Community Paramedicine

Community paramedicine (CP) is an emerging healthcare profession. It allows paramedics and emergency medical technicians (EMTs) to operate in expanded roles to provide healthcare services to underserved populations. It is a way to improve rural emergency medical services (EMS) as well as address the healthcare needs of the community.

Some rural patients lack access to primary care, and misuse 911 services in an attempt to access emergency departments for routine healthcare. This is demanding on volunteer EMS personnel in rural areas and causes strains on the workforce. Working in a primary care role, community paramedics can meet the needs of such individuals, as well as others in the community, in a more efficient and proactive way.

This topic guide:

  • Defines community paramedicine as well as community paramedics
  • Outlines issues and challenges that rural community paramedics face
  • Provides examples of community paramedicine models and existing programs
  • Provides resources related to starting a rural community paramedicine program, including ways to address workforce and program challenges
  • Outlines education and curriculum requirements for community paramedics
  • Discusses how community paramedic programs are funded

Sources: State Perspectives Discussion Paper on Development of Community Paramedic Programs; Urgent Matters E-Newsletter Spring 2013; Community Paramedic

Frequently Asked Questions

What is community paramedicine and how can this type of program benefit rural communities?

Community paramedicine is about filling local healthcare gaps by using existing providers in different roles. Community paramedics generally focus on:

  • Providing primary care
  • Post-discharge follow-up care
  • Integration with local public health
  • Providing education and health promotion programs

Paramedics and Emergency Medical Technicians (EMTs) are respected in their communities, and in rural communities are often consulted for healthcare advice by their friends and neighbors. The public welcomes these healthcare professionals into the private space – their home – without hesitation. Paramedics already have and use skills like giving shots and mixing and administering medication IV drips. While in their traditional role, a paramedic might give a patient a shot of Valium; the Community Paramedic would use that same skill in a different role, such as giving a “shot” of immunization.

This model can also benefit rural EMS agencies by:

  • Reducing requests for service that are inappropriate and not reimbursed
  • Decreasing the amount of “down time” between calls, while at the same time allowing them to better serve resident’s needs
  • Increasing revenue by billing patients or third party payers for services provided, when able to do so

What is the role of a community paramedic, and what type of education is required for this profession?

The role of both EMT- and paramedic-level Community Paramedics is to fill local healthcare gaps as a full participating member of a patient’s medical home care team.

In their emergency roles, EMTs and paramedics are excellent problem solvers, but their initial training is focused on managing a patient’s emergency condition over 30 to 60 minutes. To prepare them to participate in the medical home care team, they need additional education focused on understanding longer term care, over the next 30 to 60 days or beyond.

A standard curriculum is available free of charge to colleges and universities. It consists of approximately 114 hours of didactic education (in the social determinants of health, public heath, and tailored learning about chronic diseases) and approximately 200 hours of lab and clinical experience. For more information about the curriculum, see Community Paramedic.

How are rural community paramedicine programs funded?

Funding to start and sustain rural community paramedic programs is a significant issue. As of July 2014, most community paramedicine programs are funded either by the ambulance service itself, or through grants. There are currently three CMS Healthcare Innovation Grant awardees who receive Medicare fee-for-service for community paramedic services. In most states, community paramedicine services are not reimbursed by Medicaid, although Minnesota does allow reimbursement for certain services provided by Community Paramedics, according to the National Conference of State Legislatures.

Some hospitals and hospital-owned ambulance units support community paramedicine programs because they believe there will be a reduction in emergency medical services (EMS) and emergency department misuse and reduced readmissions. In urban areas, Accountable Care Organizations (ACOs) are starting to either contract with ambulance companies for the use of Community Paramedics, or are employing them directly within the ACO. As rural ACOs develop, there will be more opportunities. Local EMS agencies can work directly with ACOs and insurance companies in their area to determine if reimbursement for community paramedicine is an option.

In a hospital or clinic setting, patient care provided by community paramedics credentialed at that facility is reimbursable, just as it is for other allied health professionals.

For more information on how rural community paramedicine programs are funded, please see the Flex Monitoring Team policy brief, Community Paramedicine in Rural Areas: State and Local Findings and the Role of the State Flex Program.

How does an organization start a rural community paramedicine program?

There are many free online resources that organizations can use to inform their community paramedicine programs:

Some organizations may also choose to work with consultants. Prior to hiring a consultant, it is recommended that organizations have a clear understanding of a consultant’s capabilities and experience in actually bringing programs to reality.

Are there barriers to starting a rural community paramedic program?

Commitment and time are two barriers to starting a successful program. One of the first steps for any program is to complete an assessment of the community’s healthcare gaps. In order to be successful long term, the program must not duplicate services, but focus on filling gaps and working alongside other healthcare providers. A concerted and continual communication effort is essential as partnerships are formed. Local champions, including a physician and nurse champion are also necessary.

Are there examples and models of rural community paramedic programs?

Rural Community Paramedic program functions are quite similar to urban programs, so most community paramedicine programs can serve as models to rural communities. The Paramedic Foundation is currently working on a registry of programs.

Two examples of successful rural programs are:

What considerations are there related to licensure and regulation when starting a community paramedicine (CP) program?

Licensure and regulations for community paramedicine programs vary by state. CP programs do not expand the scope of practice, which has resulted in some states adopting laws or changing current regulations to accommodate this new model. As reported in Beyond 911: State and Community Strategies for Expanding the Primary Care Role of First Responders, Minnesota, Maine, and Colorado have taken steps to address regulatory barriers in community paramedic initiatives.

For further information, or if you are unsure of your state’s laws, contact your state’s EMS agency.