Author(s): Thomas Beyer. Published on January 4, 2016.

Purpose Built, Room to Move

The many variations on community paramedicine.

Innovative fire department leaders should identify specific community needs and demands, engage stakeholder groups and partners, and implement a community paramedicine program that meets those needs. Successful programs across the country have begun by focusing on a core patient group, likely the one that impacts the department the most, but with a program that is flexible enough to accommodate growth and change over time. Models include:

Indigent Care

This model is designed to allow fire-based EMS to assist in the management of a community’s homeless population and connected them with appropriate social resources to reduce this specific demographics demand on the 911 system and the emergency department.

Post-Discharge Care

Changes to the healthcare law allow government to impose penalties on hospitals that have excessive readmission. This model would allow fire departments, in partnership with hospital systems, to follow-up with patients in their community to reduce or prevent high-risk patients from readmitting.

Integrated Health Care

The design of the Affordable Care Act is to drive healthcare costs down. In this model fire departments would work collaboratively with other healthcare providers to manage patient bases. In this way community paramedicine providers could supplement other providers to reduce the likelihood of hospitalization. This model can also be used to help patients manage their medications and remain compliant with other care instructions. Failure to follow medication regimens is one of the leading causes of hospitalization for elderly patients and patients with chronic diseases.

Pre-911 Management

This model allows fire departments to better manage the 911 call volume by meeting the patient’s specific needs rather than relying on an overloaded hospital system to do so. In this case management of patients could follow one of two options, or both. In the first option for care, calls that meet specific criteria are referred to a nurse triage line. In this situation, and often times in partnership with hospital systems, a nurse speaks with the 911 caller and helps to determine the most appropriate way to access care. In the second option, fire department community paramedic providers visit frequent callers and identify the reasons that contribute to the high number of calls and provide solutions to reduce this demand. Again, through the use of partnerships with social and healthcare services, fire departments may be able to match patients with the appropriate resources to reduce patients' demand on the system.

Alternative Transport & Low-Acuity Patient Management

In this model, fire departments can use their ambulance as a mobile clinic. Patients who need specific care, but not time-critical care, can be transported to alternative care facilities such as urgent care, mental health, and chemical dependency centers. This reduces demand on hospital systems. Alternatively, fire departments could partner with other healthcare providers and hospitals to address low-acuity calls such as people with the flu, lacerations, and other medical issues that can easily be treated without overloading local hospitals.