Community Paramedicine: Expanding EMS in Maryland

Introduction

When it comes to healthcare in the United States, there are a number of challenges and issues that affect everyday Americans on a constant basis. The common refrains involve access to providers, costs, and so forth. However, proposed solutions are also gaining prominence. One such solution has come to be known as community paramedicine. The key to community paramedicine is that emergency medical services (EMS) personnel act outside of and beyond their traditional scope of duties and responsibilities. This is done as a means to enhance and improve the healthcare options that exist within communities. This report serves as a review and summary of the use of community paramedicine and how it can be created and expanded in the state of Maryland. While the community paramedicine methodology is still very much in its nascent stages, the potential benefits and improved outcomes for all serve as more than enough motivation to expand its usage.

The Community Paramedicine Model and Population Needs

As noted in the introduction, the literature review that follows in this report serves as a justification for creating and expanding the use of community paramedicine in Maryland. This would include all urban centers and larger cities such as Baltimore and Annapolis, but should also include other areas of the state that would clearly benefit from community paramedicine or have an urgent need for the services it provides. Even rural areas have been shown to benefit from community paramedicine. Some of the relevant examples are not entirely far from Maryland or the United States in general. Indeed, community paramedicine has been implemented in rural Ontario, Canada. When it comes to a rural setting, any community paramedicine program in Maryland should have four major components: ad hoc home visiting, aging at home, paramedic wellness clinics, and a proper and robust community paramedic response unit. While some configurations may be more suited to remote settings like fishing communities in states such as Alaska, there are surely situations and populations within Maryland that qualify as rural given their lack of healthcare access and other challenges. Focusing on the healthcare needs of such residents and measuring their satisfaction levels should therefore be of paramount importance (Martin, O'Meara & Farmer, 2016).

Another dimension that cannot be ignored when it comes to community paramedicine is the demographic composition of the populations being served. This applies to the rural setting just described, but it can and should also apply to areas where racial minorities constitute a majority of the population. Maryland has areas such as Baltimore where the African-American population is substantial. Given that African-Americans represent approximately 13% of the national population, their specific healthcare needs must receive focused attention. Beyond that, racial minorities tend to face healthcare access and quality challenges, and they are often at higher risk than the average white male in the population. Poverty is a major contributing factor, but other elements appear to be at play as well. Regardless, community paramedicine is a way to address this problem directly by having EMS-trained professionals available to deliver both emergency and proactive services. Treating someone for a breathing issue is important, but so is educating and helping individuals manage conditions such as type 2 diabetes. Engaging both the individual and the broader community in that process is a significant part of shifting the paradigm and fostering a culture of proactive health management in neighborhoods where it is most needed (O'Meara, Stirling, Ruest & Martin, 2016).

Personnel, Mobile Technology, and Legal Considerations

While EMS staff form the cornerstone of the community paramedicine model, several other types of personnel must be involved as well. For regulatory and legal reasons, a pharmacist is one such necessary participant. EMS professionals are able to provide life-saving treatments and medications in the field during an emergency. However, providing pharmacological solutions beyond such urgent situations is restricted. For example, treating someone experiencing extremely low blood sugar is within the scope of EMS personnel. However, managing that blood sugar on an ongoing basis requires the involvement of an endocrinologist or other qualified physician who can assess the situation and prescribe appropriate medication. Upon completion of that process, a pharmacist would dispense the prescribed medicine (Crockett et al., 2016).

This demonstrates that while community paramedicine programs may be dominated by EMS personnel, they will also necessarily involve doctors and other medical professionals such as pharmacists. This structure exists due to legal and regulatory constraints and also serves as a system of checks and balances to ensure that all participants operate within their appropriate legal and professional boundaries. What distinguishes the community paramedicine paradigm from more conventional models is that home visits and monitoring can be far more advanced and sustained. Patients with heart failure, for example, are at high risk of death or further complications, yet getting to a doctor or emergency room can be extremely difficult for them. An expanded community paramedicine framework can address this gap and, in many cases, save or extend lives (Crockett et al., 2016).

Another essential facet of any modern community paramedicine solution is the use of mobile health technology. At the same time, there are legitimate concerns regarding the security and quality of such mobile solutions. Whether the issue involves privacy, access, or other factors, any mobile solution deployed for community paramedicine must be implemented properly, comprehensively, and securely so that it serves its intended purpose and provides access only to those who require it. Just as EMS professionals involved in community paramedicine fill gaps in healthcare access and quality, mobile technology can be used to address similar gaps in areas and situations where access to healthcare and patient information is not as straightforward as it would be in a doctor's office or hospital (Choi, Blumberg & Williams, 2016).

When it comes to mobile healthcare solutions of any sort, several overarching concerns must be addressed regardless of whether they fall within the legal or regulatory framework. These concerns include efficacy, safety, and cost-effectiveness. If implemented properly, a mobile data system for community paramedicine professionals could limit readmissions due to congestive heart failure, reduce the frequency of EMS transports, and decrease overall emergency department visits. It must be acknowledged that the body of knowledge in this area is not yet as complete as it could be. Even so, the foundational elements are falling into place, including the legal and regulatory aspects of community paramedicine practice both within and outside of Maryland (Choi, Blumberg & Williams, 2016).

Conclusion

There are obvious faults and problems with the United States healthcare system. However, society as a whole also faces significant challenges related to lifestyle choices and the proper management of healthcare issues once they arise. The emergence of community paramedicine is a means to address both of those issues concurrently. Community paramedicine may not be a long-term solution to be relied upon indefinitely, given that restoring proper access to primary care is the fundamental problem that ultimately needs to be fixed. Even so, being proactive and addressing the existing problem with the resources currently available is the most sensible path forward and should be pursued in the meantime.

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