A small but growing number of hospitals around the country are finding that paramedics can do more than just "scoop and run." Places such as Wake County, N.C., are making use of more experienced advanced-practice paramedics, or APPs, to carefully coordinate care and get patients to the right setting, rather than funneling them all to costly and scarce emergency department beds.

The primary duty of Wake County paramedics still is responding to emergencies, but the agency estimates that emergency medical technicians only spend about 20 percent of their time on urgent calls. The second element of the program involves using APPs — who are required to have a minimum of 1,000 patient encounters and attend to about a dozen cardiac arrests each year — to divert nonurgent patients away from ED beds and into more suitable sites, such as mental health facilities or substance-abuse centers. All told, APPs have diverted some 200 patients with no adverse outcomes, and opened up 2,500 ED bed hours at local hospitals.

The third element of the program involves partnering with a local primary care group and assisted-living facilities to treat older patients who have fallen, before they end up in the ED. Thus far, about 230 patients have consented to take part in the program, and APPs have responded to 33 who had fallen. Sixteen of those falls didn't require a transport and, instead, a primary care physician followed up and visited the senior at the assisted-living facility.

Although few county health departments currently are using paramedics in such a fashion, interest is growing as hospitals move away from uncoordinated, episodic care. To make it happen, however, hospitals need to have the workforce and incentives for paramedics who often are only paid for ambulance-based transport.