or other injury.
Author(s): Kevin Creek
Organization(s): Idaho Department of Health and Welfare, Western Eagle County Health Services
Home Safety Assessment
Identifies potential risks to newborns and small children including outdoor hazards like pools or hot tubs and
indoor hazards like appliance cords or unsecured furniture.
Author(s): Magen Hall
Organization(s): The South Carolina Community Paramedic Advisory Committee, Abbeville County EMS