Community Paramedicine

Evaluation Tool

March 2012

U.S. Department of Health and Human Services

Health Resources and Services Administration

Office of Rural Health Policy 
This publication lists non-Federal resources in order to provide additional information to 

consumers. The views and content in these resources have not been formally approved by 

the U.S. Department of Health and Human Services (HHS) or the Health Resources and 

Services Administration (HRSA). Listing these resources is not an endorsement by HHS or 

HRSA.

This document was produced for the U.S. Department of Health and Human Services, 

Health Resources and Services Administration, Office of Rural Health Policy under contract 

with Strategic Partnerships, Inc., and the Critical Illness and Trauma Foundation.
3 

Table of Contents

Background..................................................................................................................... 4

Introduction ..................................................................................................................... 5

Using the Tool................................................................................................................. 6

The Optimal Scoring Process.......................................................................................... 8

Interpreting the Score...................................................................................................... 8

Limitations ....................................................................................................................... 9

100: Assessment........................................................................................................... 10

200: Policy Development............................................................................................... 18

300: Assurance ............................................................................................................. 34

References.................................................................................................................... 46

Appendix A: Program Information Worksheet ............................................................... 47

Appendix B: Definitions ................................................................................................. 49

Appendix C: Overview of the Community Paramedicine Programs Interviewed ........... 52

Appendix D: Additional Resources................................................................................ 54

Appendix E: Project Team............................................................................................. 55
4 

SELF-ASSESSMENT FOR COMMUNITY PARAMEDICINE 

PLANNING, DEVELOPMENT, AND EVALUATION

Background

Community Paramedicine is an emerging field in health care where EMTs and Paramedics 

operate in expanded roles in an effort to connect underutilized resources to underserved 

populations. Although EMTs and Paramedics have operated in expanded roles in several 

foreign countries, such as Canada, England, and New Zealand, for many years, in the U.S. the

concept first came to the attention of the EMS community, particularly the rural EMS community, 

with the publication of the Rural and Frontier EMS Agenda for the Future in 2004 (Appendix D:

Additional Resources). That document described community paramedicine as a potential 

framework that might allow rural communities to transition from largely volunteer EMS agencies 

to ones with at least some full time staff based not solely on their emergency response but on 

the other community health roles. The Rural and Frontier EMS Agenda for the Future defined 

community paramedicine as “an organized system of services, based on local need, which are 

provided by EMTs and Paramedics integrated into the local or regional health care system and 

overseen by emergency and primary care physicians. This not only addresses gaps in primary 

care services, but enables the presence of EMS personnel for emergency response in low callvolume areas by providing routine use of their clinical skills and additional financial support from 

these non-EMS activities.” 

Because community paramedicine programs expand the roles of EMS professionals to provide 

health services where access to physicians, clinics and/or hospitals may be difficult, there has 

been significant movement toward the implementation of such programs across rural America. 

Additionally, there have been programs that have evolved in more urban areas that serve a 

similar role in the provision of community health/public health activities. In rural areas 

community paramedicine programs are often focused on efficiently allocating scarce health care 

resources and improving access to care in these underserved areas. In urban areas, many 

community paramedicine programs have been designed to keep “frequent fliers” out of the 

emergency care system by ensuring their health care needs are met in other ways. Many 

programs, both rural and urban, take health care into the patient’s home.

Community paramedicine programs might focus on specific medical needs such as diabetic 

monitoring or on broader health care issues such as mental health. Most importantly, each of 

the successful programs now in place across the country was uniquely and specifically 

designed to meet one or more health care needs essential to that community. Additionally, 

successful programs capitalize on linkages, collaboration and integration with other health care 

resources in the community. 

Given the emergence of community paramedicine programs in the U.S., key organizational and 

government leaders felt that by establishing a common evaluation framework the growth and 

development of these community paramedicine programs could be captured and described. In 
5 

capturing such data in a standardized way, the characteristics and best practices of early 

successful adopters can be emulated by emerging programs.

While the assessment tool contained in this document is designed to allow existing programs to 

conduct self-assessments across the broad public health elements of assessment, policy 

development and assurance, the tool also serves as a potential framework to guide in the 

development of new community paramedicine programs. By looking at each indicator the 

leadership of potential community paramedicine programs will be more likely to include, or at 

least consider, all of the elements that seem to be common in successful programs. 

Introduction

In the absence of validated national benchmarks, or norms, this document stresses the need for 

each community paramedicine program to define its system-specific health status benchmarks 

and performance indicators and to use a variety of community health and public health 

interventions to improve the community’s health status. The document also addresses reducing 

the burden of illness, chronic disease, and injury as a community-wide public health problem, 

not strictly as a patient care issue.

Opportunities to review community paramedicine programs are beneficial because they allow 

for the assessment of the status of EMS activities and move systems forward in developing 

inclusive and comprehensive systems of care. Many EMS programs conduct their own internal 

or external reviews, and it is hoped that this document will serve as another tool used by these 

programs to assess the current status of community paramedicine programs and to provide 

guidance on future system enhancements. 

The assessment tool also provides a common framework by which data can be collected from 

multiple community paramedicine programs and aggregated to develop a snapshot of common 

successes and challenges. While the tool should be useful across both urban and rural 

programs it is specifically designed to address rural settings where community health/public 

health resources are often very limited. By encouraging emerging rural community 

paramedicine programs to use this evaluation framework as a planning tool, it should be 

possible to create stronger partnerships and linkages with scarce rural resources. 

The tool that follows was developed using a consensus-based process by a group of experts 

representing key national organizations and existing community paramedicine programs. The 

group consulted with a number of community paramedicine programs in both rural and urban 

settings to better understand their depth, breadth and scope (a brief description of the programs 

consulted can be found in Appendix C). Given the community health/public health nature of the 

community paramedicine efforts that emerged from those discussions, an evaluation framework 

common to public health was ultimately selected as the structure for the evaluation tool. 
6 

Because the services and activities of 

community paramedicine programs are 

so closely linked to public health issues, 

approaches and terminology familiar to 

public health are used in this evaluation 

tool. The benchmarks, indicators and 

scoring criteria contained in the 

assessment tool are organized in a 

classic public health circle. There are 

three core functions of public health: 

assessment, policy development, and 

assurance. There are ten essential 

services of public health that fall within 

the three core functions. These core 

functions and essential services are 

supported by research and 

infrastructure elements. Figure 1 

illustrates the three core functions and 

ten essential services of public health.

Figure 1: Public Health Model

Using the Tool

This objective community paramedicine self-assessment tool can be used by communities that

wish to assess the current status of their paramedicine program. It is recommended that a group 

consisting of key representatives from the community including public health, hospital, primary 

care, regulatory agencies, EMS and other health care and social service areas impacted by the 

community paramedicine program, be assembled to form a multi-disciplinary advisory 

committee. How a question is answered will depend on a group agreement on the program 

being assessed. Such an agreement is essential to ensuring consistency among participants 

during the assessment. Once there is agreement among the group about what is being rated in

each section, the tool can aid in identifying and prioritizing areas that need attention. It also 

provides the State lead agency with guidance on community paramedicine next steps or 

improvements to be made along a continuum of a maturing and developing EMS system. Many 

of the benchmarks and indicators are qualitative, and will require judgment and discretion by 

those completing the assessment—a recognized limitation of this methodology.

Communities considering the development of a community paramedicine program are also 

encouraged to use the process as a planning tool. In this case the group should not score the 

tool but rather study each benchmark and indicator to determine which ones are applicable to 

their program and how the indicator will be addressed in the future. By undertaking this exercise 

the program planners may well be reminded of aspects of the program that might, otherwise, be 

overlooked at the outset. 

Within each core function (assessment, policy development, and assurance) are a variety of 
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benchmarks. These benchmarks are based on current literature on community paramedicine 

program development, interviews with existing community paramedicine programs, and public 

health systems. For each benchmark, a number of indicators further define the benchmark. 

Scoring for each indicator is defined to assist in identifying progress, efforts, or compliance, or 

any combination of these. Each indicator contains a scoring-mechanism ordering of statements 

to assess progress to date. The following criteria are used to assess progress in complying with 

each indicator. 

Score Progress Scoring 

0 Not known 

1 No 

2 Minimal 

3 Limited 

4 Substantial 

5 Full 

The following table provides an example of how the above criteria are used to assess 

community paramedicine program progress for a specific indicator.

Table 1. Example of Scoring 

Indicator Scoring

101.1: There is a description of illnesses 

and injuries within the community 

paramedicine service area 

including the distribution by 

geographic area, high-risk 

populations (pediatric, elder, 

distinct cultural/ethnic, rural, and 

others), incidence, prevalence, 

contributing factors, determinants, 

morbidity, and patient distribution 

using any or all of the following: 

vital statistics, emergency 

department (ED) data, EMS data, 

hospital discharge data, State 

police data (those from law 

enforcement agencies), medical 

examiner data, and other data 

sources. The description is 

updated at regular intervals.

0. Not known. The scorer does not know enough about 

the indicator to evaluate it effectively. 

1. There is no written description of illness and injuries 

within the community paramedicine service area. 

2. One or more population-based data sources (e.g., 

vital statistics) describe illness and injury within the 

jurisdiction, but clinical data sources are not used. 

3. One or more population-based data sources and one 

or more clinical data sources are used to describe 

illness and injury within the jurisdiction. 

4. Multiple population-based and clinical data sources 

are used to describe illness and injury within the 

jurisdiction, and the description is systematically 

updated at regular intervals. 

5. Multiple population-based and clinical data sources 

(e.g., ED data, hospital discharge data, and others) 

are electronically linked and used to describe illness 

and injury within the jurisdiction. 

The rater would review the criteria listed and select the one that best describes the program’s 

current ability to describe injury and illness in their service area ranging from none in newly 

developing systems to very complex analyses that can help frame future community 

paramedicine interventions. 

It is important to note that a program must complete all of the criteria associated with previous 

scores before being awarded a higher score. As an example, a program should not score itself 

a 4 if it has not met all of the criteria outlined in 1-3.
8 

The Optimal Scoring Process

Based on nearly a decade of experience in using a similar tool contained in the HRSA Model 

Trauma System Planning and Evaluation document to evaluate trauma programs (Appendix D: 

Additional Resources), the most effective method of conducting the evaluation is to have each 

member of the multi-disciplinary advisory committee score the program independently. 

Following that, a facilitated meeting that assists the group as a whole to come to consensus on 

each score should be conducted. This allows for each member to hear varying perceptions and 

breaks down communication silos, providing for a broad-based understanding of the program 

for all members. At that same, or a subsequent meeting, the group should analyze the results 

and prioritize areas in which they would like to see improvements. These foci should become 

part of a strategic/tactical plan for the program and a commitment to re-evaluate the program on 

a periodic basis (every 1-2 years) should be made. 

Many evaluation or assessment criteria used by EMS professionals as they relate to patient 

care must be repeated at various intervals to be of the greatest value. Just as a single Glasgow 

coma score is meaningless in the long-term evaluation of someone with a head injury, so too 

will be a single application of this tool. The best uses of this tool are as a process to help identify 

where the program is at this moment in time, establish future benchmarks to strive towards (for 

instance moving a score from a 2 to a 4 in a certain area), and then to re-measure to determine 

the overall progress and evolution of the program. No program is likely to score a 5 on each 

indicator. There are a myriad of issues specific to the geographic area’s politics and resources 

that might preclude a high score for one or more indicators. That should be noted and attentions 

turned elsewhere where true and lasting progress can be made. This tool provides one way of 

measuring, documenting and quantifying that effort over time. 

It is important to remember that the intent of the tool is to allow an individual community 

paramedicine program to identify its own strengths and weaknesses, prioritize activities, and 

measure progress against itself over time. Additionally, the tool is seen as a planning document 

that can assist developing programs. The tool is not intended to measure one community 

paramedicine program against another.

Interpreting the Score

At first glance it might appear that it would be possible to add all of the scores together and 

come up with an aggregate score for the program, or to use the average (mean) response. 

Because the scores are derived from a consensus-based process which is inherently subjective 

and since the numbers are rank ordered, programs must use caution in analyzing the scores. 

The following section summarizes the appropriate use for the scores. That use is, primarily, to 

serve as a way to measure progress within a single community paramedicine program over time 

through a repeated measures process. 
9 

Benchmark 101 

There is a thorough description of the epidemiology of the medical conditions targeted by the 

community paramedicine program in the service area using both population-based data and 

clinical databases. 

Indicator Score

Indicator 101.1 5 

Indicator 101.2 3 

Indicator 101.3 2 

Median Score Expectation 101 3 

In this benchmark, the median score of “3” would indicate that, overall, there is evidence of 

limited, but demonstrable progress in meeting the expectation. The same process can be used 

for each of the core functions of assessment, policy development and assurance; e.g., the 

median for each of these can be similarly calculated. The key is to achieve consensus on each 

score prior to calculating the median. 

Limitations

Although this scoring mechanism provides a quantitative descriptor of each indicator and, 

ultimately, of the entire community paramedicine program, the scoring process has a number of 

methodological limitations: 

 The benchmarks focus primarily on process measures, not on outcomes. It is assumed 

that meeting these process measurements will result in improved outcomes.

 The self-assessment is but one tool to use in assessing the progress a program has 

made in meeting the above-referenced benchmarks and indicators. Any community 

paramedicine program review should include outcome measures (such as improvements 

in individual health measures, decreases in return visits to the emergency department, 

etc.) as a full measure of system performance. 

 While this evaluation methodology is designed to be as objective as possible, it still 

relies on the qualitative judgments of those completing the assessment. 

 The data presented are rank ordered. Therefore, it is not possible to do parametric 

statistical analysis such as a mean. 
10 

100: Assessment 

Regular systematic collection, assembly, analysis, and dissemination of information on 

the health of the community. 

Benchmark 101: There is a thorough description of the epidemiology of the medical 

conditions targeted by the community paramedicine program in the service area using 

both population-based data and clinical databases.

Indicator Scoring

101.1 There is a description of illnesses 

and injuries within the community 

paramedicine service area including 

the distribution by geographic area, 

high-risk populations (pediatric, 

elder, distinct cultural/ethnic, rural, 

and others), incidence, prevalence, 

contributing factors, determinants, 

morbidity, and patient distribution 

using any or all of the following: vital 

statistics, emergency department 

(ED) data, EMS data, hospital 

discharge data, State police data 

(those from law enforcement 

agencies), medical examiner data, 

and other data sources. The 

description is updated at regular 

intervals.

0. Not known.

1. There is no written description of illness and 

injuries within the community paramedicine 

service area.

2. One or more population-based data 

sources (e.g., vital statistics) describe 

illness and injury within the jurisdiction, but 

clinical data sources are not used.

3. One or more population-based data 

sources and one or more clinical data 

sources are used to describe illness and 

injury within the jurisdiction.

4. Multiple population-based and clinical data 

sources are used to describe illness and 

injury within the jurisdiction, and the 

description is systematically updated at 

regular intervals.

5. Multiple population-based and clinical data 

sources (e.g., ED data, hospital discharge 

data, and others) are electronically linked 

and used to describe illness and injury 

within the jurisdiction.
11 

Indicator Scoring

101.2 Collaboration exists between the 

community paramedicine program, 

public health officials, and health 

system leaders to complete risk 

assessments.

0. Not known.

1. No illness/injury risk assessments are 

conducted.

2. Community paramedicine officials conduct 

illness/injury assessments; however, there 

is no involvement of the broader health care 

community or public health officials in those 

assessments.

3. Public health officials, along with health 

care and community paramedicine 

participants, assist with the design of 

illness/injury risk assessments.

4. Public health officials, along with health 

care and community paramedicine 

participants, assist with the design and 

analysis of illness/injury risk assessments.

5. The public health epidemiologist, along with 

health care and community paramedicine 

participants, is involved in the development 

of illness/injury reports. There is clear 

evidence of data sharing, data linkage, and 

well-defined reporting roles and 

responsibilities.

101.3 There is an established electronic 

information system (EIS) for ongoing 

targeted surveillance and system 

performance assessment. The 

community paramedicine EIS may be 

freestanding or an 

extension/adaptation of other 

databases (e.g. EMS or hospital).

0. Not known.

1. A community paramedicine EIS exists as an 

extension of other databases, e.g. EMS or 

hospital, but it is not routinely used for 

targeted surveillance and system 

performance.

2. The community paramedicine EIS is used 

to inform performance improvement 

activities but is not used in any community 

surveillance activities.

3. The community paramedicine EIS is used 

for both surveillance and performance 

improvement activities.

4. The community paramedicine EIS has been 

integrated or linked to one or more 

administrative databases, e.g. billing.

5. The community paramedicine EIS is linked 

to both administrative and clinical 

databases to provide a comprehensive 

overview of the community paramedicine 

program and its effect on current and future 

community healthcare needs.
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Indicator Scoring

101.4 The EIS database captures all 

patient/client contacts.

0. Not known.

1. There is no database that captures 

patient/client contacts.

2. There is a simple log (electronic or paper 

based) that identifies demographic 

information about the patient/client contact, 

e.g. patient and provider identifier, date, 

time, etc.

3. There is a medical record that documents 

each patient/client contact with summary 

information in an electronic searchable 

database of all contacts.

4. There is an electronic medical record 

documentation of each patient/client contact 

that can be accessed by primary care 

physicians and case managers.

5. The community paramedicine electronic 

medical record is fully integrated with the 

patient/client’s formal health care record in 

the patient/client’s medical home.

101.5 Reports can be generated from the 

community paramedicine EIS to help 

guide performance improvement 

activities and to document the 

effectiveness and/or efficiency of the 

program.

0. Not known.

1. No community paramedicine EIS database 

exists. 

2. A community paramedicine EIS database 

exists but is not used to generate reports to 

guide either daily operations or future 

planning.

3. Special reports can be generated as 

needed and used by the program director to 

assist in scheduling or other administrative 

issues. 

4. Reports are generated on a regular basis 

and used by the program director and 

medical director to inform performance 

improvement activities and processes.

5. Reports are generated on a regular basis 

and are used to inform oversight bodies, 

funding agencies, and the general public 

about the impact of the community 

paramedicine program.
13 

Benchmark 102: A resource assessment for the community paramedicine program has 

been completed and is regularly updated.

Indicator Scoring

102.1 The community paramedicine 

program has completed a 

comprehensive inventory that 

identifies the availability and 

distribution of current capabilities and 

resources from a variety of partners 

and organizations throughout the 

community.

0. Not known.

1. There is no community-wide resource 

assessment. 

2. A community-wide resource assessment 

has been completed that documents the 

frequency and distribution of resources for 

at least two of the following categories: 

community paramedicine, prehospital and 

hospital personnel, education programs, 

facilities, and prehospital equipment.

3. A community-wide resource assessment 

has been completed that documents the 

frequency and distribution of resources for 

more than two of the following categories: 

leadership, system development, 

regulation, finances, illness/injury 

prevention, wellness promotion, workforce 

resources, education, EMS, transport, 

communications, health care facilities, 

medical oversight, system evaluation, 

performance improvement, and research.

4. The community-wide resource assessment 

has identified one or more targeted clinical 

condition groups/individuals that can be 

addressed with the resources identified 

above.

5. The community-wide resource assessment 

has identified strategies to meet the needs 

of the targeted clinical condition 

groups/individuals and methods for 

supporting those activities financially.
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Indicator Scoring

102.2 The community paramedicine 

program has completed a gap 

analysis based on the inventories of 

internal and external system 

resources as well as system 

resource standards.

0. Not known.

1. There are no resource standards on which 

to base a gap analysis.

2. The community paramedicine advisory 

committee has begun to develop resource 

standards so that a gap analysis can be 

completed.

3. The community paramedicine resource 

standards have been approved by the 

appropriate authority.

4. A gap analysis of community paramedicine 

program has been completed based on the 

adopted resource standards.

5. A gap analysis of community paramedicine 

resources has been completed and is 

updated at regular intervals based on the 

adopted resource standards.

102.3 There has been an initial assessment 

(and periodic reassessment) of 

overall program effectiveness.

0. Not known.

1. There has not been an assessment of the 

effectiveness of the community 

paramedicine program.

2. There has been at least one formal written 

assessment of the effectiveness of the 

community paramedicine program.

3. Program effectiveness is assessed on at 

least an annual basis and formal reports are 

generated.

4. There is an ongoing program assessment 

and formal reports are published annually 

and distributed to all stakeholders including: 

patients/clients, oversight bodies, funding 

sources, and the general public.

5. There is ongoing assessment of multiple 

program objective outcomes over time as 

the outcomes relate to changes within the 

program for specific program interventions.
15

Indicator Scoring

102.4 The community paramedicine 

program has undergone an external 

independent analysis of all aspects 

of the program.

0. Not known.

1. No external examination of the community 

paramedicine program overall or individual 

components has occurred.

2. An external assessment is in the planning 

stages.

3. An external assessment is scheduled 

and/or has been completed and the agency 

is awaiting the formal report.

4. An outside group of community 

paramedicine system “experts” has 

conducted a formal community 

paramedicine external assessment and has 

made specific recommendations to the 

system.

5. Independent external reassessment occurs 

regularly, at least every 5 years.

Benchmark 103: The community paramedicine program assesses and monitors its 

value to its constituents in terms of cost-benefit analysis and societal investment.

Indicator Scoring

103.1 The benefits of the community 

paramedicine program, in terms of 

cost savings, decreased EMS 

transports, decreased hospital visits, 

improved health/wellness, and so on, 

are described.

0. Not known.

1. There are no cost data from the EIS 

database, or other sources, available to 

calculate the program’s benefits.

2. Community paramedicine costs are 

included in the EIS that can serve as the 

basis for these calculations.

3. Additional sources of data, in terms of other 

economic and quality of life measures, 

(e.g., reduction in return hospital visits / 

readmissions, fewer 911 calls, shorter 

return to work interval, etc.) are available.

4. Cost and quality of life measures can be 

analyzed and presented in descriptive and 

graphic form.

5. A series of reports and fact sheets are 

available and regularly updated to 

descriptively and graphically illustrate the 

costs and benefits of the community 

paramedicine program.
16

Indicator Scoring

103.2 Cases that document the societal 

benefit are reported on so the 

community sees and hears the 

benefit of the community 

paramedicine program while 

simultaneously protecting patient 

privacy. 

0. Not known.

1. No effort is made to gather, catalogue, or 

report cases that document the benefits of 

the community paramedicine program so 

that the community sees and hears the 

benefit of the program to society.

2. Dramatic improvements in wellness and 

functional outcome returns are documented 

sporadically or within various components 

of the program.

3. Cases concerning dramatic improvements 

in wellness and return to a quality life are on 

file (at a system level) but not reported 

unless asked for by the press.

4. Cases concerning dramatic improvements 

in wellness and return to a quality life are on 

file (at a system level) and are reported to 

the press. 

5. Cases are used as part of information fact 

sheets that are distributed to the press and 

other segments of the community. These 

information fact sheets document the costbenefit of the community paramedicine 

program to the community.

103.3 An assessment of the interests of 

public officials concerning community 

paramedicine program information 

has been conducted and 

communications mechanism 

developed based on the results of 

the assessment.

0. Not known.

1. There is no routine or planned contact with 

the public officials.

2. Plans are in place to feed information to 

public officials in response to a particular 

event.

3. Public officials have been formally asked 

about what types of information would be 

helpful in reporting on community 

paramedicine and community health issues.

4. Information resources for public officials 

have been developed, based on the stated 

needs of the public officials; public official 

representatives are included in community 

paramedicine informational events.

5. In addition to routine public official contact, 

public officials are involved in various 

oversight activities such as the community 

paramedicine advisory council.
17 

Indicator Scoring

103.4 An assessment of the needs of 

health insurers/payers concerning 

community paramedicine program 

information has been conducted and 

communications mechanism 

developed based on the results of 

the assessment

0. Not known.

1. There is no routine or planned contact with 

health insurers/payers.

2. Plans are in place to provide information to 

health insurers/payers during a response to 

a particular payment, reimbursement, and 

cost issue.

3. Health insurers/payers have been formally 

asked about what types of information 

would be helpful in reporting on community 

paramedicine cases and issues to assist 

them in payment determinations.

4. Information resources for health 

insurers/payers have been developed 

based on the stated needs of the insurers; 

insurance representatives/payers are 

included in community paramedicine 

informational events.

5. In addition to routine contact, health 

insurers/payers are involved in various 

oversight activities such as the community 

paramedicine advisory councils.

103.5 An assessment of the needs of the 

general medical community, 

including physicians, nurses, 

prehospital care providers, and 

others, concerning community 

paramedicine program information 

has been conducted and 

communications mechanism 

developed based on the results of 

the assessment. 

0. Not known.

1. There is no routine or planned contact with 

the broad medical community.

2. Plans are in place to provide information to 

the broad medical community in response 

to a community paramedicine event or 

issue.

3. The broad medical community has been 

formally asked about what types of 

information would be helpful in reporting on 

community paramedicine events and 

issues. 

4. Information resources for the general 

medical community have been developed 

based on the stated needs of the general 

medical community; general medical 

community representatives are included in 

community paramedicine informational 

events.

5. In addition to routine contact, the broad 

medical community is involved in various 

oversight activities such as the community 

paramedicine advisory council.
18 

200: Policy Development

Promoting the use of scientific knowledge in decision making that includes building 

constituencies, identifying needs and setting priorities, legislative authority and funding 

to develop plans and policies to address needs, and ensuring the public’s health and 

safety.

Benchmark 201: Comprehensive statutory authority and administrative rules support 

community paramedicine program infrastructure, planning, provision, oversight, and 

future development.

Indicator Scoring

201.1 Community paramedicine activities 

are allowable/supportable within 

EMS regulations, licensure, 

certification, and scope of practice.

0. Not known.

1. No effort has been made to inform the state 

EMS agency concerning community 

paramedicine program activities to 

determine if such activities are allowable 

within the state’s regulations.

2. The state EMS agency has been made 

aware of the community paramedicine 

program but has not confirmed that the 

program is operating within state 

regulations.

3. The EMS agency has approved the 

community paramedicine program on a 

“pilot” or other restricted basis.

4. The EMS agency has approved the 

community paramedicine program without 

any restrictions.

5. Specific statutes, rules, and regulations 

govern community paramedicine programs 

statewide.
19 

Indicator Scoring

201.2 The community paramedicine 

program is not in conflict with other 

licensing agencies or authorities, 

including: nursing, physician 

assistants, home health care, 

primary care, or others.

0. Not known.

1. No effort has been made to inform the state 

regulatory agencies governing nursing, 

advanced practice nurses, physician 

assistants, home health care providers, 

primary care, or others concerning 

community paramedicine program activities 

to determine if such activities are allowable 

within the state’s regulations.

2. The regulatory agencies governing nursing, 

physician assistants, home health care, 

primary care, or others has been made 

aware of the community paramedicine 

program but has not confirmed that the 

program is operating within state 

regulations. 

3. The regulatory agencies governing nursing, 

physician assistants, home health care, 

primary care, or others have approved the 

community paramedicine program on a 

“pilot” or other restricted basis.

4. The regulatory agencies governing nursing, 

physician assistants, home health care, 

primary care, or others have approved the 

community paramedicine program without 

any restrictions.

5. Specific statutes, rules, and regulations 

govern community paramedicine programs 

statewide.
20 

Benchmark 202: Community paramedicine program leaders (sponsoring agency,

community paramedicine personnel, and/or other stakeholders) use a process to 

establish, maintain, and constantly evaluate and improve a community paramedicine 

program in cooperation with medical, payer, professional, governmental, regulatory, and 

citizen organizations. 

Indicator Scoring

202.1 The program leaders have 

developed and implemented a 

multidisciplinary, multi-agency 

advisory committee to provide overall 

guidance to the community 

paramedicine planning and 

implementation strategies. The 

committee meets regularly and is in 

compliance with local or state openmeeting or transparency regulations 

and protects patient privacy.

0. Not known.

1. There is no community-wide 

multidisciplinary, multi-agency advisory 

committee providing guidance to the 

program leadership in planning and 

developing a community paramedicine 

program.

2. There is no community-wide 

multidisciplinary, multi-agency advisory 

committee and attempts to organize one 

have not been successful but are 

continuing.

3. There is a community-wide 

multidisciplinary, multi-agency advisory 

committee, but its meetings are infrequent 

and guidance to the community 

paramedicine program is not always sought 

or available. Collaborative working 

arrangements are not apparent.

4. There is a community-wide 

multidisciplinary, multi-agency advisory 

committee. Committee members and 

stakeholders regularly attend meetings. 

Collaboration and consensus concerning 

the role and direction of the community 

paramedicine program are beginning.

5. There is a community-wide 

multidisciplinary, multi-agency advisory 

committee with well-defined goals and 

responsibilities relative to the development 

and oversight of the community 

paramedicine program that meets regularly. 

The committee routinely provides guidance 

and assistance to the community 

paramedicine program on system and 

program issues. There is strong evidence of 

consensus building among system 

participants. The committee is in 

compliance with all open meeting or 

transparency regulations and protects 

patient privacy.
21 

Indicator Scoring

202.2 A clearly defined and easily 

understood structure is in place for 

the community paramedicine 

program decision-making process at 

the local administrative level to 

continually improve the program.

0. Not known.

1. There is no defined decision-making 

process (written policy and procedure) 

regarding the community paramedicine 

program within the sponsoring agency or its 

committees.

2. There is an unwritten decision-making 

process that stakeholders use when 

convenient, although not regularly or 

consistently.

3. The decision-making process is articulated 

within the community paramedicine 

program plan, although it has not been fully 

implemented. Policies are not written.

4. The decision-making process is contained 

within the community paramedicine 

program plan, and there are current policies 

and procedures in place to guide decision 

making. Use of the decision-making 

process is infrequent.

5. There is a clearly defined process for 

making decisions affecting the community 

paramedicine program. The process is 

articulated in the community paramedicine 

program plan and is further identified within 

system policies. Stakeholders know and 

understand the process and use it to 

resolve issues and to improve the program.
22 

Indicator Scoring

202.3 Community paramedicine program 0. Not known. 

leaders have adopted and use goals 1. There are no goals or time-specific, 

and objectives that are specific, quantifiable, and measurable objectives for 

measureable, attainable, realistic, the community paramedicine program.

and timely for the community 2. Community paramedicine program leaders 

paramedicine program. have met to discuss time-specific, 

quantifiable goals.

3. Community paramedicine program leaders 

are beginning the process of identifying 

measurable program goals and outcomebased, time-specific, quantifiable, and 

measurable objectives.

4. Community paramedicine program leaders 

have adopted goals and time-specific, 

quantifiable, and measurable objectives that 

guide program performance.

5. Community paramedicine program leaders, 

in consultation with their community-wide 

multidisciplinary, multi-agency advisory 

committee, have established measurable 

program goals and outcome-based, timespecific, quantifiable, and measurable 

objectives that guide system effectiveness 

and program performance.

202.4 The community paramedicine 0. Not known. 

program has comprehensive 1. There are no protocols to guide community 

protocols that guide personnel to paramedicine personnel.

ensure consistency of care delivered, 2. Community paramedicine personnel 

to decrease unwarranted variation in operate under the protocols for general 

care, and to ensure patient care emergency care response as approved by 

activities remain within scope of the agency’s medical director.

practice boundaries. 3. Specific protocols for community 

paramedicine activities that are outside of 

the general emergency care response 

activities of the agency are being drafted.

4. Specific protocols for community 

paramedicine activities have been drafted 

and are undergoing review.

5. Specific protocols for community 

paramedicine activities have been formally 

adopted and guide the assessment and 

treatment of patients/clients and serve as a 

basis for ongoing performance 

improvement.
23 

Indicator Scoring

202.5 The community paramedicine 

program assures confidential (HIPAA 

compliant) two-way communication 

of patient care records related to the 

program’s care between the program 

providers and the affiliated 

hospital/physician/medical home 

providers.

0. Not known.

1. No formal exchange of patient/client 

information occurs between community 

paramedicine and other health care 

providers.

2. There is an informal, one way transmission 

of health care information from the 

community paramedicine providers and 

other health care providers and entities.

3. There is a formal written policy that governs 

the one way transmission of health care 

information from the community 

paramedicine providers and other health 

care providers and entities.

4. There is informal, two way transmission of 

health care information between community 

paramedicine and other health care 

providers and entities.

5. There is a formal written policy, HIPAA 

compliant, that governs the two way 

transmission of health care information 

between community paramedicine and 

other health care providers. Community 

paramedicine personnel have received 

specific training in HIPAA compliance.
24 

Indicator Scoring

202.6 The exchange of data and any peer 

review or performance improvement 

processes are protected from 

discoverability.

0. Not known.

1. The community paramedicine program 

does not engage in any peer review or 

performance improvement activity.

2. The community paramedicine program 

conducts peer review and performance 

improvement under the rules and 

regulations pertaining to such protection for 

traditional EMS activities. There is no formal 

engagement with other health care 

providers in these activities.

3. The community paramedicine personnel 

actively engage in multi-disciplinary, multiagency peer review under the rules and 

regulations pertaining to such protection for 

traditional EMS activities.

4. Multi-disciplinary, multi-agency peer review 

including community paramedicine 

personnel is conducted at a non-EMS 

location, e.g. hospital, under the protection 

from discoverability outlined for that entity.

5. Specific peer review and performance 

improvement protection exist in state 

statute, rule, or regulation for multidisciplinary, multi-agency peer review 

including community paramedicine 

personnel.
25 

Benchmark 203: The community paramedicine program has a comprehensive written 

plan based on community needs. The plan integrates the community paramedicine 

program with all aspects of community health including, but not limited to: EMS, public 

health, primary care, hospitals, psychiatric medicine, social service and other key 

providers. The written community paramedicine program plan is developed in 

collaboration with community partners and stakeholders.

Indicator Scoring

203.1 Community paramedicine program, 

in concert with a multidisciplinary, 

multi-agency advisory committee, 

has adopted a community 

paramedicine program plan.

0.

1.

2.

3.

4.

5.

Not known.

There is no community paramedicine 

program plan, and one is not in progress.

There is no community paramedicine 

program plan, although some individuals or 

groups have begun meeting to discuss the 

development of a community paramedicine 

program plan.

A community paramedicine program plan 

was developed and adopted by the 

sponsoring agency. The plan, however, has 

not been endorsed by community 

paramedicine stakeholders.

A community paramedicine program plan 

has been adopted, developed with a 

multidisciplinary, multi-agency advisory 

committee, and has been endorsed by the 

respective agencies.

A comprehensive community paramedicine 

program plan has been developed, adopted 

in conjunction with community stakeholders, 

and includes the integration of other 

systems (e.g., EMS, public health, 

community health, and primary care).
26 

Indicator Scoring

203.2 The community paramedicine 

program plan clearly describes the 

system design (including the 

components necessary to have an 

integrated program) and is used to 

guide system implementation and 

management. For example, the plan 

includes references to regulatory 

standards and documents and 

includes methods of data collection 

and analysis.

0. Not known.

1. There is no community paramedicine 

program plan.

2. The community paramedicine program plan 

does not address or incorporate the parallel 

and convergent resources (prehospital, 

communication, transportation, acute care, 

rehabilitation, and others), nor is it inclusive 

of all-hazards preparedness or public 

health/community health integration.

3. The community paramedicine program plan 

provides general information about all the 

program activities including all-hazards 

preparedness, EMS, and public 

health/community health integration; 

however, it is difficult to determine who is 

responsible and accountable for the 

community paramedicine programs 

performance and implementation.

4. The community paramedicine program plan 

addresses every component of a wellorganized and functioning program 

including all-hazards preparedness and 

public health/community health integration. 

Specific information on each component is 

provided, and the program design is 

inclusive of providing for specific goals and 

objectives for system performance.

5. The community paramedicine program plan 

is used to guide system implementation and 

management. Stakeholders and policy 

leaders are familiar with the plan and its 

components and use the plan to monitor 

system progress and to measure results.
27 

Benchmark 204: Sufficient resources, including those both financial and infrastructure 

related, support program planning, implementation, and maintenance.

Indicator Scoring

204.1 The community paramedicine 

program plan clearly identifies the 

human resources and equipment 

necessary to develop, implement, 

and manage the community 

paramedicine program both clinically 

and administratively.

0. Not known.

1. There is no method of assessing available 

resources or of identifying resource 

deficiencies in either the clinical or 

administrative areas of the community 

paramedicine program.

2. The community paramedicine program plan 

addresses resource needs and identifies 

gaps in resources within the community 

health system, but no mechanism for 

correcting resource deficiencies has been 

identified.

3. Resource needs are identified, and a draft 

plan, inclusive of goals and timelines, has 

been prepared to address the resource 

needs. The plan has not been implemented.

4. Resource needs are clearly identified, and 

action plans are being implemented to 

correct deficiencies in both clinical areas 

and administrative support functions.

5. A resource assessment survey has been 

completed and is incorporated into the 

community paramedicine program plan. 

Goals and measurable objectives to reduce 

or eliminate resource deficiencies have 

been implemented. Evaluation of progress 

on meeting resource needs is evident and, 

when necessary, the plan has been 

adapted.
28 

Indicator Scoring

204.2 Financial resources exist that support 

the planning, implementation, and 

ongoing management of the 

administrative and clinical care 

components of the community 

paramedicine program.

0. Not known.

1. There is no funding to support the 

community paramedicine program planning, 

implementation, or ongoing management 

and operations for either program 

administration or community paramedicine 

clinical care.

2. Some funding for the community 

paramedicine program has been identified, 

e.g. grants, but ongoing support for 

administration and clinical care outside of 

the third-party reimbursement structure is 

not available.

3. There is current funding for the 

development of the community 

paramedicine program within the 

sponsoring agency organization consistent 

with the community paramedicine program 

plan, but costs to support clinical care 

support services have not been identified 

(transportation, communication, 

uncompensated care, standby fees, and 

others). No ongoing commitment of funding 

has been secured.

4. There is funding available for both 

administrative and clinical components of 

the community paramedicine program plan. 

A mechanism to assess needs among 

various activities has begun. 

Implementation costs and ongoing support 

costs of the sponsoring agency have been 

addressed within the plan.

5. A stable (consistent) source of reliable 

funding for the development, operations, 

and management of the community 

paramedicine program (clinical care and 

lead agency administration) has been 

identified and is being used to support 

planning, implementation, maintenance, 

and ongoing program enhancements.
29 

Indicator Scoring

204.3 Operational budgets (program 

administration and operations and infield operations) are aligned with the 

community paramedicine program 

plan and priorities.

0. Not known.

1. There are no operational budgets.

2. There are limited operational budgets not 

sufficient to cover related program costs for 

the EMS system. 

3. There are operational budgets that may be 

sufficient to cover most program costs, but 

they are without regard to the community 

paramedicine program plan or priorities.

4. There are operational budgets that have 

some ties to the community paramedicine 

program plan and that include consideration 

for the extraordinary costs to the system 

(e.g. providers).

5. An operational budget exists for each 

component in the plan and matches system 

needs and priorities with program and 

operational expenditures.
30 

Benchmark 205: Collected data are used to evaluate system performance and to 

develop public policy.

Indicator Scoring

205.1 The community paramedicine 

program electronic information 

systems (EIS) is used to assess 

system performance, to measure 

system compliance with applicable 

standards, and to allocate program 

resources to areas of need or to 

acquire new resources.

0. Not known.

1. There is no community paramedicine EIS.

2. There is a limited community paramedicine 

EIS consisting of a patient registry, but no 

data extraction is used to identify resource 

needs, to establish performance standards, 

or to routinely assess and evaluate program 

effectiveness.

3. There is a community paramedicine EIS 

that routinely reports (written, on-line, or 

electronic) on system-wide management 

performance and compliance. Linkage 

between management reports, resource 

utilization, and performance measures has 

begun.

4. Routine community paramedicine EIS 

reports are issued at the community as well 

as at the provider level. Reports focus on 

management strengths, compliance with 

standards, and resource utilization. Trends 

are used to improve system efficiency and 

performance.

5. Community paramedicine EIS reports are 

used extensively to improve and report on 

program performance. The sponsoring 

agency issues regular and routine reports to 

providers. Program leaders assess reports 

to determine deficiencies and to allocate 

resources to areas of greatest need. 

Program performance and standard 

compliance are assessed and reported.
31

Indicator Scoring

205.2 Continuing education for community 

paramedicine providers is developed 

based on review and evaluation of 

EIS data.

0. Not known.

1. There is no correlation between training 

programs for providers and the community 

paramedicine EIS.

2. There is limited use of community 

paramedicine EIS reports to target 

educational opportunities.

3. There is evidence that some providers are 

using community paramedicine EIS reports 

to identify educational needs and to 

incorporate them into training programs.

4. Many educational forums have been 

conducted based on an analysis of the 

performance data in the community 

paramedicine EIS. Clear ties link education 

of providers with identified areas of need 

from the EIS reports.

5. Routine analysis of community 

paramedicine information and educational 

opportunities is being conducted. Integrated 

program objectives tying program 

performance and education are 

implemented and routinely evaluated. 

Regular updates to community 

paramedicine information and education are 

available. Community paramedicine EIS 

data are used to measure outcomes and 

effectiveness.
32 

Indicator Scoring

205.3 Community paramedicine leaders, 

including the multidisciplinary, multiagency advisory committee, regularly 

review system performance reports 

and system compliance information 

to monitor community paramedicine 

program performance and to 

determine the need for program 

modifications.

0. Not known.

1. There is no community paramedicine 

specific multidisciplinary, multi-agency 

advisory committee, and there are no 

regular reports of system performance.

2. There is a community paramedicine 

program community-wide multidisciplinary, 

multi-agency advisory committee, but it 

does not routinely review program data 

reports.

3. The community paramedicine program 

community-wide multidisciplinary, multiagency committee meets regularly and 

reviews process-type reports; no critical 

assessment of program performance has 

been completed.

4. The community paramedicine program 

community-wide multidisciplinary, multiagency advisory committee meets regularly 

and routinely assesses reports from 

community paramedicine data to determine 

program compliance and operational issue 

needing attention.

5. The community paramedicine program 

community-wide multidisciplinary, multiagency advisory committee and related 

stakeholder groups meet regularly and 

review data reports to assess program 

performance over time looking for ways to 

improve effectiveness and patient 

outcomes.
33 

Benchmark 206: The community paramedicine, EMS, public health, community health, 

and primary care systems are closely linked and working toward a common goal. 

Indicator Scoring

206.1 The community paramedicine 

program, EMS, public health and 

community health system, and 

primary care leaders have 

established linkages including 

programs with an emphasis on 

population-based public health 

surveillance and evaluation for acute 

and chronic disease prevention and 

health promotion.

0. Not known.

1. No community health risk assessments are 

conducted.

2. Community paramedicine program officials 

conduct health risk assessments; however, 

there is no involvement of EMS, community 

health, public health, or primary care 

officials in those assessments.

3. Public health/community health officials 

along with EMS, primary care providers, 

and community paramedicine participants 

assist with the design of community risk 

assessments. 

4. Public health/community health officials 

along with EMS, primary care providers, 

and community paramedicine participants 

assist with the design and analysis of 

community risk assessments.

5. The public health/community health 

epidemiologist along with EMS, primary 

care providers, and community 

paramedicine participants is involved in the 

development of risk assessment reports. 

There is clear evidence of data sharing, 

data linkage, and well-defined reporting 

roles and responsibilities.
34 

300: Assurance

Assurance to constituents that services necessary to achieve agreed-on goals are 

provided by encouraging actions of others (public or private), requiring action through 

regulation, or providing services directly.

Benchmark 301: The electronic information system (EIS) is used to facilitate ongoing 

assessment and assurance of system performance and outcomes and provides a basis 

for continuously improving the community paramedicine. 

 

Indicator Scoring

301.1 The community paramedicine 

program collects and uses patient 

data as well as provider data to 

assess system performance and to 

improve quality of care.

0. Not known.

1. Patient care data are not collected 

electronically by the program.

2. Patient care data are collected 

electronically but are not used to assess 

system performance or quality of care.

3. Patient care data are collected 

electronically and are used to assess 

system performance.

4. Patient care data are collected 

electronically and are used to assess both 

system performance and to improve quality 

of care across the program.

5. Patient care data are used to identify and 

meet additional health care/social welfare 

needs as they are identified.
35 

Indicator Scoring

301.2 Community paramedicine care 

providers collect patient care and 

administrative data for each episode 

of care and provide these data to the 

community paramedicine program 

which is evaluated including 

monitoring trends and identifying 

outliers.

0. Not known.

1. There is no jurisdiction-wide community 

paramedicine data collection.

2. Community paramedicine providers have a 

patient care record for each episode of 

care, but it is not yet automated or 

integrated with the community 

paramedicine EIS.

3. The community paramedicine patient care 

record electronically captures patient care 

provided by field personnel and can be 

transferred or entered into the community 

paramedicine EIS.

4. The community paramedicine patient data 

system is integrated into the community 

paramedicine EIS and is used by 

community paramedicine and other health 

care personnel to review and evaluate 

community paramedicine system 

performance.

5. The community paramedicine patient data 

system is fully integrated with all affiliated 

health care entities and with the public 

health surveillance system to help monitor 

community health needs.
36

Benchmark 302: The financial aspects of the community paramedicine program are 

integrated into the overall performance improvement system to ensure ongoing “finetuning” and cost-effectiveness.

Indicator Scoring

302.1 Cost data are collected and provided 

to the community paramedicine 

program EIS for each major 

component of the program.

0. Not known.

1. No cost data are collected.

2. Administrative and program cost data are 

collected and included in the annual 

community paramedicine program report.

3. In addition to administrative and program 

costs, clinical charges and costs are 

included in one or more major component 

areas and are provided to the community 

paramedicine EIS for inclusion in the annual 

community paramedicine program report.

4. The costs associated with individual system 

components, for example, home visitation, 

can be determined and are provided to the 

EIS registry for inclusion in the annual 

community paramedicine program report.

5. The cost of an aggregate system can be 

determined and is provided to the system 

registry for inclusion in the annual 

community paramedicine program report.

302.2 Cost, charge, collection, and 

reimbursement data are aggregated 

with other data sources including 

insurers and data system costs and 

are included in annual community 

paramedicine program reports.

0. Not known.

1. No outside financial data are captured.

2. Outside financial data are collected from 

one or more sources (e.g. Medicaid or 

private insurers).

3. Extensive financial data, for example, cost, 

charge, collection, and reimbursement, are 

routinely collected from the hospital, registry 

data, or more sources. Sufficient expertise 

is available to the community paramedicine 

program to analyze and report complex 

fiscal data.

4. Outside financial data are combined with 

internal community paramedicine program 

data and are used to estimate total program 

costs.

5. Outside financial data are combined with 

internal community paramedicine program 

data and are used to estimate total system 

costs. These financial data are described in 

detail in the annual community 

paramedicine program report.
37 

Indicator Scoring

302.3 Financial data are combined with 

other cost, outcome, or surrogate 

measures, for example, avoidance of 

EMS transports, avoidance of 

hospital visits, improved wellness 

measures, and others, to estimate 

and track true system costs and cost 

benefits.

0. Not known.

1. No nonfinancial burden of disease costs 

and outcome measures are collected or 

modeled.

2. Estimated savings using various burdens of 

disease costs or outcome measure models 

are calculated for all community 

paramedicine programs.

3. Estimated savings using various burdens of 

disease costs or outcome measure models 

are calculated for actual community 

paramedicine program costs.

4. Estimated savings using various burdens of 

disease costs or outcome measure models 

are calculated for all community 

paramedicine programs and activities and 

are combined with other system cost data 

to determine costs and savings of the total 

system. 

5. Estimated savings using various burdens of 

disease costs or outcome measure models 

are calculated for all community 

paramedicine programs and activities, are 

combined with actual system cost data to 

determine costs and savings of the total 

system, and are described in detail in the 

annual community paramedicine program 

report.
38 

Benchmark 303: The community paramedicine program ensures competent medical 

oversight. 

Indicator Scoring

303.1 There is authority for a community 

paramedicine medical director and a 

clear job description, including 

requisite education, training, and 

certification, for this position.

0. Not known.

1. There is no requirement for a community 

paramedicine program medical director, 

and no job description has been developed.

2. There is an EMS agency medical director 

that serves as medical director for the 

community paramedicine program, but no 

job description or expectations have been 

formally developed beyond those required 

of an EMS agency medical director.

3. There is authority for a community 

paramedicine program medical director, a 

job description, and expectations have been 

developed. This individual may or may not 

also serve as the EMS agency medical 

director.

4. There is authority for a community 

paramedicine program medical director, 

and the job description, including requisite 

education, training, and certification for the 

community paramedicine program medical 

director, is clear. A physician appropriately 

credentialed has been hired, and the job 

classification is routinely assessed for 

appropriateness of the duties required.

5. If separate individuals, the EMS agency 

medical director and CP program medical 

director regularly meet together with 

program leadership to coordinate and 

integrate the EMS and CP aspects of the 

agency’s services.
39 

Benchmark 304: The community paramedicine program is supported by an EMS 

system that includes communications, medical oversight, and transportation; the 

community paramedicine program, EMS system, and public health and community 

health agencies are well integrated.

Indicator Scoring

304.1 There is clear-cut legal authority and 

responsibility for the community 

paramedicine program medical 

director including the authority to 

adopt protocols, implement a 

performance improvement system, 

ensure appropriate practice of 

community paramedicine providers, 

and generally ensure medical 

appropriateness of the community 

paramedicine program based on 

regulatory agency scope of practice 

and accepted standards of medical 

care.

0. Not known.

1. There is no community paramedicine 

program medical director.

2. There is a community paramedicine 

program medical director with a written job 

description; however, the individual has no 

specific legal authority or time allocated for 

those tasks.

3. There is a community paramedicine 

program medical director with a written job 

description. The community program 

medical director has adopted protocols, 

implemented a performance improvement 

program, and is generally taking steps to 

improve the medical appropriateness of the 

community paramedicine program.

4. There is a community paramedicine 

program medical director with a written job 

description and whose specific legal 

authorities and responsibilities are formally 

granted by law or by administrative rule.

5. There is written evidence that the 

community paramedicine program medical 

director has, consistent with the formal 

authority, adopted protocols, implemented a 

performance improvement program, is 

restricting the practice of community 

paramedicine program providers (if 

indicated), is making significant efforts to 

improve the medical appropriateness of the 

community paramedicine program, and is 

working to fully integrate the program into 

the community health/primary care 

systems. Sufficient resources have been 

allocated for the medical director’s 

participation and oversight to ensure that an 

appropriate amount of his/her time is 

dedicated to program responsibilities.
40 

Benchmark 305: The community paramedicine program ensures a competent and safe 

workforce.

Indicator Scoring

305.1 In cooperation with the prehospital 

certification and licensure authority, 

established guidelines exist for 

community paramedicine personnel 

for initial and ongoing training 

including community paramedicine 

specific courses.

0. Not known.

1. There are no community paramedicine 

training guidelines for prehospital personnel 

as part of initial or ongoing certification or 

licensure.

2. Some community paramedicine personnel 

have completed initial training using a state, 

national, or internationally accepted 

community paramedicine curriculum.

3. All community paramedicine personnel that 

provide medical services to patients/clients 

have completed initial training using a state, 

national, or internationally accepted 

community paramedicine curriculum.

4. The program has established continuing 

education (CE) requirements for all 

community paramedicine program providers 

that are specific to community paramedicine 

program skills. These CE requirements 

exceed the CE courses for EMS personnel 

in time required and must cover topics 

specific to the community paramedicine 

program.

5. The community paramedicine program CE 

requirements are based upon identified 

knowledge or competency gaps in 

providers, are specific to address these 

gaps, and are altered over time to address 

newly identified gaps.
41 

Indicator Scoring

305.2 The community paramedicine 

program has established, with 

oversight by the medical director, a 

credentialing process that assures 

each community paramedicine 

provider has proven competence in 

performing the skills within the scope 

of practice.

0. Not known.

1. There is no credentialing process for 

community paramedicine personnel.

2. A written credentialing process has been 

developed that assures that the community 

paramedicine program is staffed by 

professional, reasonable, and well-trained 

individuals. This includes documentation of 

appropriate background checks and 

successful completion of required 

educational programs.

3. A credentialing process documents 

evaluation of competence performing at 

least three skills that are specific to the 

community paramedicine program beyond 

the skills of an EMS provider within the 

agency.

4. A credentialing process evaluates each 

community paramedicine program provider 

including a structured assessment of 

competence, professionalism, interpersonal 

communications skills, medical care, and 

system-based integration of healthcare 

resources.

5. In addition to local credentialing, state 

and/or national recognition in the form of 

certification or licensure has been attained 

for all community paramedicine personnel.
42 

Indicator Scoring

305.3 Conduct at least one multidisciplinary 

community paramedicine/community 

health conference annually that 

encourages system and team 

approaches to community health.

0. Not known.

1. There are no multidisciplinary community 

paramedicine conferences conducted within 

geographic boundaries of the community.

2. There are sporadic multidisciplinary 

community paramedicine conferences 

conducted.

3. Multidisciplinary community paramedicine 

conferences are conducted occasionally, 

and attendance by community 

paramedicine practitioners is monitored and 

reviewed.

4. Multidisciplinary community paramedicine 

conferences are conducted at least 

annually.

5. Multidisciplinary (EMS, physicians, nurses, 

physiatrists, policy makers, consumers, and 

others) community paramedicine 

conferences are conducted regularly, new 

findings from quality assurance and 

performance improvement processes are 

shared, and the conferences are open to all 

practitioners within the system. Regular 

attendance is required.

305.4 There are mechanisms within the 

system performance improvement 

processes to identify and correct 

systemic personnel deficiencies 

within the community paramedicine 

program.

0. Not known.

1. There is no mechanism to identify through 

performance improvement processes 

systemic personnel deficiencies within the 

community paramedicine program.

2. The community paramedicine program has 

begun to identify systemic personnel 

deficiencies.

3. The community paramedic program has a 

mechanism to identify systemic personnel 

deficiencies and is working on a process for 

corrective action.

4. The community paramedic program has a 

mechanism to identify systemic personnel 

deficiencies and is instituting corrective 

actions across the program.

5. Community paramedicine leadership and 

other stakeholders, including hospitals and 

the lead agency, monitor and correct 

personnel deficiencies as identified through 

quality assurance and performance 

improvement processes. A method of 

corrective action has been instituted, and 

appropriate follow-up is occurring. 

Monitoring of program deficiencies and 

corrective actions is ongoing.
43 

Indicator Scoring

305.5 There are mechanisms in place 

within agency and institutional 

performance improvement processes 

to identify and correct deficiencies in 

practice patterns of individual 

practitioners within the community 

paramedicine programs.

0. Not known.

1. There is no mechanism in place to routinely 

assess the deficiencies in community 

paramedicine practice patterns of individual 

practitioners.

2. The community paramedicine program has 

begun a process to evaluate deficiencies in 

practice patterns of individual practitioners.

3. A mechanism is in place to monitor and 

report on deficiencies in practice patterns of 

individual practitioners within the community 

paramedicine program. The process is 

evolving as part of the quality assurance 

and performance improvement processes.

4. There is a well-defined process to assess 

care provided by practitioners within the 

community paramedicine program. The 

quality assurance and performance 

improvement processes identify 

deficiencies, and corrective action plans are 

instituted.

5. Practice patterns of individual practitioners 

performing outside the standards of care 

are routinely assessed by the medical 

director and sponsoring agency. Corrective 

actions (training, additional education, and 

disciplinary), as appropriate, are instituted, 

and trends are monitored and reported to 

the sponsoring agency and/or other 

licensing agency.
44 

Benchmark 306: The program acts to protect the public welfare by enforcing various 

laws, rules, and regulations as they pertain to the community paramedicine program.

Indicator Scoring

306.1 The program works in conjunction 

with the prehospital and other 

regulatory agencies to ensure that 

community paramedical care 

provided by licensed individuals is in 

compliance with any rules, 

regulations, or protocols specific to 

community paramedicine delivery.

0. Not known.

1. There is no evidence that the community 

paramedicine sponsoring agency and the 

prehospital regulatory agency work together 

to ensure appropriate provider agency 

licensure and compliance.

2. The community paramedicine sponsoring 

agency refers complaints concerning issues 

of prehospital agency performance to the 

prehospital regulatory agency.

3. The community paramedicine sponsoring 

agency and the prehospital regulatory 

agency work together to resolve complaints 

involving prehospital personnel 

performance.

4. The community paramedicine sponsoring 

and the prehospital regulatory agency work 

together to monitor compliance of 

prehospital providers with any rules, 

regulations, or protocols specific to 

prehospital practice.

5. The prehospital regulatory agency, working 

cooperatively with the community 

paramedicine sponsoring agency, is 

involved in ongoing community 

paramedicine program performance 

improvement processes and prehospital 

provider compliance with any rules, 

regulations, or protocols specific to 

prehospital practice.
45 

Indicator Scoring

306.2 The program refers issues of 

personnel noncompliance with laws, 

rules, and regulations to appropriate 

boards or licensure authorities.

0. Not known.

1. Individual personnel performance is not 

monitored.

2. Complaints about individual personnel 

noncompliance with laws, rules, and 

regulations go directly to appropriate boards 

or licensure authorities.

3. Community paramedicine sponsoring 

agency personnel collaborate actively with 

licensure authorities to resolve complaints 

involving individual personnel 

noncompliance with laws, rules, and 

regulations governing community 

paramedicine personnel.

4. Individual personnel performance issues 

are addressed within community 

paramedicine program’s performance 

improvement processes unless they involve 

breaches of State or Federal statute.

5. Appropriate boards or licensure authorities 

are involved in the system performance 

improvement processes addressing 

individual personnel performance issues.
46 

References

1. McGinnis, K. (2004). Rural and Frontier EMS Agenda for the Future. Kansas City MO, 

National Rural Health Association. 

2. Health Resources and Services Administration (2006). Model trauma system planning 

and evaluation. Washington DC, U.S. Department of Health and Human Services. 

3. Institute of Medicine (1988). The future of public health. Washington, DC: National 

Academy Press. 

4. Department of Transportation. National EMS Scope of Practice Model. In: National 

Highway and Traffic Safety Association, ed.; 2007.

5. National Registry of EMTs. Practice Analysis. National Registry of EMTs. ; 2009.

6. Public Health Functions Steering Committee (1994). The public health workforce: An 

agenda for the 21st century. Full Report of the Public Health Functions Project. U.S. 

Department of Health and Human Services.

7. Winchell, R.J., Ball, J.W., Cooper, G.F., Sanddal, N.D., and Rotondo, M.F. (2008) An 

assessment of the impact of trauma systems consultation on the level of trauma system 

development. Journal of the American College of Surgeons, 207(5), 623-629.
47 

Appendix A: Program Information Worksheet

This descriptive information serves as a program summary and will be useful as a source of 

data for State and Federal agencies and organizations interested in community paramedicine 

programs. It is suggested that the form be completed, updated at least annually, and kept on file 

as a resource to provide other entities who may request summary information concerning your 

program. 

Name of Program: _________________________________________________ 

Program Location (city, state): _______________________________________

Where does the Program Operate?: Urban Rural

Program Sponsor/Agency: __________________________________________

Agency Type: ____________________________________________________

Population Served: _________________________________________________

Description of Program (What services do you provide): ____________________

________________________________________________________________

Number of Community Paramedics in Program: __________________________

Call Volume (Indicate whether daily/monthly/annually): _____________________

Program Start Date (Month/Year): ___/____

Continuous Operation Since Start: Yes No

If No, What Caused the Interruption: _____________________________

___________________________________________________________
48 

How is the Program Funded/Supported: (check all that apply)

 Agency funds

 Grant support

 3rd party payers

 Tax revenue

 Other (describe) ____________________________________________

Who is the community paramedicine program Medical Director: 

________________________________________________________________

Who is the EMS agency medical director (if different): _____________________

Under what state or local authority does the program operate:

________________________________________________________________

Healthcare Affiliations:

 

Contracted health plans/insurers: _______________________________

 

Contracted hospitals: _________________________________________

 

Contracted physician practices/medical homes: ____________________

___________________________________________________________

Other contracted healthcare organizations (home health agencies, etc):

___________________________________________________________
49 

Appendix B: Definitions

Accountable Care Organization: Teams of doctors, hospitals, and other health care providers 

and suppliers working together

Benchmarks: Global overarching goals, expectations, or outcomes. In the context of the 

community paramedicine program, a benchmark identifies a broad system attribute. 

Certification: The issuing of certificates by a private agency based upon standards adopted by 

that agency that are usually based upon minimum competence.

Community Paramedic: A state licensed EMS professional that has completed a formal 

internationally standardized Community Paramedic educational program through an 

accredited college or university and has demonstrated competence in the provision of 

health education, monitoring and services beyond the roles of traditional emergency 

care and transport, and in conjunction with medical direction. The specific roles and 

services are determined by community health needs and in collaboration with public 

health and medical direction.

Community Paramedicine: An organized system of services, based on local need, which are 

provided by EMTs and Paramedics integrated into the local or regional health care 

system and overseen by emergency and primary care physicians. This not only 

addresses gaps in primary care services, but enables the presence of EMS personnel 

for emergency response in low call-volume areas by providing routine use of their clinical 

skills and additional financial support from these non-EMS activities.

Credentialing: An institution's or individual's authority or claim of competence for a course of 

study or completion of objectives.

EMS Professionals: Paid or volunteer individuals who are qualified, by satisfying formalized 

existing requirements, to provide some aspect of care or service within the EMS system.

EMS Professionals - Emergency Medical Technician (EMT): Acting under the oversight of a 

medical director, an EMT “initiates immediate lifesaving care to critical patients”. EMT’s 

perform numerous tasks in the prehospital setting including, but not limited to, basic 

airway management, cervical spine immobilization, cardiopulmonary resuscitation, and 

bleeding control. 

EMS Professionals - Advanced Emergency Medical Technician (AEMT): Acting under the 

oversight of a medical director, an AEMT builds upon the knowledge and skills of an 

EMT by expanding treatment utilized to patients in the prehospital setting. AEMT’s 

perform numerous tasks in addition to an EMT including, but not limited to, intravenous 

access and advanced airway management.

EMS Professionals - Paramedic: Acting under the oversight of a medical director, a Paramedic 

possesses “complex knowledge and skills necessary to provide patient care and 

transportation”. Paramedics perform numerous tasks including, but not limited to, 

intravenous access, advanced airway management, obtainment and interpretation of 

electrocardiograms, and administration of lifesaving medications.
50 

EMS Systems: A comprehensive, coordinated arrangement of resources and functions 

organized to respond to medical emergencies in a timely manner.

Health: Health is a state of complete physical, mental, and social well-being and not merely the 

absence of disease or infirmity.

Indicators: Those tasks or outputs that characterize the benchmark. Indicators identify actions or 

capacities within the benchmark. Indicators are the measurable components of a 

benchmark. 

International Roundtable on Community Paramedicine (IRCP): An collaborative developed to 

promote the international exchange of information and experience related to the 

provision of flexible and reliable health care services to residents of rural and remote 

areas using novel health care delivery models, and to be a resource to public policy 

makers, systems managers, and others.

Joint Committee on Rural Emergency Care (JCREC): Joint committee between NASEMSO and 

NOSORH dedicated to advancing policy and practice to ensure access to timely, 

affordable, and high quality emergency care services in rural America.

Licensure: The act of a State granting an entity permission to do something that the entity could 

not legally do without such permission. Licensing is generally viewed by legislative 

bodies as a regulatory effort to protect the public from potential harm. In the health care 

delivery system, an individual who is licensed tends to enjoy a certain amount of 

autonomy in delivering health care services. Conversely, the licensed individual must 

satisfy ongoing requirements that ensure certain minimum levels of expertise. A license 

is generally considered a privilege and not a right.

Medical Oversight: Supervision of the medical aspects of systems designed to provide 

emergency care in the out-of-hospital setting.

National Association of EMS Physicians (NAEMSP): An organization of physicians and other 

professionals partnering to provide leadership and foster excellence in out-of-hospital 

emergency medical services.

National Association of EMTs (NAEMT): An organization of physicians and other professionals 

partnering to provide leadership and foster excellence in out-of-hospital emergency 

medical services.

National Association of State EMS Officials (NASEMSO): The lead national organization for 

EMS, a respected voice for national EMS policy with comprehensive concern and 

commitment for the development of effective, integrated, community-based, universal 

and consistent EMS systems.

National EMS Information System (NEMSIS): A nationally recognized prehospital patient care 

data standard, including comprehensive data dictionary and the supporting XML 

standard to ensure portability of the data; NEMSIS was developed to help states collect 

more standardized data elements and eventually submit data to a national EMS 

database.
51 

National Organization of State Offices of Rural Health (NOSORH): Organization established to 

help State Offices of Rural Health in their efforts to improve access to, and enhance the 

quality of, health care for America’s 61 million rural citizens.

National Registry of Emergency Medical Technicians (NREMT): A national certifying agency 

that establishes uniform standards for training and examination of personnel active in the 

delivery of emergency ambulance service.

Scope of Practice: Defined parameters of various duties or services that may be provided by an 

individual with specific credentials. Whether regulated by rule, statute, or court decision, 

it represents the limits of services an individual may legally perform.

Scoring: Breaks down the indicator into completion steps. Scoring provides an assessment of 

the current status and marks progress over time to reach a certain milestone. 

Standard Curriculum: With goals and objectives to improve the quality of emergency medical 

care, the standard curriculum consists of core curriculum of minimum required 

information to be presented within each respective EMS certification levels.
52 

Appendix C: Overview of the Community Paramedicine

Programs Interviewed

Fort Worth, Texas

Name of Program: MedStar Community Health Program

Active Dates: 2009 – Present

Funding: Cost savings in reducing unnecessary 9-1-1 responses

Core Activities: The goal of the Community Health Program is to reduce the unneeded 9-

1-1 calls and EMS transports that put strain on an already overloaded emergency 

system, provide the patient more appropriate health care (as opposed to the emergency 

room), as well as reducing overall healthcare costs. Since its' inception, it is estimated 

that the program has saved more than $1.3 million in emergency room charges, and 

reduced 9-1-1 use by these patients by nearly 50 percent, saving nearly $1 million in 

EMS charges. 

San Francisco, California

Name of Program: San Francisco Fire/EMS Homeless Outreach and Medical 

Emergency (HOME) Team 

Active Dates: 2004 – 2009

Funding: City general fund

Core Activities: Originally conceived as a means to stop sending expensive EMS 

resources to repetitive, non-emergency calls. HOME Team members were veteran 

SFFD paramedics who had been selected and trained to be paramedic outreach 

workers. They were clinically experienced, empathetic and had good street sense from 

their tenure on the job. 

HOME Team members concentrated on areas where high populations of chronically 

homeless people congregate. Team members were taught to motivate these people to 

accept care and treatment through a series of specialized interventional techniques. 

They started with a psychosocial assessment of the client's perceived needs. They 

asked the client's view of why he/she repeatedly calls 9-1-1. They assumed a positive 

and supportive role, but were more directive than traditional social work.

The program is not currently operating due to a funding shortage. 
53 

Scott County, Minnesota

Name of Program: Scott County Community Paramedicine

Active Dates: 2008 – 2010; 2011 – Present

Funding: Grants and 3rd party payers 

Core Activities: Free fixed and mobile clinics to reduce inappropriate use of 9-1-1 

resources. Community paramedics have been primarily used in the mobile clinic. 

They’ve seen between 300-400 patients who have visited the clinic for various reasons. 

The community paramedics have also done clinical work with the physician medical 

director and other providers.

The program underwent a one year hiatus in the absence of funding. Minnesota recently 

passed legislation that will allow community paramedic programs to bill for their services. 

University of Pittsburgh, Pennsylvania

Name of Program: Emed Health

Active Dates: 1997 – Present 

Funding: University Health Plan, 3rd party payers

Core Activities: Emed Health promotes prevention and disease management using 

emergency medical service (EMS) agencies and their personnel to deliver community, 

emergency department and home-based prevention and disease management services. 

Community paramedics have immunized more than 50,000 people since start and have 

recently begun biometric screening. Trained paramedics have conducted those 

screenings on employees at university and other large employers with 30-40,000 

screenings to date. They also have asthma prevention and fall prevention programs. A 

very successful component includes the Safe Landing program where community 

paramedics are sent out to homes to work with patients who have been discharged from 

the hospital. This occurs within 48 hours of discharge and community paramedics 

ensure that the patients understand discharge instructions and connect with their 

primary care provider to prevent readmission.

 

Vail, Colorado

 

Name of Program: Western Eagle County Ambulance District – Community 

Paramedicine

Active Dates: 2009 – 2010; 2011 – Present 

Funding: Grant funds

Core Activities: Patients are referred to emergency medical services personnel by their 

primary care physician to receive services in the home, including hospital discharge 

follow-up, blood draws, medication reconciliation and wound care. The program will 

initially operate with two specially trained community paramedics who will coordinate 

with the referring physician to ensure quality of care and appropriate oversight. In 

addition, paramedics will work with Eagle County's Public Health Department to provide 

preventative services throughout the community.

This program underwent a several month hiatus to resolve regulatory issues with state 

agencies. 
54 

Appendix D: Additional Resources

Rural and Frontier EMS Agenda for the Future: 

http://ircp.info/Portals/22/Future/RF%20EMS%20Agenda%20for%20the%20Future.pdf

HRSA Model Trauma System Planning and Evaluation: The complete report can be found 

at: http://www.ncdhhs.gov/dhsr/EMS/trauma/pdf/hrsatraumamodel.pdf. The Trauma System 

Self-Assessment Supplemental Tool: Benchmarks, Indicators, and Scoring can be found at: 

http://www.publicsafety.ohio.gov/links/ems_self_assessment_tool.pdf 

International Roundtable on Community Paramedicine (IRCP): The IRCP promotes the 

international exchange of information and experience related to the provision of flexible and 

reliable health care services to residents of rural and remote areas using novel health care 

delivery models and to be a resource to public policy makers, systems managers, and others.

http://www.ircp.info 

Joint Committee on Rural EMS Care (JCREC): In 2009 the National Association of State 

EMS Officials (NASEMSO) and National Organization of State Offices of Rural Health 

(NOSORH) created a Joint Committee on Rural Emergency Care (JCREC). This Committee is 

dedicated to advancing policy and practice to ensure access to timely, affordable, and high 

quality emergency care services in rural America. 

State Perspectives Discussion Paper on Development of Community Paramedic Programs:

http://www.ruralcenter.org/sites/default/files/community_paramedic_programs.pdf 

Community Paramedicine Insight Forum (CPIF): The Community Paramedicine Insights 

Forum (CPIF) is a project sponsored by the Joint Committee on Rural Emergency Care (of the 

National Association of State EMS Officials and the National Organization of State Offices of 

Rural Health) and the Center for Leadership, Innovation and Research in EMS (CLIR). It is 

intended to serve as a regular meeting place, educational opportunity and discussion group for 

those folks trying to establish community paramedicine services or systems on a local, regional 

or statewide basis. 

http://cpif.communityparamedic.org 
55

Appendix E: Project Team

Minnesota – Community Paramedicine Program

Michael R. Wilcox, MD, FACEP, FAAFP

National Association of Emergency Medical Technicians

Rod Barrett, BA, RN, NREMTP

National Association of State EMS Officials

D. Randy Kuykendall, MA, President

Jim DeTienne, President – Elect, Chair JCREC

Douglas F. Kupas, MD, EMT-P, FACEP – Chairman EMS Medical Directors Council

North Central EMS Institute

Gary L. Wingrove, EMT-P, Ret.

National Highway Traffic Safety Administration – Office of EMS

National Organization of State Offices of Rural Health

Matt Womble, MHA, NCEMT-P

National Registry of Emergency Medical Technicians

Melisa Bentley

Western Eagle County, Colorado – Community Paramedicine Program

Chris Montera

Anne Robinson
56

 

 

 

 

 

Public Domain Notice

All material appearing in this document is in the public domain and may be reproduced 

without permission from HRSA. Citation of the source is appreciated.

Recommended Citation

Community Paramedicine Evaluation Tool, U.S. Department of Health and Human Services 

(2012), Health Resources and Services Administration, Office of Rural Health Policy, 

Rockville, MD 20857

Contact Information

U.S. Department of Health and Human Services

Health Resources and Services Administration

Office of Rural Health Policy

5600 Fishers Lane

Rockville, MD 20857

www.hrsa.gov/ruralhealth

Tel: 301-443-0835

Fax: 301-443-2803

This document is available online at: http://www.hrsa.gov/ruralhealth