Defining Sustainability in the Context of Community Paramedicine
Sustainability has long
been a challenge for rural emergency medical service (EMS) providers. Low call volumes, long
distances, and staff shortages have historically made it difficult to maintain profitable operations
that offer lifesaving access to healthcare services, particularly when EMS is the sole safety net
provider in rural communities. While community paramedicine may offer an alternative funding stream
from standard EMS reimbursement mechanisms, it cannot replace the role and function of emergency
medical treatment. To be sustainable, rural EMS providers interested in expanding their activities to
include community paramedicine must have the capacity or flexibility to serve patients with regularly scheduled
appointments, while continuing to address life-threatening emergencies that can arise at any time.
To achieve sustainability, rural community paramedicine programs will need to consider
how to maintain their resources, staff, and partnerships. Sustainability can best be done by
demonstrating value to potential funders, which might be partner organizations, government agencies, healthcare
payers, and even residents who use the services. Evaluation
will provide meaningful data that demonstrate the program's value and impact on the community.
Value can be defined differently depending on the needs of the community. What is most
valuable — reducing 911 calls, lowering hospital readmissions, or improving access to primary care
services, for example — depends on where there are pain points within the healthcare system. For
example, if a community hospital sees a lot of uninsured emergency department patients who would be
better served by primary care and social services, a community paramedicine program may be able to
reduce the hospital's costs while ensuring that patients receive more appropriate care. Tailoring
community paramedicine programs to high-value needs can help bring stakeholders into the
sustainability planning process.