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Community Paramedicine: An Evolving Perspective

Whether your department serves a rural, suburban or urban community, it’s undeniable that you have community members who could benefit from additional services. The search for a mechanism to provide more personalized healthcare has found that the fire service is once again the camel that will carry more.

The concept of community paramedicine (CP) has gained traction in several areas of the world. Each community that has successfully implemented a program has strived to improve the care provided to their communities while drumming up support from numerous community organizations to help with funding.

A successful recipe for a CP program can be found in many communities. Baxter Regional Medical Center EMS (Baxter County, Ark.) is one success story.

Baxter County EMS, a hospital-based service, has built a program to serve a predominately rural area. This program has quickly reduced the hospital’s revenue loss caused by readmittance to a trickle. But the relationship that exists between this hospital and its hospital-based EMS can be difficult for fire-based EMS to bridge.

Currently, the issues associated with a local need for a CP program are often identified by fire service members seeking to do more.

However, if patient readmittance rates to local hospitals are the driving financial motivator to fund these programs, the implementation of a CP program must be weighed against the often different and competing needs of healthcare system-based medical services and fire-based emergency medical services.

Considering which entity realizes financial benefits following the implementation of a CP program—usually the hospital—it may be quite difficult for a fire-based system to demonstrate a benefit to establishing a CP program. This may be one reason more communities haven’t implemented and engaged CP.

Many programs have demonstrated several ancillary benefits, such as more interaction with community members and the opportunities to perform residence-safety checks and install smoke detectors. Such benefits are valuable, but with respect to all, why wouldn’t fire companies already be managing such tasks?

It appears as though the financial benefit of community paramedicine may go to the bottom line of a local health system. If this is the case in your community, possibly the need for a CP program should be viewed as a health-system issue and the use of a fire-based EMS system may not be the most efficient use of these scarce resources.

The case may be that your community is efficiently served by your fire department continuing to administer, manage, deliver and improve the services it currently does, that is, responding to calls for service where life or property face an immediate and direct threat.

At a recent conference hosted by Baxter Regional Medical Center EMS, they posed a concept stating that a community paramedic doesn’t have to be a paramedic who receives subsequent education and training; rather, the role and responsibilities of a community paramedic may fall within the knowledge and abilities of an EMT.

The primary point is that although a community paramedic may carry a common title, the steady pool of trained EMTs may be a viable source to carry out these duties. Removing the ego that comes with being a paramedic while still recognizing the time, effort and energy that I and my fire department committed to my education, I must say that this concept intrigues me.

Providing a common title to a CP, regardless of the EMT vs. paramedic education, may be the ticket to common awareness. For instance, whether we ride in the back of a pumper or ladder, in the driver’s seat, in the officer’s seat or even in a staff vehicle, the community knows us as firefighters, and we still embrace that. While we may have a rank associated with our job, it doesn’t matter to the hundreds, thousands or millions we serve to protect. We can all be their firefighter and their paramedic.

One thing is certain; the international fire service is capable of delivering the services of community paramedicine. However, in order to provide a service that requires additional education, equipment and staff, funding and resources must match.

Partnerships within communities are paramount, but if a local problem belongs to one segment, why must we be the organization to identify it and solve it for them? Each community may benefit by implementing a CP program, but standardizing terminology and concepts throughout our industry will better enable our community members, staffs and municipal administrators to understand the conversation when it comes to their door.

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