The framework itself isn’t new. What’s useful about Bloomington’s version is that it turns community risk reduction in community paramedicine into a structure that fire chiefs, EMS directors, and public health administrators already recognize, rather than asking them to learn a separate prevention model from scratch. Below is what each of the 5 E’s looks like when applied to MIH-CP work, with the data behind why it matters.
How Does Community Risk Reduction Apply to Mobile Integrated Healthcare?
Community Risk Reduction applies to mobile integrated healthcare through the fire service’s 5 E’s: engineering that fixes physical risks before they cause a call, education that teaches the skills that prevent the next emergency, enforcement through codes and inspections, economic incentives that remove the cost barrier to safety, and emergency response that shows up ready. Bloomington Fire Department’s MIH team mapped its work onto that framework at NAMIHP 2026.
Key Takeaways
- The 5 E’s are a U.S. Fire Administration framework for preventing 911 calls before they happen.
- Bloomington Fire mapped MIH-CP onto the framework; the application is theirs.
- Engineering and education are where most MIH visits already sit.
- The framework gives MIH a language fire chiefs already use.
How Does Engineering Fix Physical Risks Before They Cause a Call?
Engineering means identifying and correcting hazards in a patient’s physical environment, most commonly fall risk, before they cause an injury. One in four adults 65 and older falls every year, and non-fatal fall injuries cost the U.S. more than $80 billion annually (National Council on Aging, citing CDC data).
A home hazard assessment is the direct MIH-CP application of Engineering: a community paramedic walks through a patient’s home looking for loose rugs, poor lighting, missing grab bars, and stairs without railings, then works with the patient or family to fix what’s fixable. A 2023 meta-analysis of ten studies found home hazard modification programs reduced falls by 7% (Lektip et al., PeerJ). That’s a modest number on its own, but it compounds fast across a caseload of repeat fall patients, and it’s a lower-cost intervention than a single ER visit. We’ve covered the mechanics of running these assessments in more depth in our guide to preventing senior falls.
How Does Education Prevent the Next Emergency?
Education means putting prevention skills directly in the public’s hands, not just handing out a pamphlet. For MIH-CP programs, that’s CPR training, home fire escape planning, and naloxone education delivered during the same visit where a community paramedic is already building trust with a patient or family.
The data on why this matters is specific. Bystander CPR is associated with a 28% greater chance of cardiac arrest survival compared to no bystander CPR (NIH/NHLBI, 2024). On the naloxone side, a 2025 systematic review of 41 studies found a 97.3% survival rate among people who received naloxone from a bystander or community program. This number held up even as fentanyl changed the overdose landscape (BMC Public Health, 2025). An MIH-CP visit is one of the few points of contact where a family already at risk gets that training in person, rather than being expected to seek it out.
Enforcement: Codes and Inspections as Prevention Tools
Enforcement means making sure the codes already on the books-working smoke alarms, safe egress, occupancy limits-actually get followed. For MIH-CP, this is usually a coordination role: flagging code violations found during a home visit to the fire marshal’s office, rather than an MIH team acting as the inspector.
It’s worth flagging because the payoff is large and well-documented: working smoke alarms cut the risk of dying in a home fire by more than half, and the majority of home fire deaths happen in homes with no smoke alarm or a non-working one (NFPA, 2024). A community paramedic standing in a patient’s living room is often the first person in months to notice an alarm with a dead battery.
How Do Economic Incentives Remove the Cost Barrier to Safety?
Economic Incentives means removing the cost barrier that keeps someone from fixing a hazard they already know about. In practice, that’s mostly free equipment, smoke alarms, and grant-funded home modifications, rather than tax policy, which isn’t where most departments actually operate in this category.
The American Red Cross’s Sound the Alarm campaign has installed more than 2.5 million free smoke alarms and made over a million households safer since 2014 (American Red Cross). An MIH-CP visit is a natural distribution point for programs like this: the community paramedic is already in the home, already has the patient’s trust, and can install an alarm on the spot instead of relying on the patient to request one.
For programs weighing their options, Julota has outlined ten funding strategies MIH-CP programs can use to build long-term financial sustainability, from folding costs into existing EMS budgets to pursuing philanthropic and grant support (see Julota’s guide to funding community paramedicine and mobile integrated healthcare programs).
Emergency Response: Making Sure the System Shows Up Ready
Emergency Response means the rest of the system, the part that shows up when prevention doesn’t catch everything, is trained and resourced to handle what comes in. MIH-CP doesn’t replace 911 response; it reduces the volume of calls that reach it and improves the readiness of the calls that do reach it.
A 2025 NAEMSP position statement describes MIH-CP’s role in closing healthcare access gaps for underserved populations, work that keeps lower-acuity patients from becoming 911’s problem in the first place (Ulintz et al., Prehospital Emergency Care, 2025). A 2022 meta-analysis found MIH-CP programs associated with measurable reductions in emergency department visits (ScienceDirect, 2022). Every call an MIH-CP program prevents or redirects is capacity returned to the crews handling calls that genuinely need a fast, well-resourced response.
Why Does the Community Risk Reduction Framework Matter for MIH?
None of the five categories in community risk reduction in community paramedicine work alone. A free smoke alarm (Economic Incentives) does nothing if no one installs it (Enforcement, Engineering). A fall risk assessment (Engineering) means less if the patient was never taught what to do if they do fall and can’t get up (Education).
It also gives programs a diagnostic tool. A team that’s strong on Emergency Response but has never formalized a process for Enforcement referrals has a visible gap, not just a vague sense that “something’s missing.” Running your own program through the 5 E’s is a fast way to find where the next hire, partnership, or grant application should go.
Related reading
- What Are The Top Community Paramedicine Risks
- How Community Paramedicine Supports Risk Stratifications for Advanced Illness
- The Optimal MIH-CP Balance: Quality, Safety, and Access
