Evaluation of Community Paramedicine Pilot Projects

In November 2014, the California Office of Statewide Health Planning and Development authorized a Health Workforce Pilot Project that assessed the feasibility of community paramedicine, a model of care in which paramedics provide care beyond their traditional scope of practice, which is limited to treating persons on the scene of an emergency and transporting them to an emergency department. The pilot project was sponsored by the California Emergency Medical Services Authority (EMSA) and tested the following six different community paramedicine concepts at 10 sites across California. 

1. Providing short-term, in-home follow-up care for persons recently discharged from a hospital who are at an increased risk of an ED revisit or a hospital readmission: Butte County, San Bernardino County, Solano County, parts of Alameda County, and parts of Los Angeles County. 
2. Addressing the needs of frequent 911 callers or frequent visitors to EDs: parts of Alameda County and parts of San Diego County.
3. Collaborating with hospices to meet the needs of hospice patients when 911 is called: Ventura County.
4. Delivering directly observed therapy (DOT) to persons with tuberculosis: Ventura County.
5. Transportation for people with mental health needs to mental health crisis centers:  Stanislaus County
6. Transportation for patients with low-acuity medical conditions to urgent care centers:  parts of Los Angeles, Orange, and San Diego Counties.

Community paramedics at the 10 pilot sites began providing care in June 2015. A seventh concept – transportation of acutely intoxicated people to sobering centers – was added to the pilot project in 2017.

Seven additional sites were added to the pilot project between 2017 and 2019, including one additional frequent EMS user project (City and County of San Francisco), three additional mental health crisis center projects (Fresno County and parts of Los Angeles and Santa Clara Counties), and three sobering center projects (City and County of San Francisco, parts of Los Angeles and Santa Clara Counties). Five sites closed and one suspended enrollment over the course the pilot project.

On September 25, 2020, California’s governor signed AB 1544, a bill that authorizes local emergency medical services agencies to develop community paramedicine or triage to alternate destination programs in accordance with regulations that EMSA will develop. When AB 1544 went into effect on January 1, 2021, responsibility for the 14 pilot sites that were in operation was transferred from OSHPD to EMSA. These pilot projects will continue to operate as they have in the past pending EMSA’s adoption of regulations to implement AB 1544.

A team of researchers from the Healthforce Center at UCSF and the Philip R. Lee Institute for Health Policy Studies at UCSF served as the external evaluators.