The traditional emergency medical services (EMS) model is relatively simple—ambulances staffed with paramedics or EMTs wait in their stations until a member of the community calls 9-1-1, and those ambulances respond to take those callers to an emergency room. It’s critical, however, for city and county managers to know that the changing health care landscape presents opportunities for emergency medical services (EMS) to evolve from a reactive to a proactive model of health care delivery—one that better meets the needs of their communities by preventing unnecessary ambulance transports, reducing emergency department visits, and providing better care at lower costs. A recent ICMA InFocus report states that the cornerstone programs of that evolution are community paramedicine and mobile integrated healthcare.

Community Paramedicine

In community paramedicine programs, EMS paramedics receive extra training so that they can provide basic primary care services in areas with limited medical resources. Services can include wound care, suturing, and antibiotic administration.

Mobile Integrated Healthcare

Mobile Integrated Healthcare (MIH) programs are designed to use providers and organizations of all types to provide the best care in the home and other nonclinical environments. MIH programs may use paramedics with advanced training as physician extenders to treat minor illnesses, as adjunctive mobile care to perform home visits and provide post-hospitalization care, to perform patient triage to non-hospital locations like detox or urgent care centers, as community health service providers to provide immunizations or fall assessments, or any combination.

Considerations for your community

1. What problem are you trying to solve? Programs that are created simply to copy another community’s model may not be appropriate and are likely to fail. Conversely, programs that are tailored to your community’s issues are likely to succeed. Are there too many “super users” or “frequent flyers” using your EMS system unnecessarily? Tailor your program to address that specific issue.
2. Potential partners. Are there hospitals or home health care agencies in your communities that you can partner with for funding, training, or personnel?
3. Regulatory climate. Some states have been hesitant to expand the scope of practice for paramedics to allow for mobile integrated healthcare. What does your state allow?

The full InFocus report on how EMS systems can improve service in tough economic climates and navigate new challenges and opportunities is available in ICMA's Digital Bookstore.