A fundamental difference between community paramedicine – an emerging practice within the paramedic profession – versus traditional paramedicine, is that community paramedics essentially bring the care to patients, rather than having patients come to the care.

And that is both the spirit and the intent behind the Community Paramedic – Care by Design Program in Nova Scotia, which started more than a decade ago.

Quality emergency care for older adults living in Long Term Care (LTC) is dependent on managing frailty.(1) Typical ground ambulance emergency responses to LTC cannot address this complexity, and responses often result in transport to EDs and hospital admission, even if this is against the patients’ wishes.(2) 

To address this gap, a community paramedic service began in 2011 in collaboration with Nova Scotia Health’s new model of care referred to as “Care by Design”.(3) This novel approach to care focused on older adults living in LTC and included dedicated physician staffing for each facility, on-call LTC physician coverage, and interdisciplinary care.(3) 

Under this model, paramedics collaborate with health care colleagues at LTC facilities within the Halifax Regional Municipality to deliver patient care at the bedside, preventing unnecessary trips to the ED.

Community Paramedicine  

Community Paramedicine is an evolving concept. A global definition of community paramedicine describes a paramedic who provides “person-centered care in a diverse range of settings (including LTC) that address the needs of the community”.(4) They may provide primary health care, disease management, and needs based interventions and they should be integrated in interdisciplinary health care teams.(4) Their role in providing care to older adults often includes aspects of in-home assessment, referral options, education, and communication.(5)

Initial results in Nova Scotia demonstrated a 47% reduction in LTC-ED transports, and fewer hospital admissions when a community paramedic responded.(6) 

Improved provider satisfaction and collaboration with primary and emergency care physicians’ and nurses’ was observed.(7)  

This program has been slow to be implemented elsewhere, but results are promising, and it should be considered when addressing gaps in care for older adults living in LTC.   

References:  

1. Goldstein J, McVey J, Ackroyd-Stolarz S. The role of emergency medical services in geriatrics: bridging the gap between primary and acute care. Canadian Journal of Emergency Medicine. 2016; 18(1): 54-61.
2. Gruneir A, Bell CM, Bronskill SE, Schull M, Anderson GM, Rochon PA. Frequency and pattern of emergency department visits by long-term care residents-a population-based study. Journal of the American  Geriatrics Society. 2010;58(3):510–7.
3. Marshall EG, Clarke B, Peddle S, Jensen JL. Care by Design: new model of coordinated on-site primary and acute care in long-term care facilities. Canadian Family Physician 2015; 61: e129-34.
4. Shannon B, Baldry S, O’Meara P, Foster N, Martin A, Cook M, Stewart K, Miles A. The definition of community paramedic: an international consensus. Paramedicine. 2023; 20(1): 4-22. 
5. Van Vuuren J, Thomas B, Agarwal G, MacDermott S, Kinsman L, O’Meara P, Spelten E. Reshaping healthcare delivery for elderly patients: the role of community paramedicine: a systematic review. BMC Health Services Research. 2021; 21:29. 
6. Jensen JL, Marshall EG, Carter AJ, Boudreau M, Burge F, Travers AH. Impact of a novel collaborative long-term care – EMS model: a before-and -after cohort analysis of an extended care paramedic program. Prehospital Emergency Care. 2016; 20 (1): 111-6.
7. Jensen JL, Travers AH, Marshall EG, Cain E, Leadlay S, Carter AJE. Insights into the implementation and operation of a novel paramedic long-term care program. Prehosptial Emergency Care. 2014; 18(1): 86-91.       

Judah Goldstein, Remo Zaccagna, Canada