Community Paramedics

communityI hate that I hate the very thought of Community Paramedics, and Mobile Integrated Healthcare.

I hate it because on the surface it is actually a good idea, and might work, but under the surface lies the problem. Implementing a socialist health care system that is administered by for profit providers will end badly, mark my words.

I hate it that my optimism concerning the future of EMS has been destroyed by working in an urban enviornment with a populace that uses EMS as their personal valets, and a fire department that considers the EMS division little more than a means to increase fire department visibility, distort run statistics and produce revenue by giving just about anybody who calls 911 a ride to the hospital.

I hate that I’ve heard more than once that “the privates” wouldn’t touch Providence EMS because the populace served would make the venture unprofitable.

I hate it it that I am in the minority of EMT’s and Paramedics who even know or care about Community Paramedics and Mobile Integrated Healthcare; the majority of people in this field keep their heads down and collect their pay.

I hate it that the people advocating for Community Paramedicine and Mobile Integrated Healthcare are mostly management and administrators, or owners of private companies who need taxpayer dollars, ie. The Affordable Healthcare Act to make their initiatives possible.

I hate it that my friend and doctor closed her practice because her values and integrity were in direct contrast to the system that the aforementioned Affordable Healthcare Act forced upon her.

I actually hate the entire healthcare system.

Until me or somebody I care about gets sick, then I’ve gotta learn how to love it.

Because by then, we don’t have time for debate, and have to trust the people who have the highest stake in the system, and play our role as revenue producers while lying on our death beds.


Brandon, over at EMS Basics hosts a “What if we’re wrong-a-thon,” which asks EMS authors to be their own devil’s advocate and re-think some of their more firm beliefs, then write a post in favor of something we are actually against, or vice versa.

I’ll be re-thinking community paramedics. Might be interesting, the post will be live this Monday, the 15th of February.


  • Warren Moore says:

    Sounds like you just hate the Afforable Care Act. I don’t like it because it has some flaws, but it is better than nothing and I see it as a start toward a single payer system that will provide good care to all at “affordable” costs.
    Any doctor who shut down their practice because of the ACA is in the wrong business.
    As for community paramedicine; it will have it’s growing pains, but it is the future and the only way to reduce healthcare costs without compromising care. There is no reason that private companies have to dominate the field.
    There are actually agencies in this country that are not affiliated with fire departments and do specialize in healthcare.
    Kindest Regards,
    W. Moore
    Putnam County, WV

    • Michael Morse says:

      The doctor I spoke of is a therapist with her own practice. I’m not sure of the details but she had a choice; join a group with personal client information available to all in the group, including office staff or continue operating on her own at little or no profit. She chose to retire. The rest? Tune in Monday!

      Thanks for the input Warren.

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  • Dear Warren says:

    Warren said “Any doctor who shut down their practice because of the ACA is in the wrong business.”

    Please tell us how your primary care practice is thriving under the ACA.

    I was primary care trained and now I am a hospitalist because it has become incredibly difficult to maneuver the bureaucracy of running a practice and simultaneously provide quality evidence-based care to patients. The irony is that while I was seeing maybe a slight bump in the number of insured patients, I actually had to treat a larger number of them as if they are uninsured because they can’t afford the deductibles. They are not functionally insured although a bureaucrat can now claim to have gotten more people on board. It was smoke and mirrors

    The ACA was like saying the best way to treat a stab wound was to fire a bullet into it “because it is better than nothing,” and then claiming we now need to change to a completely undesirable system because your first ridiculous idea didn’t work.

  • Melissa says:

    I just did my research on community paramedicine, and I believe its useful and needed as discharges from hospitals occur too soon without follow up care IN THE HOME OR PRIMARY residence where the patient actually lives, it truly may help stop the merry go round of readmissions, but my beef us with the mental health /substance abuse system that uses ED and EMS as a treatment provider, a safety net for OD, and the lack of mandatory stays foe the frequent flier. We need facilities, and not necessarily a general hospital to bring these patients to for long term treatment. I’m tired of picking up the same patient that still has his bracelet on from the morning admission where he was placed in a hallway to sober up and eat a sandwich, without proper treatment for the mental health component, to return over and over payment, over burdening and risking violent encounters to EMS. Community paramedics may play a role in establishing resources for treatment while providing follow up care and compliance. It will be thankless work, but the edidemic is growing while the services arent..which just leads to intolerance, poor patient care, and over burdened ED. What say you all?

    • Michael Morse says:

      Thank you for the thoughtful response Mellissa, I’ll have a response soon, too much going on today and your comment deserves proper thought.

  • Sherri says:

    Wow, you hate a lot. I believe Community Paramedicine is viable alternative to our current healthcare point of access problem. I believe public and private can work well together as long as each understands and respects each other and has open communication. Our health care system is extremely over burdened and paramedics are a under used resource.

    • Michael Morse says:

      Paramedics are abused, overworked, understaffed, assaulted, attacked and burned out here in Providence, RI. People who think we are an under used resource are what worry me.

  • Mike says:

    While I understand and believe the theory behind “Community” Paramedicine, what kind of ratios are we talking about – how many units per 10,000 or 100,000 people? How are they dispatched or are they directed to patients by first responders who identify a need? Who should foot the bill…. the pre-hospital system (usually Fire) the hospital system or should it be a joint effort? How much of this is funded through the ACA?

  • Hazmat Medic says:

    I see a lot of comments bashing Mike for being anti-CP/MIHC. I wonder if some of you actually read what he wrote. He’s not against it; he just is skeptical it would work under our current system of funding healthcare and a culture that looks at EMS as a free taxi ride that gets them access to an ER doc quicker.

    I’ve worked and volunteered for a variety of agencies (from a 10 person volunteer squad to the FDNY) in a variety of communities (in the northeast and midatlantic) since the mid-80’s, I share his concerns and thinks he hits the nail square on the head. Community Paramedicine is a great CONCEPT. HOW WELL it works depends on HOW it is implemented.

    The Affordable Healthcare Act is a system that was intended to provide adequate health care to all. It has far from achieved that goal. I’ve cared for many patients, worked with many colleagues, and have friends and neighbors who all have experienced real problems with it. For many of them, it doesn’t function as what we think of as health coverage: affordable preventative care, affordable treatment for preexisting conditions, and affordable treatment for most minor to moderate emergencies. For them it’s essentially catastrophic care coverage, because the deductibles for the more affordable premium plans are exorbitantly and prohibitively high. Great that you have coverage, but when you can’t afford the $300 doc visits, the $50-300 weekly or monthly prescriptions, when it’s actually more affordable for you to pay the tax penalty than the monthly premium, there’s something wrong.

    There is a range of working people who don’t qualify for tax credits and/or who live in states that don’t provide assistance with healthcare for adults because they opted out of the ACA participation. My girlfriend is one of those, so I speak from (second hand) experience. The ACA is a watered down plan that benefits few and gave the insurance companies reasons to jack up everyone’s premiums. They claimed they needed to pass on the cost to their customers to cover the projected overhead created by implementing the ACA. In reality, that projected additional cost from them hasn’t materialized. In addition, I remember them jacking up my premiums 1-2 years before a majority of the elements of the ACA even kicked in.

    The colleagues and friends I have in places with “socialized medicine” (Canada, UK, Germany) think we’re crazy; they haven’t experienced the “healthcare rationing”, “long waits for care”, “additional expense”, or “lack of access to diagnostic and treatment” that those against the idea of single payer/socialized medicine have claimed will happen.

    I do sincerely hope that Community Paramedicine will help address the frequent flyers and other non-emergencies we respond to. But without a cultural change and educational campaign that successfully changes how the 911 system is used in many communities, we’ll be continuing the same broken system that destroys EMS Providers and does not provide the kind of prehospital emergency care communities need.

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