What if we are Community Paramedics Already?
At my real job the other day, I was offered a chance to participate in a state-wide summit on community paramedicine. Our state ambulance leadership is interested in understanding how other community paramedic programs are operating and whether this model is appropriate for Michigan.
This got us talking around the office about what, exactly, a community paramedicine program is. Community paramedicine has been in the news lately as state after state (most recently Maine) looks at the usefulness of developing such a program. Issues with funding and reimbursement as well as educational standards not withstanding, let’s look at what a community paramedic was intended to be. According to communityparamedic.org:
The Community Healthcare and Emergency Cooperative (CHEC) formed in July 2007 to address critical health care shortages in rural and remote areas—specifically by developing a new community health provider model.
Now this is all well and good, but I work in a largely urban/suburban system. What if I want a community paramedic program? A search for the term “urban” on the CHEC site turns up:
Now the International Roundtable on Community Paramedicine site states:
While its focus is on rural and remote medicine, the lessons learned may prove beneficial to the better provision of urban health care.
And I couldn’t agree more. The goal of a community paramedic program seems to be providing care to fill a gap in a particular community. While many of the existing and proposed programs are focused on the rural environment, why can’t we do the same in urban systems? In fact, what if we’re already doing this in an urban system?
When I worked in Alameda County, my manager Mike Taigman developed a program to send EMTs and paramedics into the homes of chronic adult asthma patients to work on educating them in “asthma-proofing” their homes. The county offered a similar program for children, but nothing for adults. Find a need and fill it.
Here in Grand Rapids, crews are able to take indigent and intoxicated patients to a sobering center staffed by nurses and EMTs to reduce load on the local emergency rooms. The hospitals subsidize the cost of the program because it provides a direct benefit to the community. Find a need and fill it.
At the end of the day, the term “community paramedic” is more of a buzz word than anything else. With state legislators becoming involved we are at an increased risk of building a “one size fits none” program by blindly patterning it off of existing programs. Each community needs to define what they need from their EMS practitioners both for emergency and non-emergency care. If we rush into implementing community paramedicine before we establish a usefulness and a need, then all we will do is prove that a system which worked in rural Minnesota doesn’t work in metro New York City. We are so interested in changing what we do now that we haven’t looked carefully at what we ARE doing that takes us outside traditional 911 response.
What about your system? Do you function outside of the traditional EMS realm already? Are you considering a community paramedic program? Who is guiding that process? Let me know in the comments.