Community paramedicine is an emerging healthcare profession. It allows paramedics and emergency medical technicians (EMTs) to operate in expanded roles to provide routine healthcare services to underserved populations, and helps to improve rural emergency medical services (EMS).
Some rural patients lack access to primary care, and use 911 services for non-urgent healthcare. This is a burden for volunteer EMS personnel in rural areas. Community paramedics who work in a primary care role can meet the needs of rural residents in a more efficient and proactive way.
This topic guide:
- Defines community paramedicine and community paramedics
- Outlines issues and challenges faced by rural community paramedics
- 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
Frequently Asked Questions
- What is community paramedicine and how can this type of program benefit rural communities?
- 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 paramedic program?
- Are there examples and models of rural community paramedic programs?
- What considerations are there related to licensure and regulation when starting a community paramedicine program?
What is community paramedicine and how can this type of program benefit rural communities?
Community paramedicine helps fill gaps in local healthcare by using existing providers in expanded roles. Community paramedics generally focus on:
- Providing primary care
- Post-discharge follow-up care
- Integration with local public health agencies
- Providing education and health promotion programs
Paramedics and EMTs in rural communities are trusted and respected for their medical expertise, and are often consulted for healthcare advice by their friends and neighbors. The skills they develop in their role as first responders can be equally useful to them as providers of primary care. For example, the technique used to administer an injection in an emergency situation is also used for routine inoculations.
The community paramedicine model can benefit rural EMS agencies by:
- Reducing requests for non-urgent services that are not reimbursed
- Decreasing the amount of “down time” between calls, while better serving residents' primary care needs
- Increasing revenue by billing patients or third party payers for services provided, when appropriate
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 emergency condition over 30 to 60 minutes. To participate effectively in the medical home care team, they need additional education focused on providing longer term care.
A standard curriculum is available free of charge to colleges and universities. It consists of approximately 114 hours of 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.
Additions to this curriculum will be available in early 2017 and will focus on EMTs and Community Paramedics who are focusing on only 911 callers in such ways as treat and release, treat and refer, or assess and report. Each course is 80 hours long and is drawn from the existing Community Paramedic course. This additional curriculum will change the branding of Community Paramedics. EMTs who complete the 80-hour course will be known as Primary Care Technicians. Paramedics who complete their version of the 80-hour course will be called Community Paramedic Technicians. Paramedics who complete the 314-hour course will be called Community Paramedic Clinicians.
The Paramedic Foundation and Paramedic Health Solutions have announced the innovative, standards-based, 2017 Community Paramedicine National Curriculum and Career Pathway. The Community Paramedicine Curriculum introduces appropriately designated levels of certificate and degree programs; entry level through doctorate. More information is available at Mobile CE.
How are rural community paramedicine programs funded?
Most community paramedicine programs are funded 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 some states allow reimbursement for certain services, according to the National Conference of State Legislatures.
Some hospitals and hospital-owned ambulance units support community paramedicine programs in the belief that there will be a reduction in readmissions and emergency department misuse. In urban areas, some Accountable Care Organizations (ACOs) contract with ambulance companies for the use of 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.
In a hospital or clinic setting, patient care provided by credentialed community paramedics is reimbursable, just as it is for other allied health professionals.
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?
There are many free online resources that organizations can use to inform their community paramedicine programs:
- Community Paramedicine Program Handbook – Includes information about program planning and feasibility, state regulations, and more.
- International Roundtable on Community Paramedicine – Website includes articles, presentations, and other resources on community paramedics.
- Community Paramedicine Insights Forum – Monthly webinar and discussion forum related to experiences in implementing community paramedicine programs. Includes archive of past webinars.
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 Minnesota Department of Health sponsored a CMMI funded project to create an employer's toolkit to starting a Community Paramedic program. While there is some information in the toolkits that is specific to Minnesota, much of the information can be used nationally.
Are there barriers to starting a rural community paramedic program?
Lack of 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 instead focus on filling gaps and working in cooperation with 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?
The Rural Health Information Hub's Rural Project Examples: Community Paramedics page features examples of successful programs. In addition, an archive of webinars and conference calls featuring model community paramedic programs can be found at Community Paramedic.
Some examples of successful rural programs are:
- Eagle County Paramedic Services – Located in Colorado, this program has been featured in many news outlets, including the Rural Monitor article, Community Paramedics Widen Medical Services in Rural Areas
- Humboldt General Hospital EMS Rescue – Hospital-based EMS unit located in Winnemucca, Nevada. Director Pat Songer is featured in this MedicCast YouTube video, which discusses the community paramedicine program:
- Examples of rural programs in Minnesota can be found in the Minnesota Community Paramedic Employer's toolkit.
What considerations are there related to licensure and regulation when starting a community paramedicine program?
Licensure and regulations for community paramedicine programs vary by state. Typically, practicing community paramedicine is considered an expanded role for paramedics and EMTs rather than requiring an expanded scope of practice. However, in some states, new laws or updated regulations have been necessary to accommodate this new model. Beyond 911: State and Community Strategies for Expanding the Primary Care Role of First Responders tells of the steps Minnesota, Maine, and Colorado have taken to address regulatory barriers for community paramedic initiatives.
For further information, or if you are unsure of your state's laws, contact your state EMS agency.
Last Reviewed: 2/3/2017