Community paramedics: need of legal education specific to the pre-hospital non-emergency environment (discussion based on Texas)

Emergency medical services (EMS) are an essential part of every community that grew out of the recognition that rapid transport to the hospital resulted in fewer fatalities in motor vehicle crashes, and essentially has been advancing on its own, even with a lack of regulation and research. The field of EMS has continued to advance at the state level adapting to the individual characteristics of the community, despite lack of government oversight (Shah, 2006).

The Affordable Care Act (ACA) has implemented a series of healthcare reforms designed to reduce healthcare spending, reduce emergency room and hospital admissions, and improve overall health through preventative healthcare (Bittle, 2015). The advent of the ACA has caused a shift in the healthcare industry.

EMS is a niche market that caters to life-saving emergency care and transportation of patients to the hospital. Medicare recognises EMS only as a transportation service and reimburses if the patient is transported to Medicare-defined medical facilities including emergency rooms, hospitals and dialysis centres (Alpert et al, 2013), with little or no regard to the medical interventions provided. Alpert et al (2013) have shown that 74% of all emergency EMS patients are transported to an emergency room, and 34.5% of these transported patients have low-acuity conditions that do not require admission to the hospital. There is a significant amount of healthcare savings to be had with the reduction of EMS transports to the emergency room. Introducing community paramedicine, a preventative health initiative in which the patient remains at home and receives no transportation to the hospital, allows EMS to join in the Affordable Care Act's objective of reducing medical admissions and allowing the patient to become involved in their own health plan.