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Improving Health Care Access in Rural Communities through Community Paramedicine

September 12, 2017


Community paramedicine is an emerging and rapidly evolving field that can help improve health care access in rural communities. Community paramedicine involves Emergency Medical Service (EMS) providers operating in expanded roles in an effort to reach underserved populations, and can be particularly impactful in rural communities as a way to reach geographically-isolated areas.

Community paramedicine involves Emergency Medical Service (EMS) providers operating in expanded roles in an effort to “connect underutilized resources to underserved populations.” Community paramedicine can be particularly impactful in rural communities as a way to reach geographically-isolated areas and to fill gaps due to shortages of primary care providers.

A core purpose of community paramedicine is to provide needed health care services to underserved patients on location to help reduce unnecessary hospitalizations and emergency department visits. Without access to primary care, patients may forego or delay primary care and other services that could help them maintain their health and avoid costly hospitalizations. According to the Centers for Disease Control and Prevention (CDC), approximately 80 percent of adults who visited emergency departments (and whose last visit did not result in hospitalization) did so because they did not have access to other providers.

Community paramedicine programs may provide a range of patient-centered services, such as sending EMS providers into patients’ homes to provide primary care, chronic disease management and medication monitoring services. Community paramedics may also provide patient education and preventive services. Some programs may deploy telehealth approaches to connect patients in their homes with providers elsewhere. Community paramedics may also transport patients to primary care, urgent care, or other treatment centers as appropriate to help reduce unnecessary emergency department visits.

Community paramedicine programs in rural communities across the country have already demonstrated success in improving health outcomes, improving patient satisfaction with care, reducing emergency department and inpatient visits among frequent EMS users, and reducing overall health care expenses. While more systemic evaluation of community paramedicine programs is ongoing, reported outcomes have been promising.

Despite the advantages of community paramedicine programs, these programs face legal and regulatory challenges such as scope of practice, privacy, civil liability and reimbursement, among other issues. The development of successful community paramedicine programs is contingent on the resolution of key law and policy issues. As a starting point, health officials may want to consider the following legal and regulatory issues.

Scope of Practice. States vary in the ways they distinguish scope of practice among different types of EMS personnel (i.e. Emergency Medical Responder, Emergency Medical Technician (EMT), Advanced EMT, Paramedic, etc.) Some patient assessment activities may fall within the scope of practice for most professional classifications, but other less traditional EMS activities (i.e. public health vaccination) may fall outside the authorized scope of practice in some states. Some states such as California allow flexibility in scope of practice for EMS professionals in rural areas. Statutes and regulations authorizing ranges of EMS activities instead of specific tasks may facilitate an expansion of the EMS role without changing scopes of practice.

Practice Location Restrictions. EMS professionals are generally authorized to assess and treat patients at the scene of an emergency and during ambulance transport. Assessment at a patient’s home or other locations for nonemergency purposes may fall outside this authority in some jurisdictions. State laws or regulations that authorize EMS personnel to provide services in various settings and allow EMS personnel to transport patients to alternate destinations, facilitate expansion of the traditional EMS role.

Health Information Privacy. EMS professionals operating in expanded roles may acquire more extensive protected health information than is typical during emergency response activities. HIPAA-compliant policies and training are essential to a well-designed community paramedicine program.

Civil Liability Protections. Expanding the role of EMS professionals may escalate negligence or malpractice claims if their actions fall below the applicable professional standard of care. Adequate training, physician consultation and adherence to protocols are critical to ensure that community paramedics comply with established standards of care.

Reimbursement. While community paramedicine programs may reduce overall health care costs, health care reimbursement mechanisms may not include these services. Many current programs may not be reimbursed through private or public health insurance programs. However, some states have expanded Medicaid coverage to include community paramedicine services. For example, Minnesota’s Medicaid program authorizes reimbursement for community paramedicine services for eligible recipients who would otherwise be frequent users of emergency departments.

There are several helpful resources that address the legal issues and opportunities in this evolving field. In 2014, the Network’s Western Region partnered with the Association of State and Territorial Health Officials (ASTHO) to conduct a legal analysis of the issues involved in expanding the roles of EMS providers. The report identifies legal issues that may impede community paramedicine activities as well as law and policy best practices, based in part on policy research in 13 select jurisdictions.

The National Association of State EMS Officials (NASEMSO) has also been maintaining a regularly updated Status Board that tracks community paramedicine programs in all 50 states and contains information on relevant state statutes and regulations. The Status Board contains information on states’ enabling legislation and regulations, reimbursement activity, training requirements, and lessons learned, among other information. The Status Board is updated on an ongoing basis with results from an in-process 2017 NASEMSO survey of state EMS offices. With all the ongoing legal developments in this rapidly changing field, this area is ripe for additional policy surveillance and analysis on how the different legal approaches taken by states are affecting community paramedicine in their communities. 

This post was developed by Brittney Crock Bauerly, J.D., Staff Attorney for the Network for Public Health Law–Northern Region.

The Network for Public Health Law provides information and technical assistance on issues related to public health. The legal information and assistance provided in this post does not constitute legal advice or legal representation. For legal advice, readers should consult an attorney in their state.

Support for the Network is provided by the Robert Wood Johnson Foundation (RWJF). The views expressed in this post do not necessarily represent the views of, and should not be attributed to, RWJF.