Skip to main content Accessibility help
×
Home

Community paramedicine: A systematic review of program descriptions and training

  • Joyce Chan (a1), Lauren E. Griffith (a1), Andrew P. Costa (a1), Matthew S. Leyenaar (a1) and Gina Agarwal (a2) (a1)...

Abstract

Objectives

The aim of this study is to identify the types of community paramedicine programs and the training for each.

Methods

A systematic review of MEDLINE, Embase, grey literature, and bibliographies followed a search strategy using common community paramedicine terms. All studies published in English up to January 22, 2018, were captured. Screening and extraction were completed in duplicate by two independent reviewers. The Mixed Methods Appraisal Tool (MMAT) was used to assess studies’ methodological quality (full methodology on PROSPERO: CRD42017051774).

Results

From 3,004 papers, there were 64 papers identified (58 unique community paramedicine programs). Of the papers with an appraisable study design (40.6%), the median MMAT score was 3 of 4 criteria met, suggesting moderate quality. Programs most often served frequent 911 callers (48.3%) and individuals at risk for emergency department admission, readmission, or hospitalization (41.4%); and 70.7% of programs were preventive home visits. Common services provided were home assessment (29.5%), medication management (39.7%), and referral and/or transport to community services (37.9%); and 77.6% of programs involved interprofessional collaboration. Community paramedicine training was described by 57% of programs and expanded upon traditional paramedicine training and emphasized technical skills. Study heterogeneity prevented meta-analysis.

Conclusion

Community paramedicine programs and training were diverse and allowed community paramedics to address a spectrum of population health and social needs. Training was poorly described. Enabling more programs to assess and report on program and training outcomes would support community paramedicine growth and the development of formalized training or education frameworks.

Objectif

L’étude visait à relever les différents types de programmes de paramédecine communautaire et à décrire la formation donnée dans chacun d'eux.

Méthode

Une revue systématique des bases de données MEDLINE et Embase, de la documentation parallèle ainsi que de bibliographies a été entreprise à la suite d'une stratégie de recherche élaborée à l'aide de termes utilisés souvent en paramédecine communautaire. Ont été saisies toutes les études publiées en anglais jusqu'au 22 janvier 2018. Le tri et l'extraction des données ont été faits en double, par deux examinateurs indépendants. L’évaluation de la qualité méthodologique des études a été réalisée à l'aide de l'instrument Mixed Methods Appraisal Tool (MMAT) (description complète de la méthode dans PROSPERO : CRD42017051774).

Résultats

Sur 3004 articles relevés, 64 ont été retenus (58 programmes distincts de paramédecine communautaire). Le score médian MMAT des articles présentant un plan d’étude susceptible d’évaluation (40,6%) était de 3 sur 4 quant au respect des critères établis, résultat évocateur d'une qualité moyenne. Les programmes avaient surtout pour cible les usagers fréquents du service 911 (48,3%) et les personnes susceptibles d'admission ou de réadmission au service des urgences, ou encore d'hospitalisation (41,4%); 70,7% des programmes portaient sur les visites préventives à domicile. Les services fréquemment offerts étaient les évaluations à domicile (29,5%), le contrôle de la pharmacothérapie (39,7%) et l'orientation ou le transport des malades vers des services communautaires (37,9%); 77,6% des programmes incluaient un volet de collaboration interprofessionnelle. La formation en paramédecine communautaire a été décrite par 57% des programmes et étendu sur le champ de pratique habituel de la paramédecine traditionnelle et visait l'acquisition de compétences techniques. Enfin, il n'a pas été possible de procéder à une méta-analyse en raison de l'hétérogénéité des études.

Conclusion

Les programmes de paramédecine communautaire et la formation afférente sont diversifiés et permettent, de ce fait, aux professionnels du domaine de répondre à un large éventail de besoins sociaux et de besoins en matière de santé de la population. Pour ce qui est des descriptions de la formation donnée, elles étaient insuffisantes. Si les responsables de programmes étaient tenus d’évaluer les programmes et la formation offerte et de faire état des résultats obtenus, cela favoriserait le développement de la paramédecine communautaire et l’élaboration de cadres structurés d’études ou de formation.

Copyright

Corresponding author

Correspondence to: Dr. Gina Agarwal, McMaster University Family Medicine, David Braley Health Sciences Centre, 100 Main Street West, 6th Floor, Hamilton, ON L8P 1H6; Email: gina.agarwal@gmail.com

References

Hide All
1.Jensen, JL, Marshall, EG, Carter, AJE, et al. 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 2016;20(1):111–6.
2.Abrashkin, KA, Washko, J, Margolis, A, et al. Eyes and ears on the homebound patient during an emergency response: adding video technology to a community paramedicine program. J Am Geriatr Soc 2015;63:S139.
3.Everden, P, Eardley, M, Lorgelly, P, Howe, A. Emergency care. Change of pace. Health Serv J 2003;113(5865):2830.
4.Iezzoni, LI, Dorner, SC, Ajayi, T. Community paramedicine – addressing questions as programs expand. N Engl J Med 2016;374(12):1107–9.10.1056/NEJMp1516100
5.Pang, P, Liao, M, Litzau, M, et al. Community paramedicine: a systematic review. PROSPERO International prospective register of systematic reviews. 2016. Available at: https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=52543 (accessed January 7, 2017).
6.Agarwal, G, McDonough, B, Angeles, R, et al. Rationale and methods of a multicentre randomised controlled trial of the effectiveness of a Community Health Assessment Programme with Emergency Medical Services (CHAP-EMS) implemented on residents aged 55 years and older in subsidised seniors' housing buildings in Ontario, Canada. BMJ Open 2015;5(6):e008110.10.1136/bmjopen-2015-008110
7.Brice, JH, Overby, BA, Hawkins, ER, Fihe, EL. Determination of infant-safe homes in a community injury prevention program. Prehosp Emerg Care 2006;10(3):397402.10.1080/10903120600726007
8.Smeby, L Jr. Fire and Emergency Services Administration: management and leadership practices. 2nd ed. USA: Jones & Bartlett; 2013.
9.Ontario Health Professions Regulatory Advisory Council. Paramedicine in Ontario: consideration of the Application for the Regulation of Paramedics under the Regulated Health Professions Act, 1991. 2012. Available at: https://www.hprac.org/en/resources/HPRAC_Paramedic_Report_Volume_2.pdf (accessed December 2, 2018).
10.Province of Nova Scotia. College of Paramedics Effective April 1, 2017. Available at: https://novascotia.ca/news/release/?id=20170330003 (accessed December 2, 2018).
11.Canadian Standards Association C. Community paramedicine: framework for program development. 2017. Available at: http://cradpdf.drdc-rddc.gc.ca/PDFS/unc292/p806005_A1b.pdf (accessed August 2018).
12.Emergency Medical Services Chiefs of Canada. The Future of EMS in Canda: defining the new road ahead. 2006. Available at: http://www.emscc.ca/docs/EMS-Strategy-Document.pdf (accessed January 12, 2019).
13.Canadian Organization of Paramedic Regulators. Vision and role statement. 2016. Available at: http://www.copr.ca/index.php/about-us/strategic-plan/vision-role-statement (accessed January 5, 2019).
14.Bigham, BL, Kennedy, SM, Drennan, I, Morrison, LJ. Expanding paramedic scope of practice in the community: a systematic review of the literature. Prehosp Emerg Care 2013;17(3):361–72.10.3109/10903127.2013.792890
15.Choi, BY, Blumberg, C, Williams, K. Mobile integrated health care and community paramedicine: an emerging emergency medical services concept. Ann Emerg Med 2016;67(3):361–6.10.1016/j.annemergmed.2015.06.005
16.Chan, J, Agarwal, G. Key elements and training required among existing community paramedicine programs. 2017. Available at: https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=51774 (accessed August 30, 2017).
17.Arksey, H, O'Malley, L. Scoping studies: towards a methodological framework. Int J Soc Res Methodol 2005;8(1):1932.10.1080/1364557032000119616
18.The Joanna Briggs Institute. Joanna Briggs Institute reviewers’ manual 2015: methodology for JBI scoping reviews. 2015. Available at: http://joannabriggs.org/assets/docs/sumari/Reviewers-Manual_Methodology-for-JBI-Scoping-Reviews_2015_v2.pdf (accessed December 5, 2018).
19.Pluye, P, Robert, E, Cargo, M, et al. Mixed methods appraisal tool (MMAT) – version 2011. 2011. Available at: http://mixedmethodsappraisaltoolpublic.pbworks.com/w/page/127425845/Download%20the%20MMAT (accessed December 2016).
20.Abrashkin, KA, Washko, J, Zhang, J, et al. Providing acute care at home: community paramedics enhance an advanced illness management program-preliminary data. J Am Geriatr Soc 2016;64(12):2572–6.
21.New program set to intervene to prevent readmissions, repeat ED visits due to acute exacerbations of asthma. ED Manag 2013;25(12):139–41.
22.Community paramedics fill gaps, take load off EDs. ED Manag 2014;26(3):30–4.
23.Partnership aims to cut unnecessary ED use. Hosp Case Manag 2014;22(3):2930.
24.Mobile integrated healthcare and community paramedicine (MIH-CP): a national survey. EMS World 2015;Supp:516.
25.Mobile teams fill the gap between the hospital and the community. Hosp Case Manag 2016;24(2):25–6.
26.Agarwal, G, Angeles, R, Mcdonough, B, et al. Effectiveness of a community health and wellness pilot in a subsidized seniors' apartment building: CHAP-EMS. Can J Diabetes 2014;38:S72.
27.Andrew, J. Extending care – meeting the needs of modern healthcare. Australas J Prehosp Care 2011;10(2):36–7.
28.Carter, A, Arab, M, Harrison, M. Paramedics providing palliative care at home in Nova Scotia and PEI, Canada. J Pain Symptom Manag 2016;52(6):e100.
29.Arendts, G, Sim, M, Johnston, S, Brightwell, R. ParaMED home: a protocol for a randomised controlled trial of paramedic assessment and referral to access medical care at home. BMC Emerg Med 2011;11:7.10.1186/1471-227X-11-7
30.Ashcraft, SJ, Post, L, Young, C. Closing the gap: integrating community paramedics in stroke patients transition to home. Stroke 2017;48:AWP390.
31.Ashton, C, Duffie, D, Millar, J. Conserving quality of life through community paramedics. Healthc Q 2017;20(2):4853.10.12927/hcq.2017.25228
32.Bennett, KJ, Yuen MW, M. Community paramedicine applied in a rural community. J Rural Health 2018;34 Suppl 1:s39–47.
33.Blumberg, C. Overview of REMSA CHP with preliminary outcomes. 2014. Available at: http://mihpresources.com/programs/preliminary-outcomes-executive-summary/ (accessed January 20, 2015).
34.Boykin, A, Wright, D, Stevens, L, Gardner, L. Interprofessional care collaboration for patients with heart failure. Am J Health Syst Pharm 2018;75(1):e45–49.
35.Brice, JH, Kingdon, D, Runyan, C. “Welcome to the world”: process evaluation of a paramedic home safety intervention. Prehosp Emerg Care 2009;13(2):228–36.10.1080/10903120802474497
36.Brown, DR, Carter, A, Goldstein, J, et al. Evaluating the impact of a novel mobile care team (MCT) on the prevalence of ambulatory care sensitive conditions presenting to emergency medical services in Nova Scotia. CJEM 2016;18(S1): s83.
37.Chellappa, DK, Munjal, KG, Jervis, R, et al. Evaluation of physician and paramedic perspectives on the Mount Sinai community paramedicine program. J Am Geriatr Soc 2017;65:s1.
38.Cooper, S, Barrett, B, Black, S, et al. The emerging role of the emergency care practitioner. Emerg Med J 2004;21(5):614–8.10.1136/emj.2003.011247
39.Crockett, BM, Jasiak, KD, Walroth, TA, et al. Pharmacist involvement in a community paramedicine team. J Pharm Pract 2017;30(2):223–8.10.1177/0897190016631893
40.Dixon, S, Mason, S, Knowles, E, et al. Is it cost effective to introduce paramedic practitioners for older people to the ambulance service? Results of a cluster randomised controlled trial. Emerg Med J 2009;26(6):446–51.
41.Drennan, IR, Dainty, KN, Hoogeveen, P, et al. Expanding paramedicine in the community (EPIC): study protocol for a randomized controlled trial. Trials [Electronic Resource] 2014;15:473.
42.Faddy, SC, McLaughlin, KJ, Cox, PT, Muthuswamy, SS. The mental health acute assessment team: a collaborative approach to treating mental health patients in the community. Australas Psychaitry 2017;25(3):262–5.
43.Gerson, LW, Schelble, DT, Wilson, JE. Using paramedics to identify at-risk elderly. Ann Emerg Med 1992;21(6):688–91.
44.Gray, JT, Walker, A. AMPDS categories: are they an appropriate method to select cases for extended role ambulance practitioners? Emerg Med J 2008;25(9):601–3.
45.Hauswald, M, Raynovich, W, Brainard, AH. Expanded emergency medical services: the failure of an experimental community health program. Prehosp Emerg Care 2005;9(2):250–3.10.1080/10903120590924942
46.Jensen, JL, Travers, AH, Bardua, DJ, et al. Transport outcomes and dispatch determinants in a paramedic long-term care program: a pilot study. CJEM 2013;15(4):206–13.
47.Kusel, E, Savino, PB. Boots on the ground. Alameda County, Calif., community paramedics curb hospital readmissions & non-emergent 9-1-1 use. J Emerg Med Serv 2015;40(12):55–7.
48.Marshall, EG, Clarke, B, Peddle, S, Jensen, J. Care by design: new model of coordinated on-site primary and acute care in long-term care facilities. Can Fam Physician 2015;61(3):e129–34.
49.Martin-Misener, R, Downe-Wamboldt, B, Cain, E, Girouard, M. Cost effectiveness and outcomes of a nurse practitioner–paramedic–family physician model of care: the Long and Brier Islands study. Prim Health Care Res 2009;10(1):425.
50.Mason, S, Wardrope, J, Perrin, J. Developing a community paramedic practitioner intermediate care support scheme for older people with minor conditions. Emerg Med J 2003;20(2):196–8.10.1136/emj.20.2.196
51.Mason, S, Knowles, E, Freeman, J, Snooks, H. Safety of paramedics with extended skills. Acad Emerg Med 2008;15(7):607–12.
52.Mason, S, Knowles, E, Colwell, B, et al. Effectiveness of paramedic practitioners in attending 999 calls from elderly people in the community: cluster randomised controlled trial. BMJ 2007;335(7626):919.
53.McCarthy, J, Dalgarno, D. Care in the community-home transfusion by community paramedics. Transfusion 2016;56:226A.
54.McCarthy, P, Brown, A, Nystrom, P, Ho, J. Impact of community paramedic program on health service utilization. 2017. Available at: https://www.eventscribe.com/2017/SAEM/ajaxcalls/PresentationInfo.asp?efp=SFFWWlhCWFYzMzA1&PresentationID=267683&rnd=0.6724276 (accessed October 18, 2018).
55.MedStar Mobile Healthcare M. 2015. Available at: http://www.medstar911.org/Websites/medstar911/files/Content/1089414/MedStar_CHF_Program_Overview_-_2015.pdf (accessed October 18, 2016).
56.National Association of Emergency Medical Technicians, NAEMT. Mobile integrated healthcare and community paramedicine (MIH-CP): a national survey. 2015. Available at: https://www.naemt.org/docs/default-source/community-paramedicine/naemt-mih-cp-report.pdf?sfvrsn=4 (accessed October 18, 2016).
57.Nejtek, VA, Aryal, S, Talari, D, et al. A pilot mobile integrated healthcare program for frequent utilizers of emergency department services. Am J Emerg Med 2017;35(11):1702–5.10.1016/j.ajem.2017.04.061
58.Patterson, DG, Coulthard, C, Garberson, LA, et al. What is the potential of community paramedicine to fill rural health care gaps? J Health Care Poor Underserved 2016;27(4A):144–58.10.1353/hpu.2016.0192
59.Roeper, B, Mocko, J, O'Connor, LM, et al. Mobile integrated healthcare intervention and impact analysis with a medicare advantage population. Popul Health Manag 2018;21(5):349–56.
60.Shah, MN, Caprio, TV, Swanson, P, et al. A novel emergency medical services-based program to identify and assist older adults in a rural community. J Am Geriatr Soc 2010;58(11):2205–11.10.1111/j.1532-5415.2010.03137.x
61.Snooks, HA, Anthony, R, Chatters, R, et al. Paramedic assessment of older adults after falls, including community care referral pathway: cluster randomized trial. Ann Emerg Med 2017;70(4):495505.10.1016/j.annemergmed.2017.01.006
62.Snooks, HA, Anthony, R, Chatters, R, et al. Support and assessment for fall emergency referrals (SAFER) 2: a cluster randomised trial and systematic review of clinical effectiveness and cost-effectiveness of new protocols for emergency ambulance paramedics to assess older people following a fall with referral to community-based care when appropriate. Health Technol Assess 2017;21(13):1218.
63.Snooks, H, Kearsley, N, Dale, J, et al. Towards primary care for non-serious 999 callers: results of a controlled study of “Treat and Refer” protocols for ambulance crews. Qual Saf Health Care 2004;13(6):435–43.10.1136/qshc.2003.007658
64.Snooks, H, Anthony, R, Chatters, R, et al. Support and assessment for fall emergency referrals (SAFER 2) research protocol: cluster randomised trial of the clinical and cost effectiveness of new protocols for emergency ambulance paramedics to assess and refer to appropriate community-based care. BMJ Open 2012;2:e002169.
65.Swain, AH, Hoyle, SR, Long, AW. The changing face of prehospital care in New Zealand: the role of extended care paramedics. N Z Med J 2010;123(1309):11–4.
66.Tangherlini, N, Villar, J, Brown, J, et al. The HOME team: evaluating the effect of an EMS-based outreach team to decrease the frequency of 911 use among high utilizers of EMS. Prehosp Disaster Med 2016;31(6):603–7.
67.The California Health Care Foundation, CHCF. Overview: California's community paramedicine pilot projects. 2017. Available at: https://www.chcf.org/wp-content/uploads/2018/05/CommunityParamedicinePilotProjects.pdf (accessed January 2, 2018).
68.Wilcox, MR. Community paramedicine in a rural setting. Minnesota's approach includes free clinics and a mobile unit that travels the community. EMS World 2016;45(2):17–9.
69.Yaworski, H, Hutlet, P, Grierson, R, et al. HIV point of care testing by community paramedics in a vulnerable population: a pilot study. CJEM 2016;18(S1):s126.10.1017/cem.2016.319
70.Agarwal, G, Angeles, R, Pirrie, M, 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;17(1):8.
71.Agarwal, G, McDonough, B, McLeod, B, et al. A community health and wellness pilot in a subsidised seniors' apartment building: CHAP-EMS. Can J Cardiol 2013;29(10 Suppl 1):S327–8.
72.Agarwal, G, Mcdonough, B, Mcleod, B, et al. A community health awareness program in subsidized seniors homes: using CANRISK as a risk assessment and health promotion tool. Can J Diabetes 2013;37:S75.10.1016/j.jcjd.2013.08.230
73.Agarwal, G, Angeles, RN, McDonough, B, 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;8:113.
74.New program set to intervene to prevent readmissions, repeat ED visits due to acute exacerbations of asthma. ED Manag 2013;25(12):139–41.
75.Misner, D. Community paramedicine: part of an integrated healthcare system. Emerg Med Serv 2005;34(4):8990.
76.Zavadsky, M. Trained paramedics provide ongoing support to frequent 911 callers, reducing use of ambulance and emergency department services. 2016. Available at: https://innovations.ahrq.gov/profiles/trained-paramedics-provide-ongoing-support-frequent-911-callers-reducing-use-ambulance-and (accessed October 2016).
77.MedStar Mobile Healthcare M. Program overview – high utilizer 9-1-1/emergency department patients. 2017. Available at: https://www.naemt.org/Files/communityparamedicinegrid/CHPProgramOverview.pdf (accessed January 2, 2018).
78.Harrison, M. Paramedics providing palliative care at home. 2017. Available at: https://novascotia.ca/dhw/ehs/palliative-care.asp (accessed February 2019).
79.LaCalle, E, Rabin, E. Frequent users of emergency departments: the myths, the data, and the policy implications. Ann Emerg Med 2010;56(1):42–8.
80.Brault, I, Kilpatrick, K, D'Amour, D, et al. Role clarification processes for better integration of nurse practitioners into primary healthcare teams: a multiple-case study. Nurs Res Pract 2014;2014:170514.
81.Minnesota Department of Health. Community paramedics (CP). 2017. Available at: http://www.health.state.mn.us/divs/orhpc/workforce/emerging/cp/ (accessed October 18, 2018).
82.National Association of State EMS Officials CP-MIH Committee. State by state community paramedicine – Mobile Integrated Healthcare (CP-MIH) status board. 2018. Available at: https://nasemso.org/wp-content/uploads/CP_State_Status_Board_CURRENT.pdf (accessed October 2018).
83.McHugh, ML. Interrater reliability: the kappa statistic. Biochem Med (Zagreb) 2012;22(3):276–82.
84.Mandrekar, JN. Measures of interrater agreement. J Thorac Oncol 2011;6(1):67.

Keywords

Type Description Title
WORD
Supplementary materials

Chan et al. supplementary material
Chan et al. supplementary material 1

 Word (29 KB)
29 KB

Community paramedicine: A systematic review of program descriptions and training

  • Joyce Chan (a1), Lauren E. Griffith (a1), Andrew P. Costa (a1), Matthew S. Leyenaar (a1) and Gina Agarwal (a2) (a1)...

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed