EMERGENCY MEDICAL SERVICES
Mobile Integrated HealthcareCommunity Paramedicine Programs
SAEM PULSE | SEPTEMBER-OCTOBER 2022
By Reena Underiner, MD; Emily Smith, MD; and Irfan Husain, MD, MPH, on behalf of the SAEM Emergency Medical Services Interest Group
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Over the last few decades, there has been a rapid rise in emergency medical services (EMS) agencies seeking better ways to serve their communities and address gaps in the local health care system. Although EMS traditionally has served the role of responding to 911 calls and providing treatment and transport to the emergency department, the role of EMS has broadened in scope to include a greater focus on tailored, need-based prehospital initiatives practiced within the community. Much of this has been accomplished through the development of mobile integrated healthcare-community paramedicine (MIH-CP) initiatives/programs.
What is Mobile Integrated Healthcare-Community Paramedicine?
Though there is no singular definition of MIH-CP, it can generally be thought of as a model to provide out-of-hospital care to patients using mobile resources, with the overarching goal of enhancing access to health care and reducing strain on existing emergency care systems. Community paramedicine programs fall under the umbrella of
the MIH approach in which specialized EMS professionals are equipped with an enhanced scope of practice that usually includes management of common chronic diseases and other primary care skill sets. However, MIH is not limited to just the use of community paramedics; it can involve various healthcare professionals such as advanced practice providers, mental health professionals, social workers, and nurses, to name a few.
and are continually evolving to meet the specific needs of various rural, suburban, and urban communities. These programs have expanded to include a broad range of services, like readmission reduction, alternatives for high EMS and ED utilizers, chronic disease management, redirection of patients to alternative care sites (e.g. behavioral health centers, primary care offices, urgent care centers), referral to social services, and 911 nurse triage.
MIH-CP was first developed to meet the needs of rural communities, where access to healthcare is often limited due to provider shortages, geographic barriers, and/or other limitations. In these settings, community paramedicine has been used to address gaps in healthcare needs. EMS providers have taken on expanded roles, including chronic disease surveillance, administration of routine immunizations, and community health education.
Let’s take a closer look at a few MIHCP program models:
Expanding Beyond Rural Communities
Although having originated in the rural setting, MIH-CP programs have been widely adopted to all community types
911 Nurse Triage. In this model, a nurse triage line is built into the 911 dispatch system. After the standardized call-taking protocol is followed, low acuity calls may be directed to a nurse line. The nurse will then be able to further triage the patient to decide whether if the patient would be better suited to a different care setting (e.g. urgent care, primary care office, dentist, etc.). They can alternatively determine if the patient is safe for private transport (if the patient is amenable). At any point, the nurse is able to initiate ambulance transport if deemed necessary.