Defining Sustainability in the Context of Community Paramedicine

Sustainability has long been a challenge for rural emergency medical service (EMS) providers. Low call volumes, long distances, and staff shortages have historically made it difficult to maintain profitable operations that offer lifesaving access to healthcare services, particularly when EMS is the sole safety net provider in rural communities. While community paramedicine may offer an alternative funding stream from standard EMS reimbursement mechanisms, it cannot replace the role and function of emergency medical treatment. To be sustainable, rural EMS providers interested in expanding their activities to include community paramedicine must have the capacity or flexibility to serve patients with regularly scheduled appointments, while continuing to address life-threatening emergencies that can arise at any time.

To achieve sustainability, rural community paramedicine programs will need to consider how to maintain their resources, staff, and partnerships. Sustainability can best be done by demonstrating value to potential funders, which might be partner organizations, government agencies, healthcare payers, and even residents who use the services. Evaluation will provide meaningful data that demonstrate the program's value and impact on the community.

Value can be defined differently depending on the needs of the community. What is most valuable — reducing 911 calls, lowering hospital readmissions, or improving access to primary care services, for example — depends on where there are pain points within the healthcare system. For example, if a community hospital sees a lot of uninsured emergency department patients who would be better served by primary care and social services, a community paramedicine program may be able to reduce the hospital's costs while ensuring that patients receive more appropriate care. Tailoring community paramedicine programs to high-value needs can help bring stakeholders into the sustainability planning process.