Community paramedicine is a relatively new and evolving healthcare model. It allows paramedics and emergency medical technicians (EMTs) to operate in expanded roles by assisting with public health and primary healthcare and preventive services to underserved populations in the community. The goal is to improve access to care and avoid duplicating existing services.
Some rural patients lack access to primary care and use 9-1-1 and emergency medical services (EMS) to receive healthcare in non-emergency situations. This can create a burden for EMS personnel and health systems in rural areas. Community paramedics can work in a public health and primary care role to address the needs of rural residents in a more efficient and proactive way.
This topic guide defines community paramedicine and outlines challenges faced in rural areas. It also discusses community paramedicine models and existing programs, while providing resources for starting a rural community paramedicine program such as education and curriculum requirements.
Frequently Asked Questions
- What is community paramedicine? How can a community paramedicine program benefit rural communities?
- Is mobile integrated healthcare the same as community paramedicine?
- What is the role of a community paramedic, and what type of education is required for this profession?
- How are rural community paramedicine programs funded?
- How does an organization start a rural community paramedicine program?
- Are there barriers to starting a rural community paramedicine program?
- Where can I find examples and models of rural community paramedicine programs?
- What considerations are there related to licensure and regulation when starting a community paramedicine program?
What is community paramedicine? How can a community paramedicine program benefit rural communities?
Though there are differences from program to program, a working definition of a community paramedic from the Joint Committee on Rural Emergency Care (JCREC) is:
…a state licensed EMS professional that has completed an appropriate educational program and has demonstrated competence in the provision of health education, monitoring and services beyond the roles of traditional emergency care and transport and in conjunction with medical direction. The specific roles and services are determined by community health needs and in collaboration with public health and medical direction.
Community paramedics generally focus on:
- Providing and connecting patients to primary care services
- Completing post hospital follow-up care
- Integration with local public health agencies, home health agencies, health systems, and other providers
- Providing education and health promotion programs
- Not duplicating available services in the community
Paramedics and EMTs in rural communities are trusted and respected for their medical expertise, the emergency care they provide, and are generally welcome in patients' homes. These professionals are often consulted for healthcare advice by their friends and neighbors. Their skill set can be equally useful to them in addressing unmet needs for primary care services in the community. For example, the technique used to administer an injection in an emergency situation is the same used for routine inoculations.
The community paramedicine model can benefit rural EMS agencies by:
- Reducing 9-1-1 requests for non-urgent, non-transport services that are not reimbursable
down timebetween calls, exercising medical skills, and improving access to providers to meet the community's primary care needs
- Increasing revenue by billing patients or third party payers for services provided, when appropriate
The 2014 Flex Monitoring Team briefing paper No. 34, The Evidence for Community
Paramedicine in Rural Areas: State and Local Findings and the Role of the State Flex Program, describes
two principal models of community paramedicine programing, both of which can address the needs of rural
communities. The primary healthcare model
focuses on providing services to help prevent
hospital readmissions, including post-discharge care, monitoring chronic illness, and targeting specific
high-risk patients. The community coordination model works to
connect patients to a
primary care physician and other social and medical services. Rural community paramedicine programs can
incorporate aspects of both models into their program to meet the needs of their community.
A 2016 Journal of Health Care for the Poor and Underserved article, What is the Potential of Community Paramedicine to Fill Rural Health Care Gaps?, describes multiple aspects of community paramedicine practices in rural areas, including service area characteristics, program goals, and services offered. The article discusses beneficial outcomes for rural communities reported by community paramedicine programs, such as reductions in hospital readmissions, cost savings per patient, the number of transports avoided, reductions in emergency department usage by community paramedic patients, and more.
Is mobile integrated healthcare the same as community paramedicine?
The term mobile integrated healthcare (MIH) is often used interchangeably with community paramedicine, particularly outside of the EMS community. However, MIH is broader, including healthcare services provided outside of a healthcare facility by any type of health professional, such as community health workers (CHWs). To be inclusive, some organizations use the term community paramedicine and mobile integrated healthcare (CP-MIH).
An MIH approach often starts with a triage professional who assesses the needs of someone calling for care. If the call is through a 9-1-1 system, it is first triaged as a non-emergency by the emergency call-taker and referred to the MIH triage. The MIH triage person determines the most appropriate resource available in the local MIH arrangement, such as a community paramedic, nurse practitioner, social worker, or a team, and dispatches them or makes other arrangements to bring the resource and the patient together, which might include vouchers or other transportation assistance.
What is the role of a community paramedic, and what type of education is required for this profession?
Community paramedics function as fully participating members of a patient's medical home care team.
As first responders, EMTs and paramedics are trained to focus primarily on managing a patient's immediate emergency medical condition. To participate effectively in a medical home care team approach, they need additional education and training focused on providing care over a longer period of time, such as for managing chronic health conditions. Filling Gaps and Avoiding Duplication: Community Paramedics and Ambulance Services further discusses the role of community paramedics.
A national consensus standard curriculum is available free of charge to colleges and universities. It consists of two phases:
- Phase I consists of approximately 100 hours, based on prior experience, of foundation skills
- Phase II consists of 146 to 190 hours, based on prior experience and clinical skills
Topics covered include the social determinants of health, public heath, and tailored learning about chronic diseases, community assessments, and strategies for managing care and disease prevention.
A new curriculum is available and focuses on EMTs and paramedics whose community paramedicine programs are addressing only 9-1-1 callers in such ways as treat and release, treat and refer, or assess and report. Each course is 88 hours long and is drawn from modules of the existing community paramedic course. This additional curriculum has changed the branding of community paramedics. EMTs who complete the 88-hour course are known as Primary Care Technicians (PCTs). Paramedics who complete their version of the 88-hour course are called Community Paramedic Technicians (CPTs). Paramedics who complete the original 300-hour course are now called Community Paramedic Clinicians (CPCs).
Mobile CE is a non-profit college and university education network that provides innovative, standards-based community paramedicine academic programs. Multiple programs are available, certificate level through doctoral degree.
Some community paramedicine programs focus narrowly on one or two community health needs. Education may be provided to enable CPs to manage only these needs. As community paramedicine evolves, the standards of care and education will also evolve.
How are rural community paramedicine programs funded?
As a new type of service on the healthcare scene, most community paramedicine programs are funded by the ambulance service or hospital itself, through grants, and increasingly by insurance plans. Some hospitals and hospital-owned EMS programs support community paramedicine to reduce readmissions and emergency department misuse. Some Accountable Care Organizations (ACOs) contract with ambulance companies to use community paramedics or employ them directly. EMS agencies can work directly with ACOs and insurance companies in their area to determine whether they will receive reimbursement for community paramedicine services. In a hospital or clinic setting, patient care provided by credentialed community paramedics may be reimbursable, just as it is for other allied health professionals. Several states now provide coverage for community paramedic visits under their Medicaid programs.
In some states, such as Minnesota, Medicaid programs reimburse for some community paramedicine services. Some commercial health insurance providers, including Anthem Blue Cross and Blue Shield in its fourteen states, have begun to reimburse for, or fund services providing, community paramedicine.
For more information on how rural community paramedicine programs are funded, 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?
Several organizations offer resources that can be used to guide the development of a community paramedicine program but ultimately the program should be tailored to address the specific needs of the community. Some organizations may choose to work with consultants. Prior to hiring a consultant, organizations should have a clear understanding of a consultant's capabilities and experience in designing and implementing programs.
- The Community Paramedicine Program Manual includes information on multiple topics for consideration when planning and implementing a community paramedicine program, such as program planning and feasibility, state regulations, assessing community needs, budgeting, policy development, training, beginning operations, and more. For the past several years a webinar program called the Community Paramedicine Insights Forum has featured community paramedicine services around the country. An archive of past webinars is available to serve and inform those who may be wanting to start community paramedic services.
- The International Roundtable on Community Paramedicine provides articles, data sets, presentations, research, and other resources on community paramedicine.
- The Minnesota Department of Health, Office of Rural Health and Primary Care published a Community Paramedic Toolkit and has many other research and educational resources. Some information in the toolkits is specific to Minnesota but much of the information can be used nationally.
- Check with the state EMS office to be aware of any resources, guidance, or requirements it may have for new community paramedicine services.
Are there barriers to starting a rural community paramedicine program?
The 2014 Flex Monitoring Team briefing paper No. 34, The Evidence for Community Paramedicine in Rural Areas: State and Local Findings and the Role of the State Flex Program, identifies multiple barriers and challenges to work through when establishing a rural community paramedicine program:
- Involving stakeholders and building collaboration
- Providing education and training
- Determining if community paramedics have an expanded role or scope of practice
- Navigating legislative barriers and medical direction regulations
- Securing funding and reimbursement
A 2017 Western Journal of Emergency Medicine article, Emergency Medical Services Professionals' Attitude About Community Paramedic Programs, found that among EMS providers there was a general understanding of community paramedicine and knowledge that their communities are interested in community paramedic care, but fewer were willing to attend community paramedicine training and/or willing to perform community paramedicine duties.
In some cases, existing healthcare providers may feel threatened by the presence of a new provider model such as CP. However, these issues have been worked through in over 250 communities across the United States. For example, home health agencies in communities where the CP model has been implemented have realized that CP can be used to address the needs of patients who do not qualify for home health and can be a source of referrals for patients who do. Many CP programs work hand-in-hand with home health providers and may be dispatched by them.
To overcome potential barriers such as those mentioned here:
- Consult the state EMS office for resources, guidance and requirements in starting a CP program.
Connect with other health care providers in the area to be served and work with them to assess community
health needs that are not being met. Together, develop a plan to meet these needs that addresses:
- Definition of the need
- Medical oversight
- Services to be provided for the patient population identified
- Protocols for providing the services
- Staffing plan
- Financial plan
- Training/education plan
- Performance improvement plan
- Service impact monitoring
- Other aspects identified by the EMS agency and its partners
- Start small and focus on one or two needs that can be relatively easily addressed. Prove the value of CP through patient improvement, satisfaction, appropriate/inappropriate resource utilization and other measurements. Add new services only on the basis of measured and proven need, agreement with health care partners, and potential sustainability.
Where can I find examples and models of rural community paramedicine programs?
RHIhub's Models and Innovations: Community Paramedics highlights successful community paramedicine programs:
- Abbeville County's Community Paramedic Program focuses on reducing non-emergent visits to the emergency department and inpatient stays in rural South Carolina.
- Community Healthcare Integrated Paramedicine Program makes scheduled visits to older adults in rural Arizona, connecting them to community resources and helping reduce 911 calls.
- Livingston County Help For Seniors meets the healthcare needs of geriatric patients in rural Livingston County, New York.
- Rugby Community Paramedic Program allows EMS providers to provide transitional and chronic disease management care to meet the needs of a 5-county region in rural North Dakota.
The National Association of State EMS Officials, National Organization of State Offices of Rural Health, and the Center for Leadership, Innovation, and Research in EMS jointly hosts monthly webinars and conference calls called the Community Paramedicine Insights Forum (CPIF). To participate in a monthly webinar, you can register online. Past webinars and conference calls are available online.
Community Paramedics Widen Medical Services in Rural Areas discusses pilot community paramedicine programs in Minnesota and Colorado. The Minnesota Office of Rural Health and Primary Care provides examples of rural community paramedic programs in the state.
What considerations are there related to licensure and regulation when starting a community paramedicine program?
Licensure and regulations for community paramedicine programs vary from state to state. Typically, practicing community paramedicine is considered an expanded role for paramedics and EMTs rather than an expanded scope of practice requiring additional licensure or certification. However, in some states, new laws or updated regulations have been implemented to accommodate this new healthcare delivery model. The 2018 Status Board report, State by State Community Paramedicine – Mobile Integrated Healthcare (CP-MIH), from the National Association of State EMS Officials (NASEMSO) summarizes the progress and implementation of community paramedicine programs, and information on community paramedic licensure and regulations for all 50 states and U.S. territories.
A 2017 Prehospital Emergency Care journal article, State Regulation of Community Paramedicine Programs: A National Analysis, found varying consistency in scope of practice models and program requirements across the nation. For additional information or if you have questions on community paramedicine licensure or regulations in your state, contact your state EMS agency.
Beyond 911: State and Community Strategies for Expanding the Primary Care Role of First Responders describes the steps Minnesota, Maine, and Colorado have taken to address regulatory barriers for community paramedic initiatives.
Last Reviewed: 6/26/2018