BMC Health Services Research · 6 authors, 3 centres
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Community paramedics (CPs) perform diverse roles, with health assessments being most common (96.5%) and vaccine administration least (38.6%). Role clarity and interprofessional collaboration significantly enhance professional identity, while training completion improves role satisfaction. Sustainable funding and service expansion are critical for the future of community paramedicine.
**Background:** Community paramedicine is an evolving model that expands paramedic roles from emergency care to non-emergent and preventive services tailored to local needs. Despite growing acceptance, limited information exists on community paramedics' (CPs) perceptions of their expanded roles. This study assessed CPs' perceptions of training, roles, role clarity, role readiness, role satisfaction, professional identity, interprofessional collaboration, and the future of community paramedicine.
**Methods:** A cross-sectional survey was conducted in July/August 2020 using a 43-item web-based questionnaire distributed via the National Association of Emergency Medical Technicians-mobile integrated health (NAEMT-MIH) listserv. Eligibility criteria: EMTs/paramedics ≥18 years old, currently practicing as CPs or paramedics on an MIH team. Of 343 potentially eligible recipients, 82 met criteria and 57 were analyzed after excluding missing data (response rate 16.6%). The questionnaire assessed training, roles, role clarity (4 items, 5-point Likert), role readiness (single item), role satisfaction (single item), professional identity (11 items from PIPN questionnaire), interprofessional collaboration (9 items from AITCS-II), and program/work characteristics. Four open-ended questions explored COVID-19 experiences and future perceptions. Data were analyzed using Spearman's correlation, Wilcoxon Mann–Whitney U, and Kruskal–Wallis tests; qualitative content analysis was used for open-ended responses.
**Key Results:** Participants (mean age 44.3±10.0 years) were primarily male (80.4%) and non-Hispanic White (88.2%). Most (80.7%) completed didactic/clinical training. Nearly all (96.5%) performed health assessments; only 38.6% administered vaccines. Mean role clarity was 15.5±4.3 (range 4-20), role readiness 3.3±0.8 (range 2-4), role satisfaction 4.4±0.9 (range 1-5), professional identity 46.8±6.1 (range 30-55), and interprofessional collaboration importance 9.5±0.9 (range 7-10). Role clarity (rho=0.4, p=0.0013) and interprofessional collaboration (rho=0.4, p=0.0015) were significantly associated with professional identity. Training completion was associated with higher role satisfaction (U=29.4 vs 16.7, p=0.0114) but not with professional identity (p=0.0657) or interprofessional collaboration (p=0.4326). CPs who performed patient navigation, health promotion, and injury prevention/safety assessments at least once per week reported greater interprofessional collaboration (p<0.01). COVID-19 challenges included adapting to changing policies, CP well-being, and inadequate funding; opportunities included service expansion and flexible community response. Future priorities included sustainable payment models, expanded services, and geographic reach.
**Clinical Implications:** The findings highlight the need for standardized training to improve role clarity and readiness, which could enhance professional identity and role satisfaction. Interprofessional collaboration is critical for CPs to fulfill their roles effectively. The low rate of vaccine administration (38.6%) suggests an opportunity for service expansion, especially in public health emergencies. Sustainable reimbursement models (e.g., ET3) and integration of telehealth are essential for the long-term viability of community paramedicine. Programs should prioritize clear role definitions, interprofessional education, and documentation of outcomes to demonstrate value.