Medical Direction of Mobile Integrated Healthcare and Community Paramedicine Programs

Approved by the ACEP Board of Directors October 2014

The American College of Emergency Physicians (ACEP) believes emergency medical services (EMS) systems are an integral partner in the delivery of health care in the out-of-hospital environment. Like emergency medicine in general, EMS systems are a critical part of the health care safety net and have unique skills and resources to fill health care gaps in the communities they serve. The changing needs in community-based health management are creating an evolution of EMS roles that now include community paramedicine (CP) and mobile integrated healthcare (MIH), CP and MIH programs provide health care through patient-centered, mobile resources that exist in most EMS systems today. The title of CP is not exclusive to care provided by paramedics, but is applicable to any level of practitioner working within their scope of practice in this setting.

CP providers deliver health care using common skills that are within the education and scope of practice of standard EMS personnel. The care is often delivered in non-traditional roles by redistributing traditional EMS resources to meet the patient’s health care needs. MIH integrates CP services with call centers, the medical home, and other existing health care resources to further navigate patients through the complex infrastructure of health care delivery. MIH programs do not replace existing home health resources, but instead educate health care providers to augment care and fill gaps for patients who do not qualify for, or have available to them, other health care resources.

MIH and CP services may include, but are not limited to, providing medical screening of 9-1-1 calls instead of automatic resource response, providing levels of community care, chronic disease management, preventative care, post-discharge follow-up care, and patient transport to the appropriate destinations that meet the patient’s health care needs.

The following are essential elements that must be included in any CP or MIH program:

• Strong clinical oversight and supervision by the EMS medical director in collaboration with other physicians and practitioners.
• Community health care needs assessment to identify areas for program intervention.
• Collaboration with community partners and other home health care resources to ensure the delivery of services have a patient-centered access to care focus.
• Specialized education for the CP/MIH providers and other stakeholders to ensure the needs of the patients are addressed.
• Coordination of care among call centers and collaborative health care teams to ensure the most appropriate delivery and prevent redundancy of services.
• Integration into the existing health care systems including bidirectional sharing of patient health information.
• Systems of ongoing assessment to evaluate the effectiveness of programs in meeting the identified objectives, while ensuring patient safety.
• Procedures must be in place to address and comply with EMTALA regulations.
• CP/MIH programs must not distract or diminish existing EMS service delivery or necessary emergency department care for the patient.
• A strong quality assurance/quality improvement (QA/QI) system must be in place to identify problems, ensure corrective action, and assess results.
• Assurances that if a person calls 911 (or similar emergency number) for a patient’s apparent emergency medical condition or medical emergency and requests an ambulance, the patient has a right to a medical screening examination and stabilizing treatment by a qualified medical person in accordance with EMTALA. For the purposes of an EMTALA mandated medical screening exam, paramedics and community paramedics are not believed to be qualified medical persons.


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