Starting a community paramedicine program can be quite an undertaking, and sometimes it’s hard to know where to start, or what to expect. So we asked experts with first-hand experience to share the lessons they learned throughout the process.
What was your biggest challenge starting a community paramedicine program?
Chris Montera:
Pushback from other home care providers who felt we were infringing on their turf. Keep an open collaboration. Let them know if [they] find a patient that doesn’t quality [for their program], send them our way.
Dr. Michael Wilcox:
Bring everyone together way before implementation. And pass patients back and forth depending on need.
Meet the Experts
Michael Wilcox, MD, is a family practice physician and clinical associate professor in the Department of Emergency and Family Medicine, University of Minnesota. He also serves as the medical director of the community paramedicine program at Hennepin Technical College. He has been an early architect of Community Paramedicine and remains a strong advocate of it’s importance in future health care initiatives.
Anne Robinson-Montera, RN, BSN, works as a public health nurse consultant across Colorado, and is the co-creator and public health partner for first national community paramedic pilot program in rural Eagle, Colo. She led a team of educators and experts in developing the 3.0 version of the community paramedic curriculum, which she also teaches.
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Christopher Montera, AAS, NR – P, is the Assistant CEO at Eagle County Paramedic Services. He has 23 years of experience in EMS and is the past president of the Emergency Medical Services Association of Colorado. He also produces an internet radio show 
Davis Patterson, PhD, is the Deputy Director of the University of Washington’s WWAMI Rural Health Research Center and an investigator in the Center for Health Workforce Studies. His EMS research activities have focused on the rural and volunteer EMS workforces, EMS performance measures, and community paramedicineAnne Robinson-Montera:
You need to get the buy-in within EMS itself. It’s about accepting what this is.
Let’s say this is community paramedicine for dummies. What are the first three steps to getting started?
Montera:
Get your board to buy in. Ultimately there’s going to be a spend to get this going. Get ‘the blessing.’
Then start finding the stakeholders. Get meetings going. Build what you think the program is going to look like, hand it to people, and have them rip it apart. And don’t be afraid when they do.
Robinson-Montera:
There also has to be a basis for what we do, and we won’t get any respect until we start doing education.
Wilcox:
You’ve got to get a champion on board, and your medical director. Bring stakeholders together and pitch the concept to them. Show them the gap in health care, and how you’re unique providers.
Robinson-Montera:
It also helps to have a nurse champion by your side, especially if you’re getting push back from doctors and nurses.
Montera:
As soon as we said here’s the education base and threw curriculum at them, it helped a lot with nurses.
Once everyone is on board, both paramedics and other health agencies want to move forward quickly. How do you balance that with educational requirements and planning?
Montera:
I took all my medics, sat them down with the curriculum, and went through it piece by piece asking ‘what do you think you need?’ My really smart paramedics went ‘well, almost all of it.’
It’s a career ladder step, not a step down. We’re taking our most seasoned people and throwing them into this.
And what about collaborators like hospitals and health care agencies that want a program up and running soon?
Montera:
Don’t go slow. But go slow enough. Actually, say ‘we will go as fast as you can pay for.’
Wilcox:
They need to step up to the plate if they want this done.
How do you approach data collection?
Dr. Davis Patterson:
The most common problem is an evaluator is brought in too late, and you don’t have your baseline data to compare it to.
Montera:
Grants often ask what are your measurable outcomes. That forced us to do it.
Robinson-Montera:
It didn’t actually force you.
Montera:
Well, it gave us a North Star. We hired an outside evaluator to watch the process.
Wilcox:
If you’re going to move ahead, you’re going to have to have data to show the benefit of this provider. If you don’t think about it in advance, it will be either terribly painful [when you have to sift through old data] or you won’t have the information you need.
Where do you start when it comes to figuring out a needs and gap analysis?
Montera:
Hospitals mandate a data analysis ever three years, and public health does it every five years. The data is already out there, it’s just a matter of looking at it. We started with the public health analysis.
Have you had any interest or push back from fire departments?
Robinson-Montera:
They either don’t want to do it but don’t know what it will look like, or they want to do in their own way, without any regulations.
Wilcox:
You need to have champions internally that want to make this happen.
Montera:
At some point, you’re going to be worked out of a job. The fire unions are going to have to step up and say ‘we believe in this.’