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Piloting Community Paramedicine

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University of California report recommends statewide pilot

Californians often say that California leads the country. It’s true that in some legislative initiatives, the state with the fourth largest gross national product in the U.S. has been a leader in new requirements and allowances, such as smog certification and gay rights. However, a recent University of California, Davis, report recommending that the state pilot 10–12 community paramedicine (CP) programs is an example of California borrowing from other states to alleviate its problems—specifically ones brought on by a burgeoning population and lack of healthcare access.

The UC Davis Institute for Population Health Improvement (IPHI) report “Community paramedicine: A promising model for integrating emergency and primary care” was led by Kenneth W. Kizer, MD, MPH, director of the IPHI and professor of emergency medicine in the UC Davis School of Medicine and Betty Irene Moore School of Nursing.

The feasibility study, which was released in July, states, “Early experiences with CP programs suggest that they may lead to more optimal use of EMS assets and offer some potential for diversification of the EMS funding base.”

The IPHI report specifies CP programs may result in more appropriate use of EMS, increased access for the underserved and additional opportunities for provider use of skills. “Expanding the role of paramedics is a very promising model of community-based care that uses existing healthcare workers in new and innovative ways,” Kizer said in a prepared statement. “It is a model of care that several other states and countries have implemented to better leverage the skills of paramedics to meet specific community needs and to help ensure that emergency departments are more appropriately utilized.”

The reason Chris Montera began his Colorado agency’s CP program was also to help solve an access-to-care issue. He says more than 25% of Eagle County residents are uninsured and only one of the primary care providers in the county accepts Medicare and Medicaid. In addition, the area hosts a large seasonal influx of tourists who bring their own health issues.

“Community paramedics help alleviate the access-to-care issue by providing low-cost or no-cost healthcare to people in their homes,” Montera says. “They fill a niche between home care and hospice and we see them as partners in our need to provide health care in the home. Community paramedics also alleviate the burden on frequent users in our system by providing social and other help from within the community.”

Skip Kirkwood was the EMS chief at Wake County (N.C.) EMS when the agency launched its community paramedicine program. Kirkwood says Wake County EMS didn’t pilot its community paramedicine program to solve a healthcare access problem. Rather, the program was conceived “to make sure that at least one ‘very experienced’ paramedic was available for each critical call.”

The three-person research team cites comments from a February stakeholder meeting and the results of a survey of EMS agencies when recommending that 10–12 pilot programs would be needed. “If CP pilot projects were to be undertaken, we believe that as many as 10 to 12 would be needed to provide sufficient diversity of program focus, geography, demography, and community partnerships.”

The community partnerships, and the improvement of paramedic skills, could be the keys for the California EMS community. “Community paramedicine is not just about healthcare,” Montera says. “It is about providing and linking health services like health, oral health, mental health and social services.”

—Jennifer Berry, NREMT-B

Names In The News

Marc Grossman, MD, has been named EMS medical director for Miami-Dade (County) Fire Rescue (MDFR) after serving as the assistant EMS medical director for the past few years.

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