Community Paramedicine and Triage to Alternate Destination

Emergency paramedics handing over patient to emergency nurse

In 2014, the Office of Statewide Health Planning and Development's (OSHPD) Health Workforce Pilot Project Program, temporarily waived sections of the Health and Safety Code and approved the Community Paramedicine Pilot Study. OSHPD’s approval allowed the state to test the effectiveness and safety of various local Community Paramedicine models through regional pilot programs. These pilot programs allowed paramedics, traditionally limited to treating patients at the scene of an emergency or while transporting patients, to provide their medical skills, knowledge, and abilities outside of the existing scope of practice.

In 2020 the California State Legislature passed Assembly Bill 1544 - Community Paramedicine or Triage to Alternate Destination Act , which allows Local Emergency Medical Service  Areas (LEMSAs) to establish Community Paramedicine programs as allowed, with certain restrictions. Community Paramedicine (CP) and Triage to Alternate Destination (TAD), are two separate elements of this Legislation.  AB-767 Community Paramedicine or Triage to Alternate Destination Act of 2023 is subsequent state legislation that prohibits a person or organization from providing CP and or TAD services, or representing, advertising, or otherwise implying that it is authorized to provide those services, unless expressly authorized by a Local Emergency Medical Services Authority (LEMSA).

For San Diego County, the San Diego County EMS Office, serving as the region’s LEMSA, created a Community Paramedicine (CP) Advisory Council to provide consultation on the development of provisional CP and TAD policies and protocols. The Advisory Council has worked diligently to establish provisional policies for both elements. The San Diego County EMS Office has submitted to the State Emergency Medical Service Authority (EMSA), a selection of these provisional policies and protocols including an EMS Plan amendment that includes two proposed Community Paramedicine programs.

Until the County of San Diego’s EMS Office receives State EMSA approval for its CP and TAD policies and protocols, no EMS agency within the County of San Diego is authorized to operate a CP and or TAD program. Once state approved, the County EMS Office looks forward to working with the greater healthcare community in San Diego County, to review and approve applications from EMS agencies that implement inclusive and impactful CP and TAD guidelines, along with certification criteria for both individual paramedics and CP Specialty training programs. State EMSA approval for the County’s programs are anticipated as early as the Summer of 2024. Please continue to check our website for regular updates.


What is Community Paramedicine?

Community paramedicine (CP) is an innovative and evolving model of community-based healthcare designed to provide more effective and efficient services to patients. CP allows specially trained 9-1-1 system paramedics to function outside their traditional emergency response role by facilitating care to medically underserved populations.

CP models

In California, Community Paramedics can provide two care models:

  1. Focused case management services to frequent users of 9-1-1
  2. Supportive services to patients with tuberculosis

Both CP models leverage a paramedics community knowledge, EMS experience, and resourcefulness to serve patietns. CP is not intended to supersede or replace any healthcare programs already available in the community, but to supplement and enhance existing programs.


What is Triage to Alternate Destination?

Alternate Destination Models: Triage to Sobering Center, Triage to Mental Health Facility, In-Home Hospice Care, Transport to Veterans Affairs ED

Traditionally, paramedic ambulances in California were restricted to transporting patients to hospital emergency departments. Under Assembly Bill 1544, specially trained 9-1-1 system paramedics could be authorized to transport specific patients by ambulance to state authorized mental health facilities, sobering centers, and local veteran's administration emergency departments.

In addition, specially trained paramedics could work with partnering hospice services to support care within the patient's home, instead of transporting them to an emergency department, allowing for a more rapid delivery of care to patients while also alleviating the stress on hospital emergency departments.


County of San Diego EMS Office Proposed CP & TAD Policies and Protocols

(Pending State EMSA Approval)


Please note that treatment and or transport reimbursement strategies are not contemplated in policies, protocols and legislations mentioned on this website when discussing CP and TAD. EMS agencies should establish their own independent agreements with payors regarding these matters.