Introduction To Community Paramedicine
Community Paramedic Pilot Project
Community paramedicine (CP) is a new and evolving model of community-based health care in which paramedics function outside their customary emergency response and transport roles in ways that facilitate more appropriate use of emergency care resources and/or enhance access to primary care for medically underserved populations. CP programs typically are designed to address specific local problems and to take advantage of locally developed linkages and collaborations between and among emergency medical services (EMS) and other health care and social service providers and, thus, are varied in nature. Interest in community paramedicine has substantially grown in recent years based on the belief that it may improve access to and quality of care while also reducing costs.
Some of the delivery system problems targeted by CP programs include overuse of the 911 system for social or psychological problems; the need for alternative means to manage patients who do not require transport to a general acute care hospital emergency department; repeat ED visits or hospital readmissions due to gaps in care between hospital and outpatient primary care or specialty management; limited or no capacity for short-notice home visits, especially during off hours; and supplementing primary care shortages in underserved areas.
Paramedics are presently trained to provide advanced life support services in an emergency setting or during inter-facility transfers. Currently, California Health and Safety Code (HSC 1797.52, 1797.218) limits paramedic scope of practice to emergency care in the pre-hospital environment. Moreover, patients under the care of a paramedic are required to be delivered to a general acute care hospital emergency department. The paramedic scope of practice in California is somewhat unique as compared to other licensed health professionals in that the statute refers to both a set of authorized skills/activities that emergency medical personnel may perform and the places and circumstances in which those skills/activities may be performed.
Several other countries and states around the U.S., including North Carolina, Colorado, Minnesota, Maine, and Texas, have implemented variations of Community Paramedicine or a comparable Advanced Practice Paramedic (APP) program. A full Community Paramedic training curriculum approximately 200 hours in length has been developed by Community Healthcare Emergency Cooperative (a multistate and multinational collaborative) and the North Central EMS Institute in Minnesota. These programs have demonstrated that paramedics can be trained to safely and effectively perform an expanded role.
Download: Community Paramedicine Fact Sheet
EMSA is pleased to release the final report entitled Community Paramedicine: A Promising Model for Integrating Emergency and Primary Care (July 2013), by the UC Davis Institute for Population Health Improvement, and funded by the California HealthCare Foundation.
This report is a culmination of work examining potential policy options for Community Paramedicine in California. EMSA would like to recognize the outstanding leadership and work of Dr. Ken Kizer, Director of the Institute for Population Health Improvement and his talented staff, Karen Shore, and Dr. Moulin. EMSA is also grateful for the continued vision and support of Sandra Shewry, Director of State Health Policy for the California HealthCare Foundation.
- Community Paramedicine Report [PDF]
- National Consensus Conference on Community Paramedicine: Summary of an Expert Meeting [PDF]
- "Beyond 911: State and Community Strategies for Expanding the Primary Care Role of First Responders", National Conference of State Legislatures (NCSL)
November 2014: The Emergency Medical Services Authority (EMSA) has received approval from the Office of Statewide Health Planning and Development (OSHPD) to pilot Community Paramedicine in 12 sites across California.
- Read the approval letter here
Pilot site projects have been provisionally selected to participate in the Community Paramedicine pilot, pending final approval under the Health Workforce Pilot Program and continued satisfactory development of the operational details and evaluation. Intense planning efforts are taking place with each of the pilot sites, the project manager, and the project evaluator to identify data collection requirements and discuss protocols and standardized training.
A listing of pilot sites, partnering medical providers, and services provided is available here
The Office of Statewide Health Planning and Development’s Health Workforce Pilot Projects program allows organizations to test, demonstrate and evaluate new or expanded roles for healthcare professionals or new healthcare delivery alternatives before changes in licensing laws are made by the Legislature.
Beginning in January 2015, Medical Director selected Paramedics will receive specialized training that builds upon the training and skill sets of experienced paramedics to include patient assessment, clinical skills and familiarity with the other healthcare providers and social services available in a local community, and will lead to a more integrated approach to health care delivery. Community paramedics will work under physician direction and approved patient care protocols to ensure patient safety while providing the right level of care for each patient. OSHPD and EMSA have convened a Statewide Advisory Committee to provide oversight of the pilot program to ensure patient safety.
June 2015: Pilot sites will begin providing Community Paramedic services.
The pilot project is approved for one year with the option to apply for an additional year if warranted.
Throughout the pilot project, a comprehensive evaluation will be performed by the Phillip R. Lee Institute for Health Policy Studies and Center for the Health Professions, the UC San Francisco based independent project evaluation team engaged through a grant from the California HealthCare Foundation.
June 2017: A final pilot report will be issued by the UC San Francisco evaluation team, and the OSHPD-HWPP program.
Health Workforce Pilot Project Application Information
The Office of Statewide Health Planning and Development (OSHPD), Health Workforce Pilot Project (HWPP) program staff recommendation has been released to the OSHPD Director regarding HWPP #173.
- Read the Notice and Recommendation to the OSHPD Director. Public comment must be submitted to OSHPD by November 12, 2014.
In February 2014, EMSA submitted a complete application to OSHPD to request approval to pilot Community Paramedicine through the Health Workforce Pilot Projects (HWPP) program. The application has not been approved and is currently under review by OSHPD as HWPP application #173. It can be viewed at the following link:
EMSA Community Paramedicine application to HWPP [PDF]
Visit OSHPD's website to learn more about HWPP and to review an Abstract of this project at: http://www.oshpd.ca.gov/hwdd/HWPP.html
Letter of Intent [PDF]
Community Paramedic training curriculum can be obtained by request at the following site http://communityparamedic.org/
This curriculum was developed by The Community Healthcare and Emergency Cooperative (CHEC), providing a standardized curriculum that colleges in any state, province or nation can customize for their own program. The curriculum has been used nationally, and may be used as a core curriculum platform for Community Paramedic pilot projects in California.
For questions regarding Community Paramedicine, please contact:
Community Paramedicine-Mobile Integrated Healthcare
Mobile: (209) 507-2386
Office: (916) 431-3709
Personnel Standards Manager, EMSA
Phone: (916) 431-3707