Historically, the function of emergency medical services has been two-fold: To provide medical assistance during acute and life-threatening medical conditions, and to transport patients to hospital emergency departments. As emergency care facilities and personnel are expected to deal with routine and uncommon problems alike, operations and maintenance of paramedic units incur high costs. Various models to integrate these units into community healthcare are now being proposed to optimise the cost-benefit ratio of emergency medical services.
Emergency medical services of the future are expected to manage community health, to provide acute illness and injury care and follow-up, and contribute to community health monitoring. Early pilots as far as 20 years ago had hoped that community paramedicine ‘will improve community health and result in more appropriate use of acute healthcare resources’.
With ‘cuts’ being the operative word in NHS, we are compelled to look to cost-effective ways of integrating paramedic services with community healthcare. Various pilots have been carried out throughout the UK. These have resulted in reduced emergency department visits and local 999 phone calls. Paramedics of the South East Coast Ambulance Service also conducted home visits in the community. This allowed them a better peep into the local community, and enabled them to make an informed decision during a later emergency.
For example, an elderly man who had suffered from a fall received better and efficient care as paramedics had met him during a previous home visit. Being familiar with the patient's medical history, it was easier to treat him at home, and to refer him to the GP instead of an emergency department. There are plans to deploy similar programmes tailored to local communities across the country.
It is encouraging to see emergency healthcare integrated into the wider healthcare picture. Community paramedicine pilots reportedly appreciate a rapport between local patients and paramedics, and the resultant ease in dealing with patients. On the other hand, we have recently heard news of a student paramedic being discharged after offering bereavement advice to a new mother.
While it is important for paramedics to build relations with the community, it is necessary to strike a balance between mechanical medical care and an all-in-one Call the Midwife style of care. And officials must ensure that while paramedics can be a useful resource in managing chronic community illnesses, responding to a range of routine and unexpected emergencies remains their primary function.