Beyond flashing lights and sirens: Community paramedicine as health safety nets for older adults

Abstract

Providing unscheduled, acute, and longitudinal care to older adults who are aging in place is a critical, yet largely unsolved, health system challenge. A large gap exists between the times and places where older adults need care and the resources available to address those needs. 1 Despite efforts to increase older adults' access to in-home care through home-based primary care, telemedicine, and workforce development, persistent gaps prompted recent calls by the American Geriatrics Society and the American Association of Geriatric Psychiatry to expand the "team based geriatric physician and health professional workforce by nontraditional means." 2,3 This creates an opportunity for innovative, multidisciplinary, patient-centered teams to bridge the gap.Emergency medical services (EMS) agencies and clinicians are often called upon to fill this gap: they are accessible, mobile, and a trusted source of care in communities across the nation. 4 Though originally designed for emergency treatment and transportation of the critically ill and injured, EMS clinicians are increasingly embracing roles that span community outreach, prevention, and chronic disease management in a model of care known as "community paramedicine." 5 Community paramedicine is designed to fill the space between fixed medical system resources and dynamic community needs by leveraging availability, accessibility, and versatile skills of EMS clinicians working as part of physician-led or multidisciplinary team. This model of care is of clear importance to older adults who are aging in place.JAGS has been at the forefront of rigorous examination of the community paramedicine model of care for older adults. As early as 1968, Mel Spear advocated for the concept of a physician-led, team-based, patientcentered approach to physical, emotional, and social well-being of older adults in "Paramedical Services for Older Adults." 6 More recently, JAGS authors have described an array of community paramedicine programs tailored to the needs of older adults, including providing urgent, in-home, integrated evaluation and treatment to avoid unnecessary EMS transportation of medically complex older adults, 7,8 facilitating the ED-to-home care transition, 9 using 9-1-1 calls as a sentinel event to prompt fall prevention intervention, 10,11 and integrating