Community Paramedicine & Triage to Alternate Destination
Community Paramedicine (CP) is an innovative and evolving model of community-based healthcare designed to provide more effective and efficient services at a lower cost. Community paramedicine allows paramedics to function outside their traditional emergency response and transport roles to help facilitate more appropriate use of emergency care resources while enhancing access to primary care for medically underserved populations. The Triage to Alternate Destination (TAD) Program offers people who have behavioral health needs, but no emergent medical needs, transport to a mental health crisis center instead of an emergency department (ED) after screening by the Community Paramedic. TAD also offers transport to Sobering Centers in response to 911 calls; people who are acutely intoxicated but do not have acute medical or mental health may receive transport directly to a sobering center for monitoring instead of to an ED.
What is Community Paramedicine?
“Community paramedicine program” means a program developed by a local EMS agency and approved by the Emergency Medical Services Authority to provide community paramedicine services consisting of one or more program specialties, under the direction of medical protocols developed by the local EMS agency that are consistent with the minimum medical protocols established by the authority.
Currently Approved Community Paramedicine Programs
| LOCAL EMERGENCY MEDICAL SERVICES AGENCY (LEMSA) | TYPE OF PROGRAM: TRIAGE TO ALTERNATE DESTINATION (TAD) AND/OR COMMUNITY PARAMEDICINE (CP) | TYPES OF SERVICES | TAD FACILITY NAMES | DATE OF EMERGENCY MEDICAL SERVICES AUTHORITY (EMSA) APPROVAL | ACTIVE PROGRAM (Y/N) |
|---|---|---|---|---|---|
| CENTRAL CALIFORNIA EMERGENCY MEDICAL SERVICES AGENCY (CCEMSA) (pdf) | TRIAGE TO ALTERNATE DESTINATION (TAD) | BEHAVIORAL HEALTH SOBERING CENTER MENTAL HEALTH POST DISCHARGE FREQUENT 911 | FRESNO COUNTY BEHAVIORAL HEALTH DEPARTMENT CRISIS STABILIZATION CENTER (CSC) | 6/5/2024 | YES |
| LOS ANGELES EMERGENCY SERVICES (LAEMS) (pdf) | TRIAGE TO ALTERNATE DESTINATION (TAD) | BEHAVIORAL HEALTH SOBERING CENTER MENTAL HEALTH | DAVID. L MURPHY SOBERING CENTER EXODUS EASTSIDE (USC), WESTSIDE, HARBOR AND MLK STAR VIEW LONG BEACH, CITY OF INDUSTRY& LANCASTER | 1/11/2024 | YES |
| SACRAMENTO COUNTY EMS AGENCY (SCEMSA) (pdf) | TRIAGE TO ALTERNATE DESTINATION (TAD) | BEHAVIORAL HEALTH MENTAL HEALTH SOBERING CENTER VETERAN'S EMERGENCY DEPT | SACRAMENTO COUNTY MENTAL HEALTH TREATMENT CENTER SIERRA VISTA HOSPITAL WELLSPACE HEALTH | 8/16/2024 | YES |
| SAN FRANCISCO EMERGENCY MEDICAL SERVICES AGENCY (SFEMS) (pdf) | COMMUNITY PARAMEDICINE (CP) & TRIAGE TO ALTERNATE DESTINATION (TAD) | BEHAVIORAL HEALTH SOBERING CENTER MENTAL HEALTH POST DISCHARGE FREQUENT 911 VETERAN'S EMERGENCY DEPT | SAN FRANCISCO DEPT OF PUBLIC HEALTH ALCOHOL SOBERING CENTER, SF VETERANS AFFAIRS MEDICAL CENTER | 9/7/2023 | YES |
| STANISLAUS EMERGENCY MEDICAL SERVICES AGENCY (pdf) | TRIAGE TO ALTERNATE DESTINATION (TAD) | BEHAVIORAL HEALTH MENTAL HEALTH POST DISCHARGE FREQUENT 911 VETERAN'S EMERGENCY DEPT | STANISLAUS COUNTY BEHAVIORAL HEALTH CRISIS CENTER | 12/28/2023 | YES |
FREQUENTLY ASKED QUESTIONS
1. I am a service provider, interested in developing a program in my area. How do I get started?
Please contact your LEMSA
2. I am a community member, interested in developing a program in my area. How do I get started?
Please contact your LEMSA
3. Questions regarding EMS Personnel training and accreditation? Contact:
Laura Aceves
CP & TAD Personnel Coordinator
EMS Personnel Standards Unit, EMSA
laura.aceves@emsa.ca.gov
(916) 903-9294
4. Questions regarding data requirements? Contact:
Adrienne Kim
Data and Quality Improvement Unit Manager
adrienne.kim@emsa.ca.gov
(916) 431-3742
5. May I share the resources found here?
Yes, resources on this page such as the Toolkits are intended for public distribution.
6. Is there funding available for CP/TAD Programs
Yes, the CARESTAR Foundation seeks to support the expansion of CP and TAD programs across California by providing funding to LEMSAs that pursue CP and/or TAD programs.
Please refer to the CARESTAR website for more information https://www.carestarfoundation.org/cp
What is Triage to Alternate Destination?
Currently Approved Triage to Alternate Destination Programs
| LOCAL EMERGENCY MEDICAL SERVICES AGENCY (LEMSA) | TYPE OF PROGRAM: TRIAGE TO ALTERNATE DESTINATION (TAD) AND/OR COMMUNITY PARAMEDICINE (CP) | TYPES OF SERVICES | TAD FACILITY NAMES | DATE OF EMERGENCY MEDICAL SERVICES AUTHORITY (EMSA) APPROVAL | ACTIVE PROGRAM (Y/N) |
|---|---|---|---|---|---|
| CENTRAL CALIFORNIA EMERGENCY MEDICAL SERVICES AGENCY (CCEMSA) (pdf) | TRIAGE TO ALTERNATE DESTINATION (TAD) | BEHAVIORAL HEALTH SOBERING CENTER MENTAL HEALTH POST DISCHARGE FREQUENT 911 | FRESNO COUNTY BEHAVIORAL HEALTH DEPARTMENT CRISIS STABILIZATION CENTER (CSC) | 6/5/2024 | YES |
| LOS ANGELES EMERGENCY SERVICES (LAEMS) (pdf) | TRIAGE TO ALTERNATE DESTINATION (TAD) | BEHAVIORAL HEALTH SOBERING CENTER MENTAL HEALTH | DAVID. L MURPHY SOBERING CENTER EXODUS EASTSIDE (USC), WESTSIDE, HARBOR AND MLK STAR VIEW LONG BEACH, CITY OF INDUSTRY& LANCASTER | 1/11/2024 | YES |
| SACRAMENTO COUNTY EMS AGENCY (SCEMSA) (pdf) | TRIAGE TO ALTERNATE DESTINATION (TAD) | BEHAVIORAL HEALTH MENTAL HEALTH SOBERING CENTER VETERAN'S EMERGENCY DEPT | SACRAMENTO COUNTY MENTAL HEALTH TREATMENT CENTER SIERRA VISTA HOSPITAL WELLSPACE HEALTH | 8/16/2024 | YES |
| SAN FRANCISCO EMERGENCY MEDICAL SERVICES AGENCY (SFEMS) (pdf) | COMMUNITY PARAMEDICINE (CP) & TRIAGE TO ALTERNATE DESTINATION (TAD) | BEHAVIORAL HEALTH SOBERING CENTER MENTAL HEALTH POST DISCHARGE FREQUENT 911 VETERAN'S EMERGENCY DEPT | SAN FRANCISCO DEPT OF PUBLIC HEALTH ALCOHOL SOBERING CENTER, SF VETERANS AFFAIRS MEDICAL CENTER | 9/7/2023 | YES |
| STANISLAUS EMERGENCY MEDICAL SERVICES AGENCY (pdf) | TRIAGE TO ALTERNATE DESTINATION (TAD) | BEHAVIORAL HEALTH MENTAL HEALTH POST DISCHARGE FREQUENT 911 VETERAN'S EMERGENCY DEPT | STANISLAUS COUNTY BEHAVIORAL HEALTH CRISIS CENTER | 12/28/2023 | YES |
Triage to Alternate Destination Toolkits
FREQUENTLY ASKED QUESTIONS
1. I am a service provider, interested in developing a program in my area. How do I get started?
Please contact your LEMSA
2. I am a community member, interested in developing a program in my area. How do I get started?
Please contact your LEMSA
3. Questions regarding EMS Personnel training and accreditation? Contact:
Laura Aceves
CP & TAD Personnel Coordinator
EMS Personnel Standards Unit, EMSA
laura.aceves@emsa.ca.gov
(916) 903-9294
4. Questions regarding data requirements? Contact:
Adrienne Kim
Data and Quality Improvement Unit Manager
adrienne.kim@emsa.ca.gov
(916) 431-3742
5. May I share the resources found here?
Yes, resources on this page such as the Toolkits are intended for public distribution.
6. Do I need to provide all of the training outlined, even if some categories are not applicable to the type of program I am applying for? For example, my program only transports psych patients, do I need to provide training that relates to alcohol or other substance use?
Instructors are required to teach all topics listed in section 100189. It is recommended that primary instruction and time is spent focused on the topics most relevant to the services being provided.
The regulation requirements include these topics due to the known association between behavioral health diagnosis and substance use, particularly when patients are in “crisis” or during “emergency” situations. Students should receive training in the screening, assessment, interventions, and response of co-occurring mental health and substance use to help them determine when substance use, for example, may preclude transfer to a behavioral health center.
7. Are there a certain number of hours required for the TAD Training Program?
We don’t require a minimum number of hours. We defer to the LEMSA and the training provider to ensure the topics required are covered in whatever time they find is in the best interest of their students.
8. Is there funding available for CP/TAD Programs
Yes, the CARESTAR Foundation seeks to support the expansion of CP and TAD programs across California by providing funding to LEMSAs that pursue CP and/or TAD programs.
Please refer to the CARESTAR website for more information https://www.carestarfoundation.org/cp
Questions? Email EMSA's CP and TAD Program Manager
Contact the CP and TAD Program Manager:
Candace Keefauver
Candace.Keefauver@emsa.ca.gov
(916) 969-6669
Related Links
Contact UsProgram History
Community Paramedicine and Triage to Alternate Destination programs began as pilot projects in 2014, when the Office of Statewide Health Planning and Development’s (OSHPD) Health Workforce Pilot Project Program temporarily waived sections of the Health and Safety Code and approved the CP pilot study. Previously, paramedics were unable to work in any setting other than at the scene of an emergency or while transporting patients. OSHPD’s approval allowed EMSA to test the effectiveness and safety of community paramedicine.
In November of 2023 these programs became fully realized through the approval and implementation of CCR, Title 22: Division 9. Chapter 5: Community Paramedicine and Triage to Alternate Destination.