Community Paramedicine: Bridging the Gap for Those with Little Healthcare Options

It’s estimated that 75 million people in America have health care needs that far exceed their access to necessary intervention. A disproportionate number of elderly, impoverished families, immigrants and then homeless have to turn to using 911 and ED visits to manage their chronic problems. And the wheels of social services turn very slowly sometimes.

That’s no secret to EMS workers; paramedics have long known the “frequent flyers” in their coverage areas, and face the daily problem of having their hands tied when it comes to helping them. The patients in underserviced areas and poor communities without any other healthcare options have to turn to 911-ambulance transport and ED visits in order to receive care. And it places undue burden on an already overtaxed system.

But what if we could do something different? Provide preventative care and education for these patients and reduce the impact on our agencies? Several departments around the country have turned to pilot community paramedicine programs as a way to try and combat this very issue. States like Colorado, North Carolina, Minnesota, Maine, Texas, California and Florida have all placed these pilot programs in motion. And the beta-testing data has been surprising. In one Colorado response area, for example, they found that community paramedicine saved $1,250 per each of 27 patients for one year, a health care savings of over $36,000.

So what is it and how does it work? Community paramedicine is a program in constant flux, a model of community-based healthcare that sees paramedics treating outside their usual emergency response and transport job functions. It involves partnerships between other healthcare providers, law enforcement and social services to get much-needed care to underserved and underprivileged areas, where patients lack any other outlet for primary care.

Of course, community paramedics wouldn’t be freelancing independently; they would still be working under the auspices of their medical control physician and receive additional training (and in some cases, an additional certification) to go out and provide this preventative healthcare. And, they wouldn’t be replacing other healthcare workers, simply enhancing the efficacy of service delivery.

Community paramedicine programs were born because of 911 overuse in underserviced areas that see a steady increase in patients using paramedics as their only source of healthcare. By extension, these individuals are using the EDs to treat chronic and non-emergent problems that would normally be handled in a primary care physician’s office.

emt-workIt’s a no-brainer that the poorer sections of our various response districts have large gaps in access to adequate healthcare. But what if we could lower response costs, reduce the burden on the local EDs and give the needy that desperately needed access to preventative healthcare?

And 911 overuse, as we are all aware, exacts a toll on every aspect of health care, from ambulance transports to ED visits to other community-based health systems. People with primary care physicians get preventative care. And the goal of preventative care is to keep you out of the hospital.

So how does community paramedicine work? All pilot programs are different of course, based on the demographics of their coverage areas, but they are all based on the same evolving model, which has four components:

(1) Situational Assessment

  • Vital signs
  • Blood pressure monitoring and education
  • Prescription drug compliance monitoring
  • Determining patient risks (falls, unable to care for self, etc.)

(2) Interventions

  • Breathing treatments
  • Wound care and dressing changes
  • Patient education
  • IV (port/PICC line/dialysis shunt access) assessment and monitoring

(3) Referrals

  • Mental Health services
  • Substance abuse facilities
  • Social Services

(4) Prevention and Public Health

  • Immunizations
  • Well Baby Checks
  • Asthma management
  • Oral health care
  • Disease assessment and investigation

Then what is stopping agencies from starting these pilot community paramedicine programs? As with any impetus for change, so too come the obstacles. The first one is money. These pilot programs do not receive reimbursement from traditional health insurance companies, rather they have to rely on state and grant funding, which is sometimes not easy to obtain.

There are also regulatory obstacles. State statutes and/or local medical direction may have to rewrite the rules and decide on what additional training is needed to allow a pilot program like this to exist. Workforce shortage is another big issue. Agencies are overworked and understaffed, and a community paramedicine pilot program would mean the hiring of additional personnel, which brings us back to the money problem. And those paramedics participating in a pilot program such as this may be required by their medical direction to obtain an additional certification, ‘Certified Community Paramedic.’

Schools that offer this certification have popped up across the county. In St. Cloud, MN, one of the first states to launch a community paramedicine pilot program, the North Central EMS Institute partners with accredited colleges and universities to offer the CC-P patch. The curriculum includes primary care, public health issues, immunizations, disease management and prevention, health and wellness patient education, mental health and oral health.

A little researching around tells me that there is federal and state funding for community paramedicine pilot programs, it is just a matter of finding it once you have a proper business model and grant proposal on paper, and the necessary regulatory changes approved. Something for agencies to consider, given the statistical evidence of system strain due to patients with no access to preventative healthcare.

Disclaimer: The content in this article is the opinion of the writer and does not necessarily reflect the policies or opinions of US Patriot Tactical.

Leah Dallaire

Leah G. Dallaire is a highly accomplished freelance writer, editor and consultant with 28 years of experience. She has also concurrently been a paramedic for 20 years; the last 17 she spent serving the citizens of Pinellas County, Florida, which has a call volume of about 209,000 runs per year. She holds an M.A. and a B.A. in Writing & Literature from Union University. She has also just finished her first novel.
Leah Dallaire

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