Community Paramedicine When it comes to healthcare in the United States, there are a number of challenges and issues that challenge everyday Americans all of the time. The common refrains are access to providers, costs and so forth. However, the devised and proposed solutions are also gaining prominence as well. One such solution has come to be known as community paramedicine. The key to community paramedicine is that emergency management services (EMS) personnel act outside of and beyond their traditional scope of duties and responsibilities. This is done as a means to enhance and improve the healthcare options that exist within the communities. This report is meant as a review and summary of the use of community paramedicine and how it can be created and expanded in the state of Maryland. While the community paramedicine methodology is still very much in its nascent stages, the potential benefits and better outcomes for all serves as more than a motivation to expand its usage.

Analysis

As noted in the introduction, the literature review that follows in this report shall serve as a justification for creating and expanding the use of community paramedicine in Maryland. This would include all urban centers and larger cities such as Baltimore and Annapolis but should also include other areas of the state that would obviously benefit from community paramedicine and/or have an urgent need for the services and benefits provided by the same. Even rural areas have been shown to benefit from community paramedicine. Further, some of those areas are not entirely far from Maryland or even the United States in general. Indeed, the use of community paramedicine has been used in rural Ontario up in Canada. When it comes a rural setting, any community paramedicine program in Maryland should have four major components. Those components are ad hoc home visiting, aging at the home, paramedic wellness clinics and having a proper and robust community paramedic response unit. While there may be more acclimated to fishing posts and such in states like Alaska, there are surely at least some situations and people within the Maryland area that would be classified as rural areas given the lack of healthcare access and other issues. As such, focusing on the healthcare needs of such residents and the consumer satisfaction levels of those same people should be of paramount importance and attention (Martin, O'Meara & Farmer, 2016).

Another dimension that cannot typically be ignored or disregarded when it comes to community paramedicine is the demographic mix of the people being served. This can absolutely be applied to the rural setting just referenced. However, it can and should also be applied to areas where racial minorities are the norm. Indeed, Maryland absolutely has areas such as Baltimore and others where the population of African-Americans is high. Given that African-Americans, for example, only represent 13% or so of the national population, this has to be something that is focused on. Beyond that, racial minorities tend to have healthcare access and quality issues and/or they are at higher risk than the average white male in the population. Poverty tends to be a major reason for this but there would seem to be other factors as well. Regardless, community paramedicine is a way to address this problem head on via the means of having EMS-trained professionals on hand to give services that are both emergency and proactive in nature. Indeed, treating someone for a breathing issue is important but so is educating and helping people when it comes to the management and handling of their type II diabetes. Getting the people in a community and the community as a whole engaged in that whole process is a huge part of changing the paradigm and getting the culture and neighborhoods as a whole on the right track in terms of health and being proactive about the same (O'Meara, Stirling, Ruest & Martin, 2016).

While having EMS staff in the mix is a linchpin and cornerstone of the community paramedicine model, there are a few other types of personnel and people that must be involved as well. Due to regulatory and other legal reasons, one such person would be a pharmacist. Indeed, EMS people are able to provide life-saving treatments and medicine in the field when an emergency calls for it. However, providing medicinal and pharmacological solutions above and beyond such urgent situations is definitely restricted. For example, treating someone with extremely low blood sugar is one thing and EMS personnel would assist with that. However, managing that blood sugar after EMS and/or the hospital has done their thing would also be important and EMS cannot do that on their own. For that to happen, an endocrinologist or other qualified physician would need to assess what is going on and that person...

Upon this being completed, a pharmacist would dispense the medicine (Crockett et al., 2016).
As such, this would show that any community paramedicine may very well be dominated by EMS personnel. However, there will be some doctors and other medical professionals like pharmacists involved as well. This is due to legal and regulatory constraints and it can also serve as a check and balance so as to ensure that everything is staying within their proverbial lane from a legal and guidance standpoint. What makes the community medicine paradigm so much different from the more conventional and traditional models that this all happens within is that home visits and monitoring can be much more advanced and protracted as compared to what is normally and practical. Indeed, patients that have heart failure are at high risk of dying or at least having further complications. However, such patients getting to a doctor or emergency room can be rather hard to pull off. This is where an expanded community paramedicine framework can come in hand and indeed save or at least extend lives in some to many instances (Crockett et al., 2016).

Another facet of community paramedicine that has to be part of any modernized and proper solution is the use of mobile technology. At the same time, there is a lot of valid concern when it comes to the security and quality of such mobile solutions. Whether it be privacy, access or what have you, any mobile solutions deployed for community paramedicine need to be done properly, completely and securely so that they work for the intended purpose and give access to those that require and need it...but nothing beyond that. Just as the emergency management services people involved in community paramedicine are used to fill in "gaps" in healthcare access and quality in the communities, the use of mobile technology can be used to address the same when it comes to areas and situations where access to healthcare and patient information is not as easy or possible as it would be in a doctor's office or hospital (Choi, Blumberg & Williams, 2016).

When it comes to mobile healthcare solutions of any sort, there are a few overarching and obvious concerns that may or may not involve the legal or regulatory paradigm. Regardless, any people involved in creating or expanding the community paramedicine options in Maryland need to take note. These concerns include efficacy, safety and cost-effectiveness. If done properly, a mobile data system for community paramedicine professionals could limit and mitigate things like readmissions due to congestive heart failure, reduce the number of patients that have to be frequently transported by EMS personnel and the amount of emergency department visits overall. It has to be admitted and stated up front that the body of knowledge when it comes to all of this is not as complete or resounding as it could be. Even so, the basics are firmly falling into place and this would include the legal and regulatory aspects of the community paramedicine practice, both within and outside of the state of Maryland (Choi, Blumberg & Williams, 2016).

Even with the above, the rather nascent nature of the community paramedicine paradigm requests and requires that people assess these new or at least newer questions that exist. Indeed, community paramedicine is already clearly addressing particular things that sometimes involve legal issues but also involve issues that involve ethics, what people are entitled to and what should be the deliverables of a healthcare system or any part thereof. As touched upon already, just some of the things that community paramedicine is meant to address would include insufficient access to primary medical care sources, the avoidance of using urgent care networks due to the higher costs involved and so forth. However, there are seemingly ancillary things that must also be addressed such as the training for the involved EMS personnel, the testing of competencies for those same personnel and the job satisfaction of all of the paramedicine employees involved (Iezzoni, Domer & Ajayi, 2016). Something that is taking some shape of its own is patient-centric care. Indeed, many studies and reviews of the topic, including that of some community paramedicine efforts in Montgomery County, Texas, have proven that the patients involved in the practice of…