As our population ages, older patients face a widening gap between their increasing healthcare needs and the resources they can easily access. It takes weeks to months for these patients to see their primary care provider, and appointment lengths average around 20 minutes, which is not enough time to address the complex social, medical and logistical challenges associated with good health in the elderly. Patients with unaddressed and escalating needs will seek care elsewhere, often by dialing 911 and visiting the emergency department (ED).
EDs are designed to treat emergencies and are welcoming to all comers. Unfortunately, they face severe pressures from crowding. Patients who need routine treatments, preventative care, linkage to community resources, or even just someone to talk to in the ED setting can bog down the system, meaning fewer beds and providers are available for critically ill or injured patients. The Institution of Medicine estimates that 90% of EDs in the United States are overcrowded, leading to worse outcomes for patients and financial challenges for hospitals.
It’s not all doom and gloom, however. There are ways we can alleviate crowding and improve patient outcomes, such as community paramedicine-based interventions that have real impacts on our vulnerable elderly patients.
Trying to alleviate the strain on the healthcare system is something many medical providers are passionate about, but it can be difficult to know where to start. Many EMS cohorts realize that the answer might not be in changing the emergency department at all, but rather, by bringing the hospital to our patients’ homes. Community paramedicine isn’t a new concept, but it is seeing a resurgence nationwide.
Piloting paramedicine solutions with the Quapaw Nation
Two years ago, my EMS peer, Kyle Arnall, founded a community paramedicine program for the Quapaw Nation in Ottawa County, Oklahoma. Focused on the Nation’s elders, this program sends paramedics into the Quapaw community to conduct well visits, medical appointment transports, medication delivery, air quality monitoring and more. During these visits, paramedics get to sit with each patient for however long they need, and the mobile aspect of this program is making care more accessible throughout the region.
Community paramedicine programs like this one can change patient health outcomes all over the country. Not only are we seeing happy, healthier tribal elders who are eager to participate, but county 911 dispatchers have also noticed a 17% reduction in 911 calls. This means faster response times for emergencies, less strain on the EMS system and better outcomes for patients.
The value of the Quapaw Nation community paramedicine program doesn’t have to stop here; the Tulsa metropolitan area could start to realize these same benefits by deploying a similar service to its residents. This program could be scaled up to the urban environment, and in fact would be easier to administer in a densely populated area.
Rural solutions in urban settings
Traditionally, community paramedicine was utilized in rural settings, where distance to hospitals and medical facilities was prohibitive when seeking healthcare. While the Quapaw Nation in Ottawa County resides in a rural area, these types of programs are just as powerful in urban settings. By leaning on experienced paramedics to act as a first line of defense, a community paramedicine solution in Tulsa could alleviate surging pressure on physicians and nurses, and foster better health outcomes for the entire city.
During the holiday season, emergency departments in Tulsa were seeing a wait time of 6 hours or more, depending on the severity of each patient’s needs. While it’s hard to say how many of the patients in emergency waiting rooms are there for true medical emergencies versus more primary care needs or non-emergent concerns, we have seen first-hand just how big of an impact community paramedicine can have in the lives of people who don’t need emergency medical care, but rather, just need medical care.
Going even further than cutting down on the number of people seeking care in a hospital, founder Kyle Arnall, has noticed with the Quapaw Nation that paramedicine participants are getting better preventative care, staying on top of their health concerns and getting issues resolved before they get to a state of emergency.
As paramedics, we can tell when a diabetic patient should be making an appointment with a doctor, but often, the patients themselves cannot. They’ll end up waiting too long to take action, experience a health crisis and call 911. This is a common experience for so many Americans, but in most circumstances, the right preventative care could intervene just in time.
Paramedicine across the nation
It’s not just a small group of EMS providers working with the Quapaw Nation who are seeing the benefits of community paramedicine programs; communities all over the U.S. are experiencing the same results. States like Indiana, Washington, Massachusetts and New Hampshire are just a few places where community paramedicine is making a difference.
Our hope is that Tulsa, Oklahoma, is next on that list. Oklahoma has experienced how much of a difference paramedicine has made in Ottawa County, but the impact these types of healthcare solutions could have in urban settings – e.g., in Tulsa – would be astronomical.
Community paramedicine programs require a strong supply of EMS professionals and paramedics, and with the right investments, they just make sense. Better use of hospital resources, enhanced patient health outcomes and happier communities are waiting on the other side of these innovative healthcare solutions.
Healthcare professionals in Tulsa are out of this world; they’re passionate, committed, intelligent and innovative, but it’s clear that something systemic needs to change moving forward. I believe that community paramedicine could be the catalyst needed to lead to healthier and happier citizens of Tulsa.
Additional resources
- Spelten E, Thomas B, van Vuuren J, Hardman R, et. al. Implementing community paramedicine: A known player in a new role. A narrative review. https://doi.org/10.1016/j.auec.2023.07.003
- Elden OE, Uleberg O, Lysne M, Haugdahl HS. Community paramedicine: cost–benefit analysis and safety evaluation in paramedical emergency services in rural areas – a scoping review. BMJ Open. 2022; 12(6): e057752. Published online 2022 Jun 8. doi: 10.1136/bmjopen-2021-057752
- National Conference of State Legislatures. Beyond 911: Expanding the primary care role of first responders through community paramedicine
- CDC. Evidence of impact for community paramedicine
