The New York Mobile Integrated Healthcare Association (NYMIHA) was formed by members of the local EMS community who recognized that the role of prehospital care systems was very limited in relation to the larger healthcare system and at times even at odds with the triple aims of pursuing the improvement of the patient experience, improving the health of the population, and lowering the per capita costs of delivering care. It was the feeling of both local as well as national leaders in prehospital medicine that there was a larger role that EMS could play to help fill unmet needs within our local communities.
Mobile Integrated Healthcare (a.k.a. Community Paramedicine) is a broad term that is used differently by various constituencies and in various regions. The NYMIHA uses the term to describe an expansion of the role (not scope) of EMT’s and Paramedics to provide higher quality patient-centered prehospital care and helping to prevent acute medical complications of chronic conditions. It refers to a collective group of proposed activities and roles for out-of-hospital care systems that exist outside of the traditional and existing 9-1-1 emergency response paradigm, or the interfacility transport paradigm.
We describe three aspects of community paramedicine:
1) Patient-Centered Emergency Response – Making 9-1-1 more flexible and adaptable to meet the needs of the patient including transporting to alternate destinations (Primary Care Office, Dialysis Centers, Urgent Care Centers, etc) and “treat and release” protocols.
2) Integration with the Healthcare Service Delivery System – Extending a hospital’s or health system’s care model into the community through proactive out-of-hospital care programs and improved clinical coordination of care. Adding value to routine patient interactions during non-9-1-1, interfacility, and discharge associated ambulance transports.
3) Integration with the Community & Public Health – Integrating out-of-hospital care systems into the public health infrastructure of a community. Vaccination programs, personal preparedness training, fall risk reduction are just a few of the ways that EMS can serve as the foot-soldiers of the public health system.