1. Community Paramedic
SPEAKER NOTES
About 75 million Americans live in rural or remote areas of the U.S.
80% of the U.S. geography is rural and remote.
4 times as many rural and remote residents traveled 30 miles or more for health care, compared to urban residents1
Only about 10% of America’s doctors practice in rural and remote areas
There exist limitless opportunities in every industry. Where there is an open mind, there will always be a frontier. Charles F. Kettering

2. The Rural and Remote Dilemma
¼ of Americans live in rural and remote areas
Only 10% of America’s doctors practice there
4 times as many rural and remote residents traveled >30 miles for health care, compared to urban residents
SPEAKER NOTES
About 75 million Americans live in rural or remote areas of the U.S.
80% of the U.S. geography is rural and remote.
Health worker shortages, recruitment and retention of primary care providers are major concerns among state offices of rural and remote health and public health professionals.
Access to quality health services was the most often nominated rural and remote health priority by state and local rural and remote health leaders across the nation.
[1] travel study by South Carolina Rural Health Research Center

3. The Rural and Remote Dilemma
POPULATION OF RURAL AMERICANS 25%
PRACTICING DOCTORS 10%

4. Rural and Remote Demographics
More elderly
More immigrants
More poverty
Poorer health

6. HEALTHY PEOPLE 2010 Goals: Have a source of ongoing care
Have a usual primary care provider (PCP)
Increase the number of under-represented ethnic and racial groups with degrees in health professions
Reduce avoidable hospitalizations
The Dept. of Health & Human Services launched its Healthy People 2010 Initiative with these objectives.
How do we achieve these objectives against the challenges facing rural and remote communities?

10. Filling an Unmet Need with Untapped Resources

11. Filling an Unmet Need with Untapped Resources

12. Volunteer and Paid Paramedics
EMTs/Paramedics already know how to deliver care locally
Know how to assess resources and make decisions
They could fill gaps in care with enhanced skills through targeted training

13. Seizing the Opportunity
Built on the Rural and Frontier EMS Agenda of the Future
Community Healthcare and Emergency Cooperative (CHEC) developed the curriculum
The curriculum supports the work of the International Roundtable on Community Paramedicine supports (IRCP)
Spearheading a movement
SPEAKER NOTES
Rural Health Assoc. Initiative…
To explore the CP idea, a team of experts came together and formed the International Roundtable on Community Paramedicine
Members sharing experiences with funding, data, curriculum
Discussions/collaboration spread quickly around globe via Internet
Group is driving force for a new health delivery paradigm—the Community Paramedic Program

14. The Community Healthcare and Emergency Collaborative

15. The Community Paramedic Program
Expand role, not scope
Assess and identify gaps between community needs and services
Improve quality of life/health
SPEAKER NOTES
Expands role of paramedics, not scope of work—a subtle but important difference
Example, paramedics already mix some drugs and give shots— the CP would simply expand formulary to include IV antibiotics and immunizations.
Services provided only where and when there are no others to provide them
CP navigates and establishes systems to better serve citizens
CP becomes advocate, facilitator, liaison and resource coordinator
GOAL: Empower community stakeholders, residents, business, health care workers and service providers,) and policymakers, toward optimal wellness for all

16. The Community Paramedic Program
Level 1 – Non-paramedic filling some roles of the Community Paramedic
Level 2 -- Certificate or Associate degree
Level 3 – Bachelor’s degree
Level 4 – Master’s degree

17. Expanded Services Primary care Emergency care Public health
Disease management
Prevention
Wellness
Mental health
Dental care
SPEAKER NOTES
Developed in each community in collaboration with all stakeholders
Read list of services on slide
Community Paramedic model will not interrupt any emergency care or EMS services
It will enhance skills of emergency care providers
Opportunity to care for our fellow citizens in most appropriate way, based 100% on needs of each community

18. Building on Experience
SPEAKER NOTES
We don’t have to start from scratch
IRCP studied numerous home-grown projects, each with something unique to offer in approach and success
Aiming to create a Community Paramedic model based on what has worked in other locations
Not entirely new
Similar successes around the world

19. Building on Experience
ALASKA
NOVA SCOTIA
QUEENSLAND,
AUSTRALIA
SPEAKER NOTES
We don’t have to start from scratch
IRCP studied numerous home-grown projects, each with something unique to offer in approach and success
Aiming to create a Community Paramedic model based on what has worked in other locations

20. Nova Scotia Community Paramedic Model
Serves Long and Brier Island
Population: 1,240
>50% age 65+
2 hours + to nearest hospital
No local health care provider
SPEAKER NOTES
Long and Brier Islands have aging year-round population with ever-increasing health care requirements
No local health care provider
> two hours, and two ferry rides, to closest hospital
Low volume of emergency calls on the Islands—approximately one call every 2.7 days

21. Nova Scotia Community Paramedic Model
Program Development
1. Hired project manager
2. Assigned medical oversight physician
3. Expanded paramedics’ skill set
4. Explained program to community
SPEAKER NOTES
Emergency Health Services hired project manager—a medical nurse with background in EMS quality audit management
Provincial Medical Director developed and approved all medical policies and protocols
Used curriculum to train paramedics/expand skills
Reached out to the community to explain how the program works, what services were available

22. Nova Scotia Community Paramedic Model
Reaching the Community
Health clinics
Home health assessments
Adopt-a-patient
SPEAKER NOTES
Paramedics hosted health clinics and visited residents in their homes to help detect fall hazards, other dangers
Through innovative adopt-a-patient component, paramedics were assigned to visit shut-ins regularly

23. Nova Scotia Community Paramedic Model
Impressive Results
SPEAKER NOTES
Expanded role of paramedics demonstrated a 40% reduction in ER visits and 28% reduction in clinic visits over five years for island residents
REDUCTION IN EMERGENCY ROOM VISITS
REDUCTION IN CLINIC VISITS
OVER 5 YEARS

24. Queensland, Australia Rural and Remote Paramedic Program
Australia’s second largest state
Rapidly increasing/aging population
Needed sustainable health care model
SPEAKER NOTES
Queensland faced a crisis in how to serve rapidly increasing and aging population
Role of extended-care paramedics developed in collaboration with all health services and the community

25. Queensland, Australia Rural and Remote Paramedic Program
Expanded duties
Wound dressing with local anesthetics
Suturing/minor surgical procedures
Chronic pain management
X-rays
Mental health assessment/treatment
SPEAKER NOTES
In 2006, Queensland Ambulance Service conducted survey to learn of services expanded-role paramedics provided in rural and remote locations beyond normal practice
Even included vaccinations and monitoring of blood pressure/cardiovascular health

26. Queensland, Australia Rural and Remote Paramedic Program
Expanded activities
CPR/indigenous first aid
Road accident prevention
Community presentations
SPEAKER NOTES
Survey also revealed numerous health promotion activities, from first aid to accident prevention
Included special presentations to nursing mothers, farm and industry groups and others

27. Alaska Community Health Aide/Practitioner (CHA/P)‏
> 550 CHA/Ps
180 villages
> 300,000 patient encounters
SPEAKER NOTES
Today over 550 C-H-A-Ps in 180 villages
In the 1950s and 1960, Alaska had Community Health Aide/Practitioners in scattered villages

28. Alaska Community Health Aide/Practitioner (CHA/P)‏
24-hour emergency care
Acute, non-emergent and urgent care
Prenatal, emergency childbirth and
newborn care
Preventive care
Chronic care
SPEAKER NOTES
Provide full array of health services
Use comprehensive manual of best practices to guide every patient encounter

29. The List Goes On Red River Project, New Mexico
Independent Practice Medic, military
Guanajuato, Mexico
SPEAKER NOTES
Plenty of other examples to draw from and successes to consider in developing a universally effective model
Guanajuato, Mexico – modeled from Alaska

30. Community Paramedic Training Program
• Where is the pilot based?
• Which communities will be served?
• Who is involved? Colleges? County? Town? Hospitals?
• When will it start?
SPEAKER NOTES
Describe program, components, timeline

31. Community Paramedic Program
SPEAKER NOTES
Community Paramedic Program brings together all best practices and lessons learned in creating effective new model
BRINGING THE BEST TOGETHER

32. Keys to Community Paramedic Program
Resourceful
Flexible
SPEAKER NOTES
Community Paramedic Program brings together all best practices and lessons learned in creating effective new model
Gap-filling
Rural and Remote Centric

33. Identify specific needs in community health care
Standardized curriculum, modified for communities
SPEAKER NOTES
One size does not fit all—program is tailored to the needs and resources in each community, not based on outside models
Community Paramedics will receive standardized training consistent internationally yet modified for each community, state, nation
Community Parmedics play important role assessing and identifying gaps and needs in communities

34. (but not exclusive)‏ Target sparsely populated areas
Address special population issues
Rising immigrant demographic
Aging in place
Decreasing availability of medical professionals
SPEAKER NOTES
Rural and remote locations have been trapped in a corporate, urbanized model
As more immigrants move to rural and remote/remote locations, CPP will be well equipped to address unique cultural issues
Language
Customs
Health care traditions/viewpoint
Ideally suited for elderly populations that are without health care assessment, support, treatment options
Important to note: Model could have applications in urban areas where health care providers are more visible, but not accessible

35. Identifies what is available And what is missing
SPEAKER NOTES
This model identifies, assesses and uses a community’s available physical, financial and human resources to help care for all citizens

36. Creates “health home” for citizens Eyes, ears, and voice of community
SPEAKER NOTES
Creates “health home” for citizens where none exist
CPs become advocates, facilitators, liaisons, community brokers and resource coordinators
Make referrals as necessary
Fill in missing service areas based on assessment

37. Community Paramedic Guidelines
Essential oversight by community care providers
Practice where designated underserved
Approved and welcomed
Funding specific to each locale
SPEAKER NOTES
In every community, CP will have close oversight and consultation with existing care providers
Provider input especially important for developing the needs assessment and community plan
Community Paramedics permitted to "practice" in areas designated as underserved and removed from essential professional health services
Community Paramedic only permitted to practice where they have been officially "welcomed and approved" by local government officials and existing health professionals 
Program operational in states only after appropriate notification of Secretary of Health and appropriate practice boards
Funding will be an issue that needs to be resolved, but likely will be very specific to each community/state/province, etc.

38. Major Benefits of Community Paramedic Program
Keeps rural and remote health issues on the radar of policymakers and community leaders
Measures and addresses health issues specific to rural and remote populations
SPEAKER NOTES
Policy makers and community leaders will have a significant role in the decisions around the CP so issues will be top-of-mind
Model will help capture and measure health issues in remote areas—which is currently difficult

39. Making the Program a Reality
Community/citizen support
Driven by local needs and resources
Current EMS/paramedics
SPEAKER NOTES
Communities and citizens have the power to get the program started
Current volunteer EMS force could pursue launch of CP Program
First stages of usage may come as subscription model with city or county support
Avenues for employment might be through critical access hospitals, rural and remote health clinics
Credentialing CPs may come under clinics, hospital or home health

40. Making the Program a Reality
University/community college participation
Establish international registry of student graduates
SPEAKER NOTES
University/community college participation is crucial to offer training and to initiate programs locally
Not just those with paramedic programs, but all with connections to rural and remote communities
CP creates attractive new career option for potential EMS students, current EMTs and paramedics
Upon graduation, students get certificate, can register with NCEMSI for access to job openings

41. Curriculum Ready to Go Standardized multi-module delivery model
Applicable across America and internationally
Certificate, associate, bachelor’s, master’s programs
SPEAKER NOTES
CHEC Advisory Council – oversight-registry
Standardized multi-module delivery model that can be customized for every community, province, state and nation
Can be customized to suit colleges/communities across America/internationally
New opportunities for a variety of students at a variety of levels

42. Curriculum—Phase I Foundational Skills @100 hours
Role, advocacy, outreach and public health
Community assessments
Developing community strategies for care and prevention
SPEAKER NOTES
Understand the CP role
Map community health care system
Bridge gap between communities and the health/social service systems
Educate communities on how to use these systems
Identify resources and needs
Develop locally appropriate solutions
Promote wellness by providing culturally appropriate health information to clients and providers
Foster health promotion and disease prevention
Refer and link to preventive services through health screenings and health care information
Develop partnerships in community to address the health care needs

43. Curriculum—Phase II Clinical Skills @15-146 hours SPEAKER NOTES
Phase two builds foundational clinical skills
Dependent on past training of individual
Supervised training by medical director, nurse practitioner, physician asst., and or public health provider

44. Filling the Gaps Together
SPEAKER NOTES
The time for the Community Paramedic Program is now
It is a sensible and promising option that will improve quality of life and health for millions of Americans in underserved rural and remote areas
Whether you are a public health department, town council, community college, student or EMS org., CHEC/NCEMSI will help and guide you in your efforts to put the CP program in place.

45. Filling the Gaps Together
SPEAKER NOTES
The time for the Community Paramedic Program is now
It is a sensible and promising option that will improve quality of life and health for millions of Americans in underserved rural and remote areas
Whether you are a public health department, town council, community college, student or EMS org., CHEC/NCEMSI will help and guide you in your efforts to put the CP program in place.

46. Community Paramedic Program
Not many sounds in life, and I include all urban and rural sounds, exceed in interest a knock at the door. Charles Lamb

47. THANK YOU…
QUESTIONS…