What is Community Paramedicine?

The international round table on community paramedicine provides the following definition:

…a model of care whereby paramedics apply their training and skills in non-traditional community-based environments outside of the usual emergency response/transport model. The community paramedic practices in an expanded role; working in non-traditional roles using existing skills.”(1)

Models of Care in Community Paramedicine

The CSA group describes 3 models of care for community paramedics:

  1. Care model
  2. Coordination model
  3. Response model

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Research in Community Paramedicine 

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New research is emerging regarding training in community paramedic programs:

  1. A systematic review of program descriptions and training 

    • This first study was a systematic review of 3004 papers, which included 64 papers in review, comparing program training for community paramedicine (11).
      • These papers most commonly included encounters with patients presenting to the emergency services in a stable condition, followed secondly by frequent 911 callers, people at risk for hospital readmission and seniors living in the community.
      • Training programs were not described in 43% of the papers making difficult to draw conclusions.
      • 38% of programs described the duration of their curriculum with a median time of 240 hours, ranging from 3.5 to 2080 hours.
      • Additional training topics for community paramedics included:
        • Acute care
        • Intervention specific training
        • Health management and resource utilization
        • Comprehensive health assessment
        • Knowledge of community services
      • The most common services provided included:
        • Medication management (39.7%)
        • Assessment, referral and transport to non-ED (emergency department) community service (37.9%)
        • Acute care treatment (36.2%)
        • Assessment of the home (29.5%)
        • Education and health promotion (22.4%)
        • Care of older adults (20.5%)
        • Knowledge of community services (17.9%)
  2. An environmental scan and content analysis of patient assessment in community paramedicine 

    • The second study was an environmental scan investigating community paramedic assessment programs.(12) 
    • At the time of the study, 52 paramedic programs were surveyed with a 83% response rate.
    • Of the 37 services with a community paramedic program, 16 were included in the analysis.  There were significant disparities between the programs regarding information collected on community paramedic assessment forms.  One conclusion was that creating an assessment standard may help contribute to clinical guidelines for standard of care for community paramedics.

What is the Status of Community Paramedicine in Ontario?

Interviews were conducted of several leaders in community paramedicine in Ontario:

  • Shannon Leduc
    • Commander, Clinical Programs, Ottawa Paramedic Service
  • Marc-Andre Da Ponti
    • Ottawa Paramedic Service Community Paramedic Superintendant
  • Amanda Foubert and Elizabeth Anderson
    • Community Paramedics Ottawa
  • Mike Nolan
    • Chief Renfrew Paramedic Service
  • Matt Leyenaar
    • Community Paramedic Secretariat for Ontario

Information on several programs are available online:

  1. Community Paramedic Program, Ottawa Paramedic Service (https://ottawa.cioc.ca/record/OCR4370)
  2. HealthLinks Program, Ottawa (https://www.champlainhealthline.ca/libraryContent.aspx?id=22264)
  3. Renfrew Paramedic Service

The Future of Community Paramedicine at The Ottawa Hospital

Potential future programs at The Ottawa Hospital include:

  1. Palliative care program (launching spring 2020)
  2. Decanting and safe discharge during influenza virus peak season
  3. Chronic disease program
    • Congestive heart failure (CHF) and chronic obstructive pulmonary disease (COPD) safe discharge programs
  4. Programs targeting individuals with frequent ED visits

References

  1. International Roundtable on Community Paramedicine [IRCP]. (2013). About us. http:// www.ircp.info/AboutUs.aspx (accessed January 1, 2020).
  2. CSA Group. Community Paramedicine: Framework for program development. (2017).  https://cradpdf.drdc-rddc.gc.ca/PDFS/unc292/p806005_A1b.pdf (accessed January 1, 2020)
  3. Ashton C, Duffie D, Millar J. Conserving Quality of Life through Community Paramedics. Healthc Q. 2017;20(2):48–53.
  4. Agarwal G, Angeles RN, McDonough B, McLeod B, Marzanek F, Pirrie M, et al. Development of a community health and wellness pilot in a subsidised seniors’ apartment building in Hamilton, Ontario: Community Health Awareness Program delivered by Emergency Medical Services (CHAP-EMS). BMC Res Notes. 2015 Apr 1;8(1):329.
  5. Agarwal G, Angeles R, Pirrie M, Marzanek F, McLeod B, Parascandalo J, et al. Effectiveness of a community paramedic-led health assessment and education initiative in a seniors’ residence building: the Community Health Assessment Program through Emergency Medical Services (CHAP-EMS). BMC Emerg Med. 2017 Mar 9;17(1):329.
  6. Agarwal G, Pirrie M, McLeod B, Angeles R, Tavares W, Marzanek F, et al. Rationale and methods of an Evaluation of the Effectiveness of the Community Paramedicine at Home (CP@home) program for frequent users of emergency medical services in multiple Ontario regions: a study protocol for a randomized controlled trial. Trials; 2019 Jan 22;:1–11.
  7. Hoyle S, Swain AH, Fake P, Larsen PD. Introduction of an extended care paramedic model in New Zealand. Emerg Med Australas. 2012 Oct 23;24(6):652–6.
  8. Abrashkin KA, Washko J, Zhang J, Poku A, Kim H, Smith KL. Providing Acute Care at Home: Community Paramedics Enhance an Advanced Illness Management Program-Preliminary Data. Prehosp Emerg Care. 2016 Aug 30;17(12):2572–6.
  9. Abrashkin KA, Poku A, Ramjit A, Washko J, Zhang J, Guttenberg M, et al. Community paramedics treat high acuity conditions in the home: a prospective observational study. BMJ Support Palliat Care. 2019 Apr 4;1-8.
  10. Jensen JL, Marshall EG, Carter AJE, Boudreau M, Burge F, Travers AH. Impact of a Novel Collaborative Long-Term Care –EMS Model: A Before-and-After Cohort Analysis of an Extended Care Paramedic Program. Prehosp Emerg Care. 2015 Aug 13;20(1):111–6.
  11. Chan J, Griffith LE, Costa AP, Leyenaar MS, Agarwal G. Community paramedicine: A systematic review of program descriptions and training. CJEM. 2019 Mar 19;21(6):749–61.
  12. Leyenaar MS, McLeod B, Penhearow S, Strum R, Brydges M, Mercier E, et al. What do community paramedics assess?
An environmental scan and content analysis of patient assessment in community paramedicine. CJEM. 2019 Aug 1;21(6):766–75.

 

 

 

 

 

 

 

Jessica McCallum

Jessica McCallum

Dr. McCallum is an Emergency Medicine resident at the University of Ottawa, Department of Emergency Medicine.
Pascale King

Pascale King

Dr. Pascale King is an Emergency Medicine resident in the Department of Emergency Medicine, University of Ottawa. She is a junior editor with the Digital Scholarship and Knowledge Dissemination team for the EMOttawaBlog.