Geriatric Emergency Medicine Fellowship Journal Club – Community Paramedicine

Community paramedicine is a model of healthcare that utilizes paramedic services to deliver nonurgent healthcare services to patients. 1 The intended goal is to improve patient care by identifying community dwelling patients who may benefit from additional services, such as home care services or mobile health teams, to prevent progression to more serious illness. 1 The use of community paramedicine programs has expanded in multiple jurisdictions in the last decade and offers numerous advantages. 2.,3 Paramedics are medical professionals who can efficiently be trained to gain expanded roles and skills to provide care beyond acute care management and transportation.Focused role-specific training can include recognizing geriatric syndromes, performing procedures, providing point-of-care testing and interventions, assessing and managing chronic diseases, coordinating care with primary care teams, making referrals, providing health education, and following up with patients post-discharge. 2,3 Older adults represent an increasing proportion of patients utilizing emergency services. 4The ability to provide ambulatory care is particularly advantageous to vulnerable older adults with mobility or cognitive impairments, social isolation, or multiple comorbidities.A proactive approach that addresses chronic disease management and geriatric syndromes may also help reduce healthcare costs associated with acute adverse events in older adults. 5From the emergency department perspective, community paramedicine programs offer the option of a robust resource to facilitate safe discharge plans and health promotion for older adults. 1 In this article, we summarize the Journal Club on Community Paramedicine held on February 1 st , 2024, which reviewed two articles examining the health system impacts of community paramedicine programs for older adults and their intersection with the care of older adults in the emergency department. CASE JOURNAL OF GERIATRIC EMERGENCY MEDICINEA 75-year-old woman is transported to the hospital by ambulance after sustaining a fall at home.The paramedics report that they have attended to this patient multiple times in the past few months for similar falls.Usually, the patient requires assistance to get up and then declines transport to the hospital.On this instance, the patient was unable to ambulate even with assistance and there is an obvious deformity of the right hip noted.The paramedic tells you, "Every time I see this patient's address pop-up on my shift, I worry that this time will be a more serious fall."The patient's pain is managed, she is diagnosed with a hip fracture, and consulted to orthopedics.Given the numerous interactions of the emergency medical services (EMS) and paramedics with the patient prior to today's ED visit, you wonder about community interventions to support vulnerable older adults and help prevent adverse health outcomes.