In rural Virginia, some paramedics are showing up before the emergency. Community paramedicine programs send trained medics to patients' homes to help manage chronic illness, arrange care, and fix problems that keep sending the same people back to the 911 system.
In Pulaski County, patients whose cases had been closed by the program generated 200 EMS calls in the three months before enrolling and 11 in the three months after, according to program director Erika Dalton, as reported by Cardinal News.
Those early numbers matter for families caring for older relatives in areas where ambulances are stretched thin. But the programs are fragile, because Medicare does not reimburse community paramedicine and Virginia Medicaid does not cover it.
Inside a Community Paramedic's Home Visit
Keith Carroll leads the community paramedicine program at the Danville Life Saving Crew. One of his regular patients, 79-year-old Elizabeth Fitzgerald, uses a wheelchair and has poorly managed diabetes. When they met about five years ago, she was calling 911 for help with basic needs, and she had lost consciousness more than once when her blood sugar rose sharply, Carroll said.
Carroll now visits her three or four times a month. He checks measures such as her blood oxygen level, arranges doctor's appointments and transportation, picks up her medications, and has worked with the city of Danville and the Southern Area Agency on Aging on home repairs. Her 911 calls have dropped to about once a year, he said.
"It's truly been a blessing," Fitzgerald told Cardinal News. Carroll describes the program as "a hand up instead of a hand out."
The model is straightforward. Community paramedics identify people who call 911 often for recurring or non-life-threatening problems. With a patient's permission, they look for the underlying causes and connect patients with services such as primary care, social services, senior programs, and Medicaid transportation.
Pulaski County's Early Numbers
In Pulaski County, three ambulances cover 330 square miles. Only about 15% of calls are true emergencies, said Mike Garnett, the county's assistant chief of EMS.
"People are calling us to help them get out of bed in the morning so they can start their day," Garnett said.
In 2025, county EMS recorded 5,420 patient encounters involving 3,386 people, and 230 people called 911 at least four times, Dalton said.
The county launched its program Jan. 1. By early August, about 70 people had been referred to services, and about 30 cases had been closed, Dalton said. Referrals have included a local friendship cafe for seniors, social services, and Medicaid transportation.
"In EMS, we make contact with these individuals in their environment, so we see it firsthand," Dalton said.
The pattern extends beyond Virginia. A national study in Health Affairs Scholar found that about 3% of patients account for 16% of 911 EMS encounters. In 2024, about 65% of fire department calls involved medical aid, while 3% involved fires, according to the National Fire Protection Association. The sheer volume of calls has been linked to burnout among EMS workers, according to the Journal of Emergency Medical Services.
MedicalDaily Evidence Check: The Pulaski results are program-reported figures from about 30 closed cases, with no comparison group. People often call 911 most during a crisis and less afterward even without extra help, so part of the drop may reflect that pattern. Larger studies are needed to measure lasting effects on hospital visits, health outcomes, and costs.
Small Programs, Big Funding Questions
The people who benefit most are often older adults, people with poorly controlled chronic conditions such as diabetes, and residents facing social isolation, limited transportation, or shortages of primary care. Caregivers who live far away may also gain peace of mind when a medic checks in regularly.
Funding is the main barrier. Pulaski County paid about $170,000 in startup costs from its general fund, covering Dalton's salary, training, and a vehicle, according to County Administrator Jonathan Sweet. The county now funds the program entirely through its general fund.
Danville's program costs about $200,000 a year, according to Johnny Mills, chief executive officer of the Danville Life Saving Crew. It relies largely on a local grant of about $123,000 a year that has supported the program for about five years and expires at the end of 2026.
Community paramedicine may reduce costs by preventing unnecessary 911 calls, but it does not generate revenue, said Brandan Arthur, chief of the mostly volunteer Vinton First Aid Crew. Arthur said a program is on his wish list but feels out of reach because volunteer agencies often lack the money and staff time to build and sustain one.
At least 40 states had launched community paramedicine or similar mobile health programs as of 2023, according to a survey by the National Association of Emergency Medical Technicians. There is no national policy for reimbursing them, according to the National Rural Health Association.
Finding a Program Near You
Families can ask their local fire department, EMS agency, hospital, or area agency on aging whether a community paramedicine or mobile integrated health program operates nearby. Services and eligibility rules vary, and some programs, including Danville's and Pulaski's, do not charge patients.
Community paramedics do not replace emergency care. Chest pain, trouble breathing, signs of stroke, severe bleeding, or a blood sugar emergency still require a 911 call.
For caregivers, keeping an updated list of medications, diagnoses, and doctors can help any visiting medic or emergency crew act faster. People struggling with transportation, food, or home safety can also contact local social services directly.
Legislation introduced in Virginia's General Assembly in 2025 included two $50,000 appropriations for the state Department of Medical Assistance Services to develop a plan for reimbursing community paramedicine. A reliable payment source could determine whether programs like Danville's survive beyond their grants, a question that matters most for older, isolated patients who rely on these visits.
Key Questions Answered
What is community paramedicine? A program in which paramedics visit patients at home to help manage health needs, arrange care, and connect them with services before emergencies happen.
What happens during a typical visit? Medics may check vital signs, help with medications, schedule appointments and transportation, and link patients to social services or home repair help.
Does it reduce 911 calls? Early Virginia data are promising, with one county reporting that calls among closed cases fell from 200 to 11, but the figures come from a small group without a comparison group.
Who pays for these programs? Mostly local governments and grants. Medicare does not reimburse them, and Virginia Medicaid does not cover them.
Should people still call 911? Yes, for chest pain, breathing trouble, stroke signs, severe bleeding, or other emergencies.
