Community Paramedicine for Dinosaurs


Brandon at EMS Basics asked some bloggers to consider the other side of a topic that they have strong feelings about, one way or the other, and reconsider. Here’s my reconsideration of Community Paramedicine; funny thing is, I actually like this new opinion better that the one I had before considering an alternative.

Out with the old…

In with the new…

Responding to 911 emergencies just isn’t what it used to be. It’s not the responding that has me down; it’s the”emergencies!” People used to be ashamed to call 911 for help unless the help they sought was help they could not give themselves.

Alas, times change, and I reluctantly have to change with them. My idea of what a 911 response is, and what the general public now believes it to be may be far different, but close enough for me to suspend my beliefs and change with the times.

dinoAt one time the very idea of Community Paramedics made me sick. Now, I just cringe a little. EMS has evolved, and if we are to thrive as an industry, and by thriving I do not mean respond with lights and sirens to life threatening emergencies, we need to expand our role. We can have it both ways. Dinosaurs like me have to bend, and see the profession for what it is rather than what we once dreamed it to be.

My favorite thing about being an EMT used to be all about the thrill. As time progressed, and I grew up, it was more about the people. It’s the connections I make with my patients where I get my satisfaction. I’ve learned that the people who need us may not be suffering life threatening illness or injury, but are hurting just the same.

The medical profession is a watered down resemblance of what it used to be. We may have more technology, and more doctors, and procedures, and medications, but as a whole the whole experience is greatly lacking. Doctor visits are fifteen minute checklists of insurance covered tests and scheduled exams. The care and connection that people seek as they age is gone. We are now numbers, not people.

That is where the Community Paramedic makes sense. Who better than us to make the patient/provider experience something far more that what people get at their doctor’s office. We make house calls. We go into people’s homes, share their hopes and fears, pet their cats and see how they live. We have an opportunity to bring care back to health care simply by visiting our patients where they live, seeing how they live, and helping them live better.

With all the modern advances in medicine, people still get sick, suffer and die. Doctors and surgeons cannot save everybody, and nature always wins. Our patients are not expecting miracles from us. They know our limitations. They also know that we see them as people, and will do everything we can to make them feel better.

There is room for the Community Paramedic, just as there is room for a 911 response based Paramedic. If we are able to create two separate divisions under the same umbrella the opportunities for EMT’s and Paramedics will grow exponentially. The burned out medic could be a thing of the past as chances to get off the meat wagon and onto a house call rotation improve.

We can’t do everything, but what we can do has a vital role in the well being of our patients and ourselves. I say give Community Paramedicine a chance.



  • Kenneth Strange says:

    Interesting story and possibilities for the older medics like myself to still play an important role in the healthcare of the community we live in

  • Don says:

    I agree with your last thought. Two separate divisions under the same umbrella sounds like a good model. I think it’s important to keep a particular mindset when you come to work.

  • Mike says:

    I think that the idea of community paramedicine has potential – it could be beneficial to both the patients and the EMS profession if done right. One thing that makes me wonder is that in all the discussions of community paramedicine I have read, I have seen not a single mention of the people who are already doing this – the home health nurses. Community medics and home health nurses need to be working together, in an integrated system. I wonder if this is happening anywhere.

    • Blue says:

      Bill you have brought forth what is the true problem across the board for all of medicine.MONEY,SHOW ME THE MONEY.That is was the true intent of nursing home health care.To capture those falling threw the cracracks.I am a nurse and recently retired medic.I had seen the guts and glory go to the cab fare that you won t pay and thinking I ll be seen by a doctor faster if I come in by ambulance.The it’s all about me model.National registry is all about trama and has dropped the ball on community health.One of the many reasons I crossed to nursing.It’s all about money.Always looks good on paper.

  • Bill says:

    Interesting. One small problem though, funding. I was an active, in the field medic for over 30 years with many of those years also being the Administrator. This is something we’ve talked about for at least 25 years that I can remember and funding was always the road block. As a medic and an EMS Administrator, nothing is free. It cost big dollars to put units and crews in the field.
    As most know less than 10% of our call volume is for a true emergency, and around 50% of our call volume is for geriatric patients, which means Medicare or its equal. Most other insurance, Medicare, and Medicaid do not reimburse EMS response without transport. The other issue is liability. I’ve worked in areas where the populations was dirt poor and other places where the population was extremely wealthy. Those on Medicare and Medicaid are the part of the population that seem to utilize (and abuse) 911 EMS more that anyone.
    Just some other areas to consider on this issue. As stated above, we thought the possibility of increasing the scope of practice and duties of Medics would be a good idea (and truly, I’m not opposed to this in the least), it just again, who pays for it.

  • Adam Miceli says:

    I remain skeptical of Community Paramedicine. It reminds me of how the FD got into Haz-mat. We are being used as a cheap fix to a problem that is growing do to everyone else washing their hands of these patients. Families are too busy to check on Grandma enough to keep her engaged and feeling safe. Hospitals want to have a safety net for discharging patients earlier, and we’re cheap, cheap, cheap to them. We are being pushed, unfunded into a function that nurses have been doing for years. Are we totally throwing away a system that can’t be fixed or are we just a cheaper option until some realizes the true costs. I see this working in areas where there are few volunteers and not enough emergencies to warrant FT staff, but elsewhere we fight to maintain emergency services and this is an added demand with no financial support.

  • Patrick Warner says:

    Notwithstanding funding challenges, the idea of preventing an unnecessary 911 run by meeting with “at risk” citizens is a much better idea. If we can head of a diabetic emergency by counselling and coaching a citizen in the correct way to perform a self glucose test, and just a importantly how to interpret the results and titrate their meds, will save a later panic, and maybe a life.

    I have no idea if home visits by nurses still exists everywhere but one of our local companies foled last year, putting strain on everyone else. So let’s talk community paramedicine with insurance companies and family medicine practices, and maybe we can fill the gap and get paid for it.

  • Rob says:

    What a great article! It certainly provides food for thought. In almost everything we have become merely a number. Paramedics and fire first responders do bring a little personalization to situations and ask your name not your number. In my opinion, it is a great calling, aiding someone who is in distress, no matter how small or large the incident. Bill, however, is absolutely correct. Money will always take precedence and taxpayers can’t afford to keep paying for each individual agency to continue building their own pyramids. Sharing resources, and merging services is probably a good place to start. We need more cross trained professionals using proper vehicles to save money and offer a more sustainable system which provides personal care and efficiency. As far as abuse is concerned, I can only suggest some type of monitoring system to prevent this. I’m probably reaching here, but like the old AAA and CAA their roadside assistance program responded and helped it’s members when they needed it. Within their mechanism they allowed for so many calls. After this a letter would be sent to the members and they would be cautioned to rectify the situation or their membership could be cancelled. Possibly applying something like this to medical aid would discourage abuse and the added costs.

  • Keith says:

    I am a Dino, I climbed the bent and wobbly ladder starting, by my count 39 years ago today, holding the ladder for others. I won’t even count my pre-EMS 1st Aid experiences. The rural and suburban home health calling is an overlooked way to beef up the tired and stretched thin health care system. Sometimes cost needs to be set after the life of a human.
    This needs to be SERIOUSLY revisited by the UPPER MANAGEMENT TYPES. In days to come it may be the last response someone sees. Remember: ALL THINGS OLD become new again.

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