Pinch hitting: doctor shortages in rural America have paramedics stepping up to the plate when needed.

• Author: Ancell, Michelle
• Position: Health Care

Three years ago Robert's diabetes was so severe doctors planned to amputate his leg. But because Robert lives in Minnesota, one of the first states to launch a community paramedicine program, emergency medical technicians got involved. Three times a week they stopped by to care for his wound, share diabetes management tips and evaluate his overall health.

Today Robert still has his leg and credits the North Memorial Medical Center's community paramedics for saving it.

"He loves us," says Community Paramedic Supervisor Peter Carlson. "He welcomed us from the beginning. He's happy to see us and offers us candy. And we provide care, propping him up literally and figuratively."

Beyond Emergencies

Community paramedicine systems are popping up in Colorado, Maine, Minnesota, Missouri and Nevada to provide health care where few services exist. Often, they save money for patients, hospitals and insurance companies, mostly in avoided costs. A leg amputation, for example, costs around $76,000. That's about what it would cost to fund community paramedic home visits to Robert for 11 years. Minnesota reported that because of the paramedicine program there, Medicaid providers serving 100,000 residents spent $10.5 million less in 2014 than analysts projected they would.

Community paramedicine broadens the role of emergency responders beyond the traditional paramedic training that has existed since the 1970s and that focuses on stabilizing patients as they are transported to hospitals. Community paramedics can perform health assessments, monitor chronic diseases, ensure patients use medication correctly, give vaccinations and follow up after hospital discharges. They are also a great source of information and help educate patients on the care and treatment of their illnesses, injuries and diseases.

"Paramedics are highly trained, highly regarded, trusted health care providers in their respective communities," says Nevada Assemblyman James Oscarson (R), whose bill authorizing and regulating community paramedicine services was signed into law in May. "Community paramedics will have an expanded role in health care, not an expanded scope. Now they can complement the services of the other health care professionals in the health care system."

A Rural Lifeline

Community paramedics usually work in rural and isolated areas where physicians are scarce. Patients are often from underserved populations, meaning they are typically, but not always, low-income, elderly people. In Minnesota, community paramedics are specifically trained to care for patients who visit hospital emergency...