Community paramedicine: A systematic review of program descriptions and training

Abstract

ObjectivesThe aim of this study is to identify the types of community paramedicine programs and the training for each.MethodsA 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).ResultsFrom 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.ConclusionCommunity 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.

Paramedics Have Untapped Potential to Address Social Determinants of Health in Canada

“…In Canada, most community paramedicine programs are targeted at a small number of patients and are not available to everyone. Over 70% of these programs operate through scheduled home visits, where patients have been selected using operationally driven criteria such as being a "frequent caller" or at-risk for hospital readmission (Chan et al 2019). Less than 20% of programs include initiatives that occur on an unscheduled emergency call.…”

Management of frequent ED users by community paramedics improves patient experiences and reduces EMS utilization

“…Patients in other demographic areas may experience different issues related to EMS and ED utilization, especially given the scarcity of healthcare resources in the geographic region the current CP program serves. 44 Also, while most (77.6%) CP programs utilize inter-professional collaboration to deliver care to frequent ED users, 45 the current program largely involved only EMS paramedics, with some oversight provided by an EMS-employed medical director and a social worker. This is a feature which if available, may yield improved outcomes and experience for patients.…”

Performance of the interRAI ED Screener for Risk-Screening in Older Adults Accessing Paramedic Services

“…The development and expansion of CP programs allows paramedics to apply their education and skills beyond the traditional role of emergency medical response. ( 11 – 13 ) As CP programs expand, there is potential value in developing the capacity of paramedics, both in the proactive community and emergency setting, to identify, advocate, and refer older adults who are at high risk for adverse health outcomes and who are most likely to benefit from additional health-care services or assessments. ( 14 – 16 ) Adopting a risk-screening protocol in the paramedicine context has been identified as a practical approach to ensure that high-risk older adults are effectively targeted, flagged, and provided with appropriate assessment, treatment, and follow-up.…”