Community Paramedicine & the Changing Face of EMSBy Nora Vanni

August 26, 2013

David Johnson, CP, CCEMT-P, Hennepin County Medical CenterCommunity paramedicine is an emerging field in EMS that providers across the country are beginning to adopt. The movement has been greeted with both excitement and trepidation. One contributing factor to the trepidation is confusion about what the term implies: just what is community paramedicine?

I sat down with David Johnson, CP, CCEMT-P, a tenured paramedic with Hennepin County Medical Center in Minneapolis, MN. After months of training and planning, he’s poised to begin work as HCMC’s first community paramedic.

When asked what exactly “community paramedicine” means, Johnson explains that the concept means just what its name suggests: it reflects the needs and gaps in service that appear in the local community. This means that the urban and rural variations of community paramedicine look very different.

“The initial concept was to take it down to the rural communities--like you go to the middle of Montana and there are no paramedics for 100 miles. I went to paramedic school with a guy from Montana who worked as a flight EMT--which is not a very common thing, ever--in Glasgow, Montana, and they don’t have paramedics out there,” says Johnson.

Areas such as rural Montana are so sparsely populated that it isn’t cost effective for healthcare providers to staff their EMS response teams with paramedics. In addition, primary care resources are few and far between. “It might be an hour drive to go see your regular doctor,” clarifies Johnson. Coupled with their limited access to prehospital ALS, rural communities often can’t access the resources many urban communities take for granted.

This gap in service is where community paramedicine was born: a new healthcare outreach effort designed to reach underserved populations with both primary care resources and improved prehospital care. The new outreach system aspires to address these needs in a more effective manner: by minimizing cost to providers and patients and ensuring a high quality of care.

Johnson adds, “Out there, they’re using it as a resource to connect patients with primary care resources by embedding a paramedic in the community. This also allows that community to have a paramedic on the ambulance, so it gives them two different roles.” This cost-effective incentive inspired the introduction of paramedics to rural communities.

HCMC’s urban adaptation of community paramedicine was heavily influenced by the legislation created by Mobile Healthcare in Fort Worth, Texas. The collaboration between HCMC and Mobile Healthcare reflects one of the cornerstone principles of this emerging field: sharing and combining ideas to encourage the growth of community paramedicine.  As Dave said in a follow-up email, “community paramedicine aspires to remain an ‘open source’ concept that can be shared amongst peers in EMS. Minneapolis learned from Texas, and in turn, Indianapolis EMS providers are in the process of building community paramedic resources by following the footsteps of Minneapolis’ model.”

Some in the EMS community have greeted community paramedicine with a degree of apprehension, primarily because of the varied nature of the concept. Currently, community paramedicine lacks a standardized curriculum or certification process. This is both a strength and weakness of the concept: programs from state to state can be adapted to meet the exact needs of the community, but cannot reflect a standardized certification at the “community paramedic” level.

However, with recent changes to health care legislation in the United States, proponents say that community paramedicine can effectively fill gaps unfulfilled by existing EMS services. One influential factor in the development of community paramedicine has been the move from the “pay for service” model to new legislation that offers incentives based on quality of care. Johnson explains, “Now you're incentivized to provide better service, better care--not more care. So, now, with these readmission rules that they're coming in with, where a patient comes into the hospital for, let's say, congestive heart failure, and then they get dismissed from the hospital, if they come back to the hospital within thirty days for the same thing, the hospital not only has to eat the cost of that second visit, they also could potentially be fined with decreased medicare reimbursement. So it's a huge issue.”

Johnson predicts that it’s the “safety-net” hospitals, the hospitals whose patient populations are harder to reach with primary care resources, which will end up hurting the most from these legislative changes. Hopefully, he says, community paramedicine can help address some of the gaps in primary care without the penalty falling on struggling hospitals.

More than anything, Johnson is excited for the new opportunities community paramedicine presents for EMS. “In the entire course of my career I never thought I could be excited by primary care. Because primary care is generally regarded as being boring, you know.”

But the more he worked in the field, the more Johnson saw the correlation between lacking primary care resources and strained hospitals. He hopes that community paramedicine can address this gap. “At the end of the day, once you realize how much of this stuff comes together, you finally understand why these things are actually happening.”

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