Community Paramedicine Is Changing Diabetes Care

First responders bring to mind 911 emergencies where paramedics respond to provide lifesaving care. But today, paramedics are being used for another type of support that fills a much needed gap in communities—and it has nothing to do with medical emergencies.  

Before modern EMS started in the 1960’s, if someone had a heart attack, stroke, or severe injury, the only way they got to the hospital was:

Once EMS started, it was common for volunteers with no medical training to drive them. The mentality was to just load and go. They realized a gap in care—patients weren’t even making it to the hospital—and they fixed it.

The evolution of EMS over the last 60 years started with the dawn of the EMT that had formal training. Then came the paramedic. They started to increase the scope of care from basic, life-saving measures to advanced critical care support.

Depending on need and location, flight services were formed allowing patients to be transported via helicopter or fixed-wing (small plane) aircrafts allowing patients to receive faster, more efficient care at the hospital.

Emergency services became organized, cohesive and so many lives were saved. But a new gap started forming: first responders found themselves repeatedly treating patients whose greatest needs weren’t emergency interventions, but ongoing support for chronic conditions, medication management and barriers to accessing routine care.

Community paramedicine was created to bridge that gap by bringing proactive, preventive care into the home to help patients stay healthier and avoid calling 911 for nonemergent needs. It helps patients get the care they need without going to the hospital.

What is community paramedicine?

Often called MIH-CP (Mobile Integrated Health—Community Paramedicine), these programs aren’t about replacing your healthcare provider (HCP). What it does is fill the gap between appointments so that small problems are mitigated before they become life-threatening emergencies, like diabetic ketoacidosis (DKA).

These visits can take place in the comfort of your own home, and include things like:

• Check and review your blood glucose log or continuous glucose monitor (CGM) data
• Do a comprehensive review of the medications you’re taking to ensure you’re taking them correctly
• Take a look at your feet for cuts, blisters or ulcers
• Check blood pressure and signs of dehydration
• Make sure you have enough glucose testing supplies
• Assess nutrition and whether you have consistent access to healthy food
• Make sure follow-up appointments are scheduled and transportation is available

You can start these visits by getting referrals from:

• The hospital
• EMS, after repeated 911 calls
• Your HCP
• You or your family might be even be able to directly request these services

Some insurers and accountable care organizations (ACOs) will automatically enroll patients for visits based on risk scoring for people who are likely to:

• Be hospitalized again soon
• Have uncontrolled chronic disease
• Call 911 frequently

Who can benefit from community paramedicine?

Community paramedicine visits are helpful for people with living with diabetes, especially if you:

• Live in a rural area
• Call 911 for support frequently
• Are homebound and can’t drive
• Are having a hard time managing your diabetes between HCP appointments

Once enrolled, it’s common to receive an initial home assessment to look at your current health status and what your living conditions are like. From there, you receive regular scheduled visits from a community paramedic. They could be weekly, biweekly or monthly depending on your needs.

How to find a community paramedicine program near you

To date, programs already operate in more than 40 states. A 2020 study conducted found that patients in a MP-CIH program who visited the emergency department during the six months after enrollment dropped by 59.3% compared to six months before enrollment.

If you or someone you know is interested in being in a program, you can start by calling your HCP and ask if they can refer you. You can also call your local ambulance service or fire-rescue agency to ask if they run a community paramedicine or “mobile integrated health” program.

You can also call your state EMS office and find out whether any program operates near you. 

What to do if it’s not available in your area

If you call your state EMS office and they say community paramedicine isn’t available in your area, don’t worry! That’s not a dead end. You can advocate for a program in your area by bringing the evidence of need to your county commissioners, state EMS office or legislators.

Want to advocate for people living with diabetes in your community? Become a Beyond Type 1 Ambassador!