EMS and emergency physician David Miramontes, MD, FACEP, FAEMS, NREMT, medical director of the San Antonio Fire Department (SAFD) and associate clinical professor of emergency health services at the University of Texas Health Science Center at San Antonio, has helped spearhead a variety of community paramedicine programs for SAFD.

Community paramedicine deploys paramedics with expanded training, experience, and skills in a variety of non-traditional, community-based roles and settings beyond the customary transport to the emergency department (ED). It is often proposed as a way to reduce medically unnecessary 911 calls and visits to overcrowded EDs. Community paramedics provide proactive, non-emergency care; patient education; and health promotion, helping to connect frequent 911 callers with more appropriate social and health resources.

Dr. Miramontes

Dr. Miramontes said EMS has been in his blood since working as an EMT while he was still in high school. “I’ve done lots of community EMS, community paramedicine, which is now also called mobile integrated health care.” He used the term mobile integrated health care (MIH) for a related but somewhat broader concept that incorporates the community paramedic as an essential component, often in collaboration with telemedicine support and other community resources.

High-Volume Users

In 2014, SAFD launched a pilot MIH program focused on high-volume users of 911 calls. The paramedics scheduled appointments, visited patients, performed assessments and baseline vital signs, did medication reconciliation and home safety inspections, and coordinated and navigated community resources. This led to a 54 percent reduction in 911 call volume for targeted patients.

SAFD has since added nine other service lines that use community paramedics. These include contracts with local hospice companies for paramedics to visit hospice patients who call 911; outreach programs offering medication-assisted therapy, including buprenorphine and navigation into addiction care after overdose; Integrated Mobile Partners Action Care in partnership with the San Antonio Police Department’s Mental Health Unit, with an emphasis on helping homeless people move to transitional or other housing; and an acute care station in Haven for Hope, a homeless shelter, with paramedics staffing the night shift to provide non-emergent health care.

These programs all have different funding streams and have shown great value for the investment, Dr. Miramontes said.

In 2022, SAFD’s community paramedicine programs collectively made 12,270 patient contacts. SAFD also has a contract with Molina Healthcare, a government-sponsored health plan that supports community paramedic services for its plan members. “These programs will do whatever it takes to stabilize patients and keep them out of the hospital,” Dr. Miramontes said, including buying them food or picking up and administering their injectable antipsychotic medication at the pharmacy while addressing a variety of other social determinants of health.