The Trip Report: EMS Views on Community Paramedicine

Reviewed This Month

Emergency Medical Services Professionals’ Attitudes About Community Paramedic Programs

Authors: Steeps RJ, Wilfong DA, Hubble MW, Bercher DL. 

Published in: West J Emerg Med, 2017 Jun; 18(4): 630–9. 

This month we review a manuscript dedicated to community paramedicine. I’m sure by now most of you are familiar with this new model of care. Typically community paramedics (CPs) do not have an expanded scope of practice but rather an expanded role dedicated to prevention. CPs often make scheduled home visits as part of programs tailored to local needs. 

The Health Resources and Services Administration provides a document for communities interested in starting programs to perform a needs assessment to determine the ideal focus for their CPs. Community paramedic programs will have different goals; so far many are focused on reducing unnecessary ambulance transports, ED visits and hospital readmissions. There are some challenges to implementing and sustaining CP programs, most notably long-term funding.

Challenges aside, even though this is a relatively new role, EMS is ahead of the curve. A National Agenda for Community Paramedicine Research has already been published. Most CP research has focused on determining whether programs are meeting their stated goals. There is also research focused on cost savings. The Agenda document specifically calls for research to “identify the characteristics of EMS personnel that may facilitate recruitment into CP.” The research we are about to discuss fits this priority. This study had the goal of investigating EMS professionals’ attitudes about and willingness to participate in CP programs. In research terms, this was the outcome of interest.

Before we dive in, I have to say that I absolutely love that every author of this study holds an EMS certification. Specifically, they are all nationally registered paramedics. This is great for our field and not seen very often.

Survey Findings

To examine the outcome of interest, the authors used a cross-sectional method. This is a fancy way to say the study evaluated attitudes and willingness at a specific point in time, and there was no follow-up to see if things changed.

Typically this is done by surveying individuals. The authors sent out invitations to participate in an electronic survey to a convenience sample of 350 EMS professionals from one hospital-based ALS agency in southwest Missouri. The surveys were delivered to potential respondents by their regional managers. We will come back to this later because many of the study’s limitations arise from the information discussed above. 

The survey was made available from January 19–February 23, 2015. It collected demographic information such as age, gender, race, level of education, certification level, years of EMS service, average number of calls per shift, etc. to determine whether any of it impacted respondents’ attitudes about and willingness to perform CP duties. 

This survey had an impressive response rate even for a convenience sample. Overall, 277 EMS professionals consented to participate—79% of those invited. These days getting a response rate of 60% is almost unheard of. 

The results, overall, were very interesting. Of all the respondents, 70% indicated that they felt knowledgeable about the requirements of a CP program. A large majority indicated they could dedicate at least one hour to CP duties while on shift. Only 73 said they could not commit additional time during their shift to CP work. Slightly less than a majority (47%) indicated they felt the patients they currently cared for could benefit from a CP program. 

There were 135 survey respondents (58%) who indicated they were at least somewhat likely to attend additional education to become a CP. One of the more interesting questions asked whether respondents would perform CP duties with as much or more enthusiasm as they currently had for traditional prehospital patient care. Two-thirds said they would. Finally, almost three-quarters (74%) of respondents indicated that a CP program should be a significant responsibility in their community. 

The results above are called descriptive statistics. These are just percentages of individuals who answered each question. The authors also used logistic regression to find factors that were associated with EMS professionals’ willingness to complete CP duties. In other words, a statistical model was constructed to determine which of the question answers had a statistically significant relationship with affirmation of willingness to complete CP duties. This study used a p-value less than 0.05 to indicate statistical significance. 

Interestingly, the community size (rural/urban) in which the individual worked, the individual’s rank (field provider or supervisor) and whether they worked for an EMS agency that had a CP program all were not associated with a respondent’s willingness to perform CP duties. In other words, there was not a statistically significant association (the p-value was greater than 0.05). In fact, the only variable included in the logistic regression model that showed a positive relationship with the individual’s willingness to perform CP duties was gender: Females were significantly more likely to be willing to perform CP duties (p-value less than 0.05). 

Limitations

As we discuss each month, every study has some limitations, and this one is no different. Some concern how the authors recruited individuals to participate.

First, this was a convenience sample from one hospital-based EMS agency. It is likely these results would differ if a more diverse study population were recruited. The response rate was impressive, but as mentioned, the survey invitations were sent out by regional managers.

This could introduce bias: Some individuals may have felt they had to complete the survey because they were invited to by their boss. Also, some of the survey questions may have been answered in an artificially positive way because respondents felt this was what their boss wanted to hear. Finally, the survey asked EMTs and paramedics about adding CP duties to their daily routines. The majority of CP programs utilize paramedics and prioritize CP duties for those who have completed the necessary training. 

Limitations aside, this study is a valuable addition to the CP literature. It is important to understand how EMS providers feel about the work they’re being asked to perform.

It is really important to determine whether the result suggesting females are more willing to perform CP duties can be replicated in other studies. Nothing is proven with one study. If this result is seen in similar studies, identifying why would be an essential next step. 

Again, all the authors here were EMS professionals, which is not only encouraging but aligns with the EMS Agenda for the Future and the National EMS Research Agenda. I congratulate the authors on getting this work published and hope to see more teams of authors composed entirely of EMS professionals.  

Resources

1. HRSA Community Paramedicine Evaluation Tool, https://www.hrsa.gov/ruralhealth/pdf/paramedicevaltool.pdf 

2. A National Agenda for Community Paramedicine Research, https://depts.washington.edu/uwrhrc/uploads/CP_Agenda.pdf

Antonio R. Fernandez, PhD, NRP, FAHA, is research director at the EMS Performance Improvement Center and an assistant professor in the Department of Emergency Medicine at the University of North Carolina–Chapel Hill. He has been a nationally certified paramedic since 2005 and completed the EMS Research Fellowship at the National Registry of Emergency Medical Technicians.