When the phone rings in Yancey County, N.C., it may be a 911 call, a worried neighbor or a clinic hundreds of miles away. Often, the people who respond are the same two paramedics. They check blood pressure and oxygen levels, haul portable lab kits up gravel driveways, refill pill organizers, deliver food, troubleshoot insurance paperwork and, when necessary, call an ambulance they also help staff. This is community paramedicine, a growing model of care that asks frontline responders to be clinicians, case managers and social workers all at once.

Image Illustration. Photo by Marek Studzinski on Unsplash

The Washington Post recently profiled such workers in rural North Carolina, where a small team now functions as a de facto primary care network and safety net for residents left behind by hospital closures and chronic provider shortages. Their role reflects a national experiment in delivering health care in the home, far from traditional exam rooms and emergency bays.

A System Built Around the Emergency Room

In the United States, the hospital emergency department has evolved into a catchall for medical and social crises. In 2022, Americans made an estimated 155 million emergency department visits, a rate of 47 visits per 100 people, according to federal data from the National Center for Health Statistics.

Older adults and infants account for the highest use: infants under 1 year had 99 visits per 100 children, while people 75 and older accounted for 76 visits per 100 adults, reflecting how vulnerable patients depend on emergency rooms when other parts of the health system fail them. Those numbers, compiled by federal researchers, underscore why communities are searching for new ways to keep people healthier at home.

Rural residents feel that pressure acutely. They are more likely to be older, sicker and poorer, and to live far from hospitals and physician offices. Nationwide, emergency visit rates vary widely, from about 596 visits per 1,000 residents in West Virginia to 226 per 1,000 in Nevada—a spread that often tracks with poverty, chronic disease and access to primary care.

What Community Paramedics Actually Do

Community paramedics look like traditional EMS crews: they wear uniforms, carry radios and are trained in advanced life support. But their daily work blurs the line between emergency response and long-term care management.

On a typical day, a team in rural North Carolina might:

• Visit a homebound patient with heart failure, adjust medications under a standing order and teach family members how to spot early warning signs of fluid overload.

• Check on a dialysis patient who keeps missing appointments, arranging transportation and helping navigate insurance paperwork to avoid another crisis-level hospitalization.

• Coordinate with a primary care clinic, mental health provider and county social worker after a 911 call for a suicidal resident, turning a one-time emergency visit into a months-long follow-up plan.

The model is often described as "mobile integrated health." In practice, that means paramedics can bill for scheduled home visits, not just transports, and can spend time on slow, relationship-based work that traditional fee-for-service medicine rarely pays for: medication reconciliation, safety assessments, fall-prevention checks, food and housing referrals, and caregiver support. In some programs, they have direct access to a patient’s electronic medical record and can update physicians in real time after each visit.

Evidence That House Calls Can Keep People Out of the Hospital

Although most community paramedicine programs are still relatively small, a growing body of research suggests they can reduce avoidable hospital use and improve the kind of day-to-day stability traditional health systems struggle to deliver.

In one mobile integrated health program that enrolled just over 1,000 high‑risk patients, those who had all of their medication-related needs fully addressed saw a 65 percent lower rate of total 30‑day hospital readmissions compared with patients whose medication issues went unresolved. The analysis, published in a peer‑reviewed journal in 2024, underscores how seemingly small interventions—correcting a dose, synchronizing refills, explaining side effects—can ripple into fewer returns to the hospital.

Public health officials have long documented that a significant share of ER visits stem from conditions that might be better managed in primary care. Earlier national data found that many emergency department visits are for non‑urgent problems, often linked to gaps in access to timely outpatient care and social support. Federal analysts have noted that people covered by Medicaid or children’s public insurance programs have the highest emergency visit rates, while those with private insurance have the lowest, a pattern that reflects both economic vulnerability and limited access to regular doctors’ offices.

Rural Gaps, Aging Patients and Climate Shocks

Rural counties such as Yancey face intersecting pressures: aging populations, rising rates of chronic disease and intensifying climate‑related disasters that can sever roads and power lines for days. When Hurricane Helene battered western North Carolina this year, community paramedics used off‑road vehicles to reach isolated patients who relied on oxygen machines and refrigerated medications—tasks that fall well outside the scope of traditional ambulance runs but are now part of their job description.

Emergency departments, meanwhile, are grappling with longer stays and more complex patients. Older adults now account for a disproportionate share of so‑called "boarding" cases—patients left in ER hallways for hours or days while awaiting inpatient beds. In one recent analysis, older adults made up about half of all emergency room boarding cases, a situation that researchers say can worsen confusion, delirium and functional decline for people with dementia and other cognitive conditions.

For communities with only a handful of inpatient beds—or none at all—building a workforce that can stabilize patients in their living rooms is both a practical necessity and a philosophical shift. Community paramedics are trained to see the environment around the patient: the empty fridge, the steep steps, the lack of a caregiver during the night. Those observations, they argue, are as clinically relevant as a lab result or a blood pressure reading.

Blurring the Line Between Medical and Social Care

The job increasingly demands skills that look more like social work than emergency medicine. A visit might start with a wound check but quickly turn into an impromptu counseling session about grief, addiction or domestic violence. Paramedics often find themselves connecting patients to food banks, housing navigators and legal aid, or coordinating with churches and neighborhood groups to fill gaps that formal systems will not.

Health policy researchers describe these pressures as "health‑related social needs"—the everyday realities, from unstable housing to food insecurity, that make disease harder to manage. National surveys suggest that millions of Americans struggle with at least one basic need that directly undermines their health, a dynamic that shows up in higher ER use, more hospitalizations and worse outcomes over time.

By design, community paramedicine tries to meet those needs in real time. A responder who notices an empty pantry can make a same‑day referral to a local food program or help enroll a patient in federal nutrition assistance. Someone who sees a wobbly handrail can install a temporary fix and flag the county’s aging‑services office for follow‑up. These may be small interventions, but they address the same forces that keep driving vulnerable residents back to the hospital doors.

The Limits—and Promise—of Doing It All

For all their promise, these programs are fragile. Funding is often patchwork, stitched together from short‑term grants, local tax revenue and experimental reimbursement arrangements with Medicare and Medicaid managed‑care plans. Training standards and scopes of practice vary by state. In some places, community paramedics can adjust prescriptions or order tests; elsewhere, they must phone a physician for every change, slowing down care.

There are also questions of burnout and sustainability. Asking a small workforce to serve simultaneously as 911 responders, chronic‑care coaches and social‑service navigators can stretch already thin ranks. Many rural EMS agencies struggle to recruit and retain staff, a trend that predates the pandemic but has intensified as call volumes and case complexity climbed.

Still, local data and early research are pushing more health systems and state Medicaid programs to pay attention. Hospital administrators facing overcrowded emergency rooms and steep readmission penalties are increasingly willing to partner with paramedic teams to test new models. Policymakers watching demographic shifts—by 2034, adults 65 and older are projected to outnumber children for the first time in U.S. history—see home‑based care as a practical strategy, not just an innovation pilot.

A New Front Door to the Health System

In communities like Yancey County, the front door to the health system is no longer just the hospital lobby or the family doctor’s office. It is the knock of a familiar medic who also knows which road floods first, which neighbor can be trusted with a spare key and which patient will not call for help until someone shows up and asks the right questions.

The rise of community paramedicine does not replace the need for more rural physicians, mental health professionals or robust hospitals. But it does suggest a reimagining of who counts as a health care provider and where care happens. As emergency departments grow busier and populations age, the workers who do it all—medics, social workers, neighbors and 911 rolled into one—may be less an exception than a glimpse of the health system’s future.