1. Community Paramedicine/Mobile Integrated Healthcare Survey Summary
Prepared October 2013 1 1

2. What are Community Paramedicine (CP) & Mobile Integrated Healthcare (MIHC) Programs
CP/MIHC programs use EMS practitioners and other healthcare providers in an expanded role to increase patient access to primary and preventative care, within the medical home model.
CP/MIHC programs work to decrease the use of emergency departments, decrease healthcare costs, and increase improved patient outcomes.
The introduction of CP/MIHC programs within EMS agencies is a top trend in emergency medical care.

3. Why the CP survey was conducted
To better understand the extent and characteristics of CP/MIHC programs across the country.
To have a basis for understanding the CP/MIHC trend – which helps all of us in EMS – so we can develop strategies and policies to support it.

4. CP survey participation
NAEMT joined with 16 other national EMS organizations to collect information about CP/MIHC programs.

5. NAEMT thanks the Community Paramedicine Committee for survey development 
Committee Chair: Matt Zavadsky, NAEMT Director
Committee Members:
Rod Barrett, NAEMT Director
Dr. Jeff Beeson, American College of Emergency Physicians
Jim DeTienne, National Association of State EMS Officials
Dr. James Dunford, National Association of EMS Physicians
Troy Hagen, National EMS Management Association
Dr. Paul Hinchey, NAEMT Medical Director
Dr. Doug Kupas, National Association of EMS Physicians
Scott Matin, NAEMT Director
Connie Meyer, NAEMT Immediate Past President
David Newton, National Association of EMS Educators
Mark Rector, International Academies of Emergency Dispatch
Gary Wingrove, NAEMT Advocacy Committee

6. Appreciation to CP survey contributors
Joint National EMS Leadership Forum – assisted with survey development and distribution to their individual members.
Aaron Reinert, Chair of the National EMS Advisory Council – assisted in analyzing the survey data.
Gary Wingrove, a member of NAEMT’s Community Paramedicine Committee – developed the online map of CP programs.

7. Survey results at-a-glance
3,781 total responses were received – primarily from EMS practitioners, EMS managers, medical directors, and CP/MIHC program administrators.
Total responses were evenly dispersed across all types of EMS delivery models.
Survey results identified 232 unique CP/MIHC programs (6% of responses).
566 respondents (15%) indicated that their EMS agencies were in the process of developing a CP/MIHC program.

8. Details of the CP survey summary
The summary presents information on the 232 CP/MIHC programs reported by respondents.
The summary reports only on responses received. Several respondents did not complete all of the questions in the survey.
On some questions, respondents were able to select more than one response, or didn’t select any, which caused the percentage total to not equal 100%.

9. States reporting CP/MIHC programs in place
Respondents from 44 states, plus the District of Columbia and Puerto Rico, reported programs.
(One respondent, representing an ambulance company, indicated programs in multiple states.)

10. Programs represented — all delivery models
Volunteer
Private, for profit
Public, municipal
Private, non-profit
Public, hospital
Public, fire-based
Public, county or regional

11. Population served by CP/MIHC programs
Less than 50,000:
40%
50,000 – 100,000:
16%
100,001 – 500,000:
22%
More than 500,000:

12. Annual call volume of CP/MIHC programs
Less than 10,000:
51%
10,000 – 50,000:
29%
More than 50,000:
20%

13. Size of area served for CP/MIHC programs
Less than 250 sq. miles:
46%
250 – 1,000 sq. miles:
32%
More than 1,000 sq. miles:
22%

14. Population density of CP/MIHC programs

15. Catalyst for starting a CP/MIHC program
Respondents were able to select more than one response, resulting in a percentage total greater than 100%.

16. Participants in initial CP/MIHC program assessment
Respondents were able to select more than one response, resulting in a percentage total greater than 100%.

17. Time CP/MIHC program has been in operation
Less than 1 year:
42%
1 – 3 years:
23%
More than 3 years:
35%

18. CP/MIHC program models
Respondents were able to select more than one response, resulting in a percentage total greater than 100%.

19. Comparing program type to population density
Across all population densities, the “Frequent EMS User” was selected as the most common program model.
“Primary care/physician extender” was selected as the second-most common model for programs in super rural areas.
“Readmission avoidance” was selected as the second-most common model for programs in rural, suburban and urban areas.

20. Comparing program type by delivery model
“Frequent EMS User” was selected as the most common model for all types of private programs, as well as public-county, public-fire, and volunteer programs.
“Readmission avoidance” was selected as the most common model for public-hospital programs.
“Primary care/physician extender” was selected as the second-most common model for private-for profit programs.
“Readmission avoidance” was selected as the second-most common model for private-non profit and public-county programs.

21. Vehicles used to deliver services
Ambulance:
65%
SUV:
51%
Car:
18%
Fire Truck:
17%
POV: 3%
Other: (UTV, Medevac helicopter, golf cart, crew boat, non-medical transport helicopter) 5%
Respondents were able to select more than one response, resulting in a percentage total greater than 100%.

22. Equipment used to deliver services
Respondents were able to select more than one response, resulting in a percentage total greater than 100%.

23. Program operations YES : 65% NO : 35% YES : 65% NO : 35% YES : 84%
Can providers transport patients as needed?
Does program operate on a 24/7 basis?
Does program make house calls?
YES : 65%
NO : 35%
YES : 65%
NO : 35%
YES : 84%
NO : 13%

24. CP/MIHC program funding sources
Respondents were able to select more than one response, resulting in a percentage total greater than 100%.

25. CP/MIHC practitioner deployment per patient
More than four
Four
Three
One
Two

26. Organizations partnering in program implementation
Hospitals:
83%
Physician organizations:
47%
Other EMS agencies:
45%
Public health agencies:
42%
Home health organizations:
Primary care facilities:
40%
Law enforcement agencies:
31%
Mental health care facilities:
27%
Nursing homes:
25%
None: 6%
Respondents were able to select more than one response, resulting in a percentage total greater than 100%.

27. Types of program collaboration with partners
Provides patient care:
72%
Coordinates patient services:
69%
Provides personnel:
44%
Provides oversight:
24%
Provides funding: 7%
Respondents were able to select more than one response, resulting in a percentage total greater than 100%.

28. Who provides medical direction for the CP/MIHC program
Committee
Single
Director
Multiple
Directors

29. Average number of hours per week of medical direction
Less than 10:
66%
10:
17%
More than 10:

30. Responsibilities of the Medical Director
Respondents were able to select more than one response, resulting in a percentage total greater than 100%.

31. Who approves clinical protocols for the program
Medical Director:
85%
Agency:
39%
State:
27%
Hospital:
24%
Respondents were able to select more than one response, resulting in a percentage total greater than 100%.

32. Responsibility for the overall management of the program
EMS Director/Chief/Manager:
73%
Medical Director:
24%
Other: 3%

33. Program implementation
Is there a defined process for adding new services to the program?
Is there a formal strategic plan that guides the overall direction and operation of the program?
YES : 53%
NO : 47%
YES : 74%
NO : 26%

34. Program implementation (continued)
Does the program have additional policies related to patient confidentiality?
Does the program have separate or additional liability coverage for the CP/MIHC services provided?
YES : 76%
NO : 24%
YES : 35%
NO : 65%

35. Who participates in providing patient care
Respondents were able to select more than one response, resulting in a percentage total greater than 100%.

36. Total full-time program employees
Four or more
Less than One
Three
One
Two

37. CP/MIHC practitioner qualifications
Respondents were able to select more than one response, resulting in a percentage total greater than 100%.

38. Specific training provided to CP/MIHC practitioners
Respondents were able to select more than one response, resulting in a percentage total greater than 100%.

39. CP/MIHC practitioners
Are practitioners paid a higher rate than traditional roles?
Do practitioners have an advanced scope of practice?
Do practitioners wear different uniforms than those worn by traditional providers?
YES : 37%
NO : 63%
YES : 11%
NO : 89%
YES : 33%
NO : 67%

40. CP/MIHC program data YES : 74% NO : 26% YES : 40% NO : 60% YES : 53%
Is program data being collected?
Is data collection based upon NEMSIS?
Are records integrated with other health information exchanges?
YES : 74%
NO : 26%
YES : 40%
NO : 60%
YES : 53%
NO : 47%

41. How program data is collected
Respondents were able to select more than one response, resulting in a percentage total greater than 100%.

42. What program data is collected
Ongoing surveillance:
81%
Program outcomes:
92%

43. CP Survey Summary Conclusions
NAEMT’s Community Paramedicine/Mobile Integrated Healthcare Committee will continue to study this issue and bring additional information to members.
A follow-up survey is being developed to discover more information about CP/MIHC programs being implemented.
Visit the CP/MIHC page on to learn more about this subject and how it is changing the role of EMS in healthcare delivery.

44. www.naemt.org 1-800-346-2368 / info@naemt.org