What is the community paramedic’s scope of practice? This is a common question – unfortunately, it often receives confusing answers. Even the CDC has outlined a report on community paramedicine that mentions ambiguity in interpreting protocols for mobile integrated healthcare-community paramedics (MIH-CP). While questions about the scope of practice can feel like opening a can of worms, there are general rules that can guide us.
The scope of practice of community paramedics is broadly defined and selectively adapted for each situation. What does this mean? Community paramedics can implement many possible skills and procedures; however, individual areas (governed by local medical authorities) will decide on specific protocols. This variability makes it difficult to pinpoint a universal definition of the scope of practice.
In this article, we’ll unpack that last paragraph. Admittedly, this topic can get confusing. Don’t worry. We’ll walk through it logically. By the end of this discussion, you should clearly grasp the current MIH-CP scope or practice, where it came from, and where it’s going.
What Does Scope of Practice Mean for Ambulances and Community Paramedics and what defines paramedicine protocols?
Let’s start with a definition of the term scope of practice. Scope of practice refers to the activity, procedures, and practices that a medical professional is trained and authorized to perform.
For example, the scope of practice of a surgeon will be broader (there is much more they are authorized to do) than the scope of practice of a paramedic.
EMS and community paramedicine may have one of the broadest scopes of all the medical professions. This long leash is partly due to paramedics’ activity in disaster and emergency care, where it is difficult to define every situation.
The following sections will explain how paramedics and EMTs might operate within a community paramedicine program.
The Types of Community Paramedicine Providers
The best way to understand the paramedic’s scope of practice is to understand their foundational certifications and how they build from there. There are usually two types of providers in community paramedicine who work with the ambulances: the paramedic and the EMT. Both paramedics and EMTs may be involved in MIH-CP.
Let’s look at the scope of practice for both these provider levels:
- EMT Scope of Practice
- Paramedic Scope of Practice
Let’s explore these in more depth. We’ll start with EMTs.
EMT Scope of Practice
The EMT, or emergency medical technician, is certified in basic life support, including bleeding control, CPR, and rescue breathing. However, EMTs don’t learn invasive skills during initial training – such as inserting IVs, performing intubations, placing catheters, or administering advanced medications.
Due to less training in advanced skills, many programs choose to staff their community health programs with paramedics who have received more human anatomy and physiology training and may perform advanced skills.
However, this does not mean EMTs can’t work as community providers. Indeed, with added training, some EMTs are permitted to perform blood draws, administer vaccinations, and conduct a full patient assessment.
Some places have certifications designated “CEMT” or community medical response emergency medical technicians. CEMTs can be a good option for those looking to start an MIH-CP program when adequately trained.
Not all areas have this training designation, but as community paramedicine expands, we could expect the “CEMT” to become more common.
Note: Due to the paramedic shortage, many areas turn to EMTs to fill the gaps. If you’re curious, read our article on how to recruit paramedics.
Scope of Practice of Paramedics
The paramedic receives many hours more training than the EMT. Many states require new paramedics to receive an associate degree. Paramedics receive training in advanced life support, and their scope of practice is intentionally left broad.
Paramedics often receive at least two years of training for their base level certification (including their EMT license, which they must have).
Paramedics learn medicine administration, starting IVs and drawing blood, catheter placement, advanced airway management, and much more.
For this reason, paramedics have an excellent foundation for further training, including receiving extra education as community paramedics. In many areas, a community paramedic certification is required; however, some jurisdictions rely on the medical director (the physician in charge of the area protocols) to train and authorize the paramedic in various skills and procedures.
Many people believe that, for continued growth, community paramedicine must work to achieve a standardized, base-level certification.
Now that you understand how these providers are certified let’s talk about the broader levels or procedures. What can a community paramedic do? What can they not do?
Note: In emergency medical services, CP stands for community paramedicine. However, this is often written as MIH-CP for mobile integrated healthcare community paramedicine.
Levels of Community Paramedicine and Specific Protocols
The scope of practice of community paramedics refers to what a paramedic is trained, certified, licensed, and has credentials to perform.
If you’d like to learn more about these four levels, you can read more at EMS.gov.
However, here’s a basic explanation of the four levels: training means nothing if the skill is not certified (tested). Certification doesn’t mean you’re authorized to perform the skill, as the provider must also be licensed. All these layers must be in place for paramedics to include a procedure in their scope or practice.
For the past several sections, we’ve been talking in the abstract. So let’s reel it in and talk about specifics. What can a community EMT or paramedic actually do? How do different parts of the country use their skills?
We’ll organize these systems from non-invasive to most progressive:
- Non-invasive MIH-CP care
- Minimally invasive Community Care
- Most progressive MIH-CP Scope of Practice
Note: this is not a list of “worst to best.” In many cases, a “simple” non-invasive program could produce better results than one that relies on advanced procedures. The secret to an excellent MIH-CP program comes down to good planning, strong partners, and organized execution.
Non-Invasive Community Paramedic Scope
This community paramedicine model emphasizes patient assessment, documentation, and maintaining a connection between patients and their healthcare providers.
Non-invasive simply means that the providers don’t perform blood draws, med administration, or any “advanced” home procedure. Instead, these providers will get the patient’s vitals, perform an assessment, track progress, and facilitate a connection (often via video chat) with the physician.
This program model is popular for programs that operate at the EMT level. However, many community paramedic programs, such as PORT (post overdose response) or mental health programs, are effective and don’t often require invasive skills.
Minimally Invasive CP-programs
Minimally invasive programs are probably the most common. But, again, trained paramedics usually staff these programs.
Often, these programs may have a fall risk program and may even involve an alternative destination program. A community paramedic follows established protocols for alternative destinations (urgent care, mental health facilities, rehabilitation centers, etc.).
These community paramedics will also perform medication administration, wound treatment, vaccinations, breathing treatments, and more – depending on the authorizing physician’s protocols.
Now, let’s discuss some of the most advanced options for community paramedic programs.
Most Advanced Protocols in Community Paramedicine Scope
Some areas of community paramedicine are pushing the boundaries of out-of-hospital care. For example, many rural regions realize that the only way to get care to patients is to bring it to them. Let’s look at several recent advancements.
Here are several more advanced procedures performed in the field:
- Point of care blood analysis. Many areas have begun analyzing blood lab values in the field. This gives community paramedics a significant advantage when making triage and treatment decisions. It also gives them the ability to track patient progress.
- Out of hospital CT scans and ultrasound. In some areas, paramedics use ultrasound, giving them an upper hand in hospital diagnoses. Some areas have gone as far as building entire ambulances with CT scanners, referred to as mobile stroke units. These are not widespread yet but may grow in the future.
- Advanced providers. In some areas, nurse practitioners, PAs, and even physicians may work in a community paramedicine-like capacity. “Scope of practice” is variable in these cases, as these providers may perform many advanced procedures.
Hopefully, this gave you an idea of the multiple tiers of community paramedics and their various scopes. The future of community paramedicine has exciting things on the horizon.
Let’s go over our final take.
Last Take on MIH-CP and Scope of Practice for Community Paramedicine Protocols
Community paramedicine is much more than just bringing advanced skills into patient homes. While this is undoubtedly a benefit, it’s not the whole story. Community paramedicine and mobile integrated healthcare exist to increase the collective impact of healthcare.
Increasing the training and standardizing community paramedicine will help grow these programs; however, in many cases, the resources are there – they just need to be organized and connected to the patient.
Julota exists as a platform for documentation and data collection. Julota built this tool for community paramedicine and mobile integrated healthcare. It’s a platform that connects the hospital, the nursing home, the community paramedics (and everyone else!) to the patient record. Julota facilitates effective collaboration by keeping everyone on the same page.
Contact Julota if you’re curious to learn how this tool helps community paramedic programs thrive.