Community paramedics' perception of their roles in community paramedicine programs

Community Paramedicine (CP) is an evolving care model that expands paramedic roles to a focus on non-emergent and preventive health services tailored to local community needs. Though acceptance of CP is gradually increasing, there is limited research on how community paramedics (CPs) perceive their expanded roles. Thus, the study aim is to assess CPs' perceptions about their training, roles, role clarity, role readiness, role satisfaction, professional identity (PI), and interprofessional collaboration (IPC). The results from a cross-sectional, web-based survey of 57 eligible members of the National Association of Emergency Medical Technicians (NAEMTs) were evaluated. Respondents worked as a CP for 29.0 hours/week (SD 15.8), and 30.8% had 4 years or more of CP experience, had 18.0 years (SD = 9.9) of EMT/paramedic experience, and majorly performed health assessments (96.5%). There were variations in perceptions of role clarity (M=15.5; SD=4.3), PI (M=46.8; SD=6.1), and role satisfaction (M=4.4; SD=0.9)). Eighty percent completed didactic and/or clinical training. Participants were neutral about their role readiness (M=3.3/5; SD=0.8), mostly collaborated with physicians (94.3%), and viewed IPC as very important (M=9.5/10; SD=0.9)). There was a positive, significant association between PI and role clarity (p=0.0013), and PI and IPC (p=0.0015). Role satisfaction was higher (p=0.0114) among participants that completed training (M=29.4, SD=39.3) compared to those that did not (M=16.7, SD=39.3). There were significant differences in the extent of IPC in performing patient navigation (p=0.0023), health promotion (p=0.0037), and injury prevention/safety assessments (p<0.0001). Participants with at least weekly performance of respective roles reported greater IPC compared to those who did not perform the respective roles. Sustainable payment models, a shift to CP models as EMS standard of care, and expansion in service delivery and geographic reach, and a more standardized training curriculum are important to the future of CP. COVID-19 challenges included CPs wellbeing, inadequate funding to meet service needs, and keeping up with an emerging understanding of policies/procedures; opportunities included expanded service delivery, enhanced telehealth utilization, and CPs being flexible to meet community needs. Future studies should focus on understanding factors that impact CP role clarity and how role clarity, role readiness, role satisfaction, PI, and IPC could be improved.