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Community Paramedicine

Community paramedicine is a healthcare model that allows paramedics and emergency medical technicians (EMTs) to operate in expanded roles by assisting with public health and primary healthcare and preventive services to underserved populations in the community. The goals are to improve access to care and to avoid duplicating existing services.

Some rural patients lack access to primary care and use 911 and emergency medical services (EMS) to receive healthcare in non-emergency situations. This can create a burden for EMS personnel and health systems in rural areas. Community paramedics can work in a public health and primary care role to address the needs of rural residents in a more efficient and proactive way.

This topic guide defines community paramedicine and outlines challenges faced in rural areas. It also discusses community paramedicine models and existing programs, while providing resources for starting a rural community paramedicine program, such as education and curriculum requirements.

Frequently Asked Questions

What is community paramedicine? How can a community paramedicine program benefit rural communities?

Though there are differences from program to program, a working definition of a community paramedic from the Joint Committee on Rural Emergency Care (JCREC) is:

“…a state licensed EMS professional that has completed an appropriate educational program and has demonstrated competence in the provision of health education, monitoring and services beyond the roles of traditional emergency care and transport and in conjunction with medical direction. The specific roles and services are determined by community health needs and in collaboration with public health and medical direction.”

Community paramedics generally focus on:

  • Providing and connecting patients to primary care services
  • Providing in-home visits to people who have chronic and complex medical conditions
  • Completing post-hospital follow-up care
  • Integration with local public health agencies, home health agencies, health systems, and other providers
  • Providing education and health promotion programs
  • Providing services not available elsewhere in the community

The flexibility of the community paramedicine model allowed community paramedics to play a key role in addressing the healthcare needs of their communities during the COVID-19 pandemic.

Paramedics and EMTs in rural communities are trusted and respected for their medical expertise and the emergency care they provide, and are generally welcome in patients' homes. These professionals are often consulted for healthcare advice by their friends and neighbors. Their skill set can be equally useful to them in addressing unmet needs for primary care services in the community. For example, the technique used to administer an injection in an emergency situation is the same used for routine inoculations.

The community paramedicine model can benefit rural EMS agencies by:

  • Reducing 911 requests for non-urgent, non-transport services that are not reimbursable as emergency services
  • Decreasing the downtime between calls, using their medical skills and expertise, and improving access to providers to meet the community's primary care needs
  • Increasing revenue by billing patients or third-party payers for services provided, when appropriate

The 2014 Flex Monitoring Team briefing paper No. 34, The Evidence for Community Paramedicine in Rural Areas: State and Local Findings and the Role of the State Flex Program, describes two principal models of community paramedicine programming, both of which can address the needs of rural communities. The primary healthcare model “focuses on providing services to help prevent hospital readmissions, including post-discharge care, monitoring chronic illness, and targeting specific high-risk patients.” The community coordination model works to “connect patients to a primary care physician and other social and medical services.” Rural community paramedicine programs can incorporate aspects of both models to meet the needs of their community.

A 2016 Journal of Health Care for the Poor and Underserved article, What is the Potential of Community Paramedicine to Fill Rural Health Care Gaps?, describes aspects of community paramedicine practices in rural areas, including service area characteristics, program goals, and services offered. The article discusses beneficial outcomes for rural communities reported by community paramedicine program leaders, including reductions in hospital readmissions, cost per patient, number of transports avoided, and emergency department visits.

Home health agencies in communities where the community paramedicine model has been implemented have learned that community paramedicine can address the needs of patients who do not qualify for home health and can be a source of referrals for patients who do. Many CP programs work hand-in-hand with home health providers and may be dispatched by them.

Is mobile integrated healthcare the same as community paramedicine?

The term mobile integrated healthcare (MIH) is often used interchangeably with community paramedicine, particularly outside of the EMS community. However, MIH is broader, including healthcare services provided outside of a healthcare facility by any type of health professional, which could include community paramedics, but also nurses, community health workers (CHWs), and other professionals. Some organizations use the combined term mobile integrated healthcare and community paramedicine (MIH-CP).

An MIH approach often starts with a triage professional who assesses the needs of a caller. If the call is through a 911 system and is determined to be a non-emergency by the call-taker, it is referred to the MIH triage. The MIH triage person then evaluates the situation and determines what type of care is most appropriate. This might mean intervention by a community paramedic, nurse practitioner, social worker, or a team. Finally, the MIH representative makes other arrangements to connect the patient with a professional who can best meet the caller's needs, which might include vouchers or other transportation assistance to appropriate sources of care.

Community paramedics can play a role as part of the hospital-at-home (HaH) clinical care model, also known as Advanced Care at Home (ACH). This type of care is effective for patients who are sick enough to require hospital-level care but are stable enough to be safely monitored from their own homes. It is particularly beneficial for elderly patients or those with cognitive impairment, who might find a traditional hospital stay to be stressful. In this model, a physician is assigned responsibility for the patient's care, and other team members are chosen based on the patient's needs. Medicare regulations specify that the patient be evaluated daily through telemedicine contact or in person, and receive twice daily home visits by a nurse or mobile integrated health paramedic.

For more information about the hospital-at-home model, see the American Hospital Association issue brief Creating Value by Bringing Hospital Care Home.

What is the role of a community paramedic, and what type of education is required for this profession?

Community paramedics function as fully participating members of a patient's medical home care team.

As first responders, EMTs and paramedics are trained to focus primarily on managing a patient's immediate emergency medical condition. To participate effectively in a medical home care team approach, they need additional education and training focused on providing care over a longer period of time, such as for managing chronic health conditions. Filling Gaps and Avoiding Duplication: Community Paramedics and Ambulance Services further discusses the role of community paramedics.

A national consensus standard curriculum is available free of charge to colleges and universities. It features two phases:

  • Phase I, emphasizing foundational skills and consisting of approximately 100 hours, based on prior experience
  • Phase II, focusing on clinical skills and consisting of 15 to 146 hours, based on prior experience

Topics include:

  • Social determinants of health
  • Public health
  • Chronic diseases
  • Community assessments
  • Strategies for managing care
  • Disease prevention

Another curriculum focuses on EMTs and paramedics whose community paramedicine programs are addressing only 911 callers in such ways as treat and release, treat and refer, or assess and report. The paramedic course is 88 hours long and is drawn from modules of the existing community paramedic course. This additional curriculum has changed the branding of community paramedics. EMTs complete a 44-hour course and are known as Primary Care Technicians (PCTs). Paramedics who complete their version of the 88-hour course are called Community Paramedic Technicians (CPTs). Paramedics who complete the original 300-hour course are now called Community Paramedic Clinicians (CPCs).

Mobile CE, a nonprofit college and university education network, provides community paramedicine academic programs. Programs range from certificate level to PhD degree.

Some community paramedicine programs focus narrowly on one or two community health needs, and train their paramedics to respond to only these needs. As community paramedicine evolves, the standards of care and education will also evolve.

How are rural community paramedicine programs funded?

Most community paramedicine programs are funded by the ambulance service or hospital itself, through grants or insurance plans. Some hospitals and hospital-owned EMS programs support community paramedicine to reduce readmissions and emergency department use. Some Accountable Care Organizations (ACOs) contract with ambulance companies to use community paramedics or employ them directly. EMS agencies can work directly with ACOs and insurance companies in their area to determine whether they will receive reimbursement for community paramedicine services. Patient care provided by credentialed community paramedics in a hospital or clinic may be reimbursable, just as it is for other allied health professionals. Several states now provide coverage for community paramedic visits under their Medicaid programs.

Some commercial health insurance providers reimburse for, or fund services providing, community paramedicine. However, adequate funding remains a challenge. In a 2023 survey of EMS agencies in 40 states, the National Association of Emergency Medical Technicians reported that despite the proven value of MIH-CP programs, many agencies never initiated a program or discontinued their programs due to lack of sustainable funding.

For more information on how rural community paramedicine programs are funded, see the Flex Monitoring Team policy brief Community Paramedicine in Rural Areas: State and Local Findings and the Role of the State Flex Program and the National Rural Health Resource Center document Implementing and Sustaining Rural Community Paramedicine.

How does an organization start a rural community paramedicine program?

Several organizations offer resources that can be used to guide the development of a community paramedicine program but ultimately each program should be tailored to address the specific needs of the community it serves. Some organizations may choose to work with consultants. Prior to hiring an outside expert, organizations should have a clear understanding of the potential consultant's capabilities and experience in designing and implementing programs.

  • The Community Paramedicine Program Manual includes information on topics for consideration when planning and implementing a community paramedicine program. These include program planning and feasibility, state regulations, assessing community needs, budgeting, policy development, training, beginning operations, and more.
  • The International Roundtable on Community Paramedicine provides articles, data sets, presentations, research, and other resources on community paramedicine.
  • The Minnesota Department of Health, Office of Rural Health and Primary Care offers a Community Paramedic Toolkit and other research and educational resources. Some information in the toolkits is specific to Minnesota but much of the information can be used in other states.
  • The National Rural Health Resource Center report Implementing and Sustaining Rural Community Paramedicine describes experiences of established community paramedicine programs, for the benefit of rural ambulance services and hospitals considering similar programs for their communities.
  • Check with the state EMS office to be aware of any resources, guidance, or requirements it may have for new community paramedicine services.

For more information on starting a rural program, see the Rural Community Paramedicine Toolkit.

How can rural communities overcome barriers to starting a community paramedicine program?

The 2014 Flex Monitoring Team briefing paper, The Evidence for Community Paramedicine in Rural Areas: State and Local Findings and the Role of the State Flex Program, identifies ways to respond to multiple barriers and challenges when establishing a rural community paramedicine program:

  • Involving stakeholders and building collaboration
  • Providing education and training
  • Determining if community paramedics have an expanded role or scope of practice
  • Navigating legislative barriers and medical direction regulations
  • Securing funding and reimbursement

The National Rural Health Research Center document Implementing and Sustaining Rural Community Paramedicine notes that another challenge involves collecting data, which can make it difficult for community paramedicine programs to show value to partners and stakeholders. The author suggests that it may be possible to add a community paramedicine-specific field to the patient care record system used by ambulance services.

A 2017 Western Journal of Emergency Medicine article, Emergency Medical Services Professionals' Attitudes About Community Paramedic Programs, noted that most of the EMS professionals surveyed felt they understood the nature of community paramedicine programs, and believed their communities would welcome this level of care. In addition, a majority of those surveyed were willing to attend additional training sessions in order to acquire the necessary skills.

To avoid potential difficulties:

  • Consult the state EMS office for resources, guidance and requirements in starting a CP program.
  • Connect with other health care providers in the area and work with them to assess community health needs. Together, develop a plan to meet these needs that addresses:
    • Definition of the need
    • Medical oversight
    • Services to be provided for the patient population identified
    • Protocols for providing the services
    • Staffing plan
    • Financial plan
    • Training/education plan
    • Performance improvement plan
    • Service impact monitoring
    • Other aspects identified by the EMS agency and its partners
  • Start small and focus on one or two needs that can be relatively easily addressed. Prove the value of CP through patient improvement, satisfaction, appropriate/inappropriate resource utilization and other measurements. Add new services only on the basis of measured and proven need, agreement with health care partners, and potential sustainability.

Where can I find examples and models of rural community paramedicine programs?

Our Rural Monitor and Models and Innovations: Community Paramedicine highlight successful community paramedicine programs:

The Commonwealth Fund article Can Community Paramedicine Improve Health Outcomes in Rural America? profiles community paramedicine programs serving rural communities in Minnesota, Wisconsin, Iowa, Maine, and Pennsylvania, and describes how these programs fill gaps in care in rural communities and improve health outcomes.

The Minnesota Office of Rural Health and Primary Care provides examples of rural community paramedic programs in the state. The Program Clearinghouse section of the RHIhub Rural Community Paramedicine Toolkit lists other examples of organizations that have developed promising programs designed to implement community paramedicine in rural areas.

What considerations are there related to licensure and regulation when starting a community paramedicine program?

Licensure and regulations for community paramedicine programs vary from state to state. Typically, practicing community paramedicine is considered an expanded role for paramedics and EMTs rather than an expanded scope of practice requiring additional licensure or certification. However, in some states, new laws or updated regulations have been implemented to accommodate this new healthcare delivery model. The 2018 Status Board report, State by State Community Paramedicine – Mobile Integrated Healthcare (CP-MIH), from the National Association of State EMS Officials (NASEMSO) summarizes the progress and implementation of community paramedicine programs, and information on community paramedic licensure and regulations for all 50 states and U.S. territories.

A 2017 Prehospital Emergency Care journal article, State Regulation of Community Paramedicine Programs: A National Analysis, found variations in scope of practice models and program requirements across the nation. For additional information or if you have questions on community paramedicine licensure or regulations in your state, contact your state EMS agency.

Last Updated: 8/29/2024
Last Reviewed: 8/29/2024