In a remote corner of western North Carolina, community paramedics are filling the gaps left by hospitals, clinics and social services, acting as medics, social workers, neighbors and 911 all in one. This article explores how programs like the Community Paramedic initiative in Yancey County are reducing nonemergency calls, bringing care to doorsteps, and reshaping what health care can look like in rural America.


Meet the Health Workers Who Do It All

In places where cellphone service drops out and the nearest hospital can be an hour away, health care doesn’t always happen in exam rooms. In Burnsville, a small town in Yancey County, North Carolina, community paramedics like Evan Carroll and Nicole McKinney are knocking on doors, crossing old wooden bridges, and checking in on neighbors who might otherwise slip through the cracks.

These community paramedics are part of a nationwide effort to reduce unnecessary 911 calls and emergency room visits while closing dangerous gaps in rural health care. They bring blood pressure cuffs, wound dressings, and sometimes just a listening ear to people who might not have another way to get help.


Community paramedics visiting a home in rural North Carolina
Community paramedics in Yancey County, N.C., bring medical care and support directly into people’s homes. (Image: The Washington Post)

The Problem: Rural Health Gaps and Overloaded 911 Systems

Rural communities across the United States face a perfect storm of health challenges: aging populations, higher rates of chronic disease, hospital closures, scarce mental-health services, and unreliable transportation. When people can’t access regular care, they often turn to the only door that’s always open—911.

The result is a flood of nonemergency calls: shortness of breath from unmanaged COPD, uncontrolled diabetes, medication confusion, or social crises like food insecurity and isolation. These situations are serious but often preventable when someone can intervene earlier and more holistically.

  • In many rural counties, emergency medical services (EMS) are the only health system that operates 24/7.
  • National studies have found that a notable share of 911 calls involve conditions that could be better managed in primary care or home settings.
  • Ambulance crews are increasingly asked to handle social and behavioral health issues that go far beyond traditional emergency medicine.

Inside the Yancey County Community Paramedic Program

Yancey County’s Community Paramedic program is designed to meet people where they are—literally. Instead of waiting for crises, Carroll, McKinney and their colleagues schedule home visits, follow up after hospital discharges, and check in with residents who are known “frequent callers” to 911.

On any given day, they might:

  1. Drive up winding mountain roads to check on an older adult living alone without cellphone service.
  2. Help a patient reconcile a complicated medication list after a recent hospitalization.
  3. Coordinate with local clinics, social services and mental-health providers to build a safety net around someone in crisis.
  4. Install simple safety equipment like grab bars or smoke detectors through community partnerships.
“We’re not just treating emergencies anymore—we’re trying to keep them from happening in the first place,” one community paramedic explained, describing their shift from sirens to scheduled visits.
Paramedic talking with a patient at home
Community paramedicine emphasizes relationships and continuity, not just rapid response. (Representative image)

More Than Medics: Neighbors, Social Workers and Advocates

What makes community paramedics different from traditional EMS is the blend of roles they play. They still carry emergency equipment and can respond to acute crises, but much of their work looks more like social work or community nursing.

  • Medical support: Checking vital signs, managing wounds, helping with chronic disease monitoring, and recognizing early warning signs.
  • Social care: Connecting people to food assistance, housing resources, transportation, and community organizations.
  • Mental health support: Offering calm, nonjudgmental conversation; linking individuals to counseling or crisis services when needed.
  • Systems navigation: Helping residents schedule appointments, understand insurance or Medicaid paperwork, and follow through with care plans.

For many patients, the consistent presence of a familiar paramedic is as powerful as the medical care itself. Trust becomes the gateway to better health decisions and fewer emergencies.


What the Evidence Says About Community Paramedicine

Community paramedic programs like Yancey County’s are part of a growing, evidence-informed movement across the United States, Canada, Australia and Europe. While results vary by program and population, research to date suggests several consistent benefits.

Key outcomes seen in community paramedic programs

  • Reduced nonemergency 911 calls: Programs often report fewer repeat calls from high-utilizing patients once proactive home visits begin.
  • Fewer avoidable emergency department visits: Early intervention and better self-management can keep chronic conditions from escalating.
  • Improved patient satisfaction: Patients appreciate care that is local, personal and relationship-based.
  • Stronger links between EMS and primary care: Paramedics become a bridge between the home and the clinic.

For example, evaluations summarized by the National Association of State EMS Officials and other professional groups have highlighted reductions in 911 use among high-risk populations when community paramedics provide regular follow-up and care coordination. Evidence is still emerging, and not every program sees the same level of impact, but the trend is promising.

Community paramedicine is not a replacement for primary care or hospitals. It is a complementary layer—especially vital in rural and underserved areas where traditional systems struggle to reach.
Medical professional reviewing patient data on a clipboard in a rural setting
Data from pilot programs suggest community paramedicine can reduce avoidable emergency visits, though results differ by region and design. (Representative image)

On-the-Ground Obstacles: Coverage, Funding and Burnout

The work is rewarding, but it is not easy. In Yancey County and similar regions, community paramedics face steep logistical and emotional challenges:

  • Geography: Long drive times on mountain roads mean fewer patients can be seen each day.
  • Connectivity: Lack of cellphone and broadband service complicates communication with dispatch, clinicians and patients.
  • Funding: Many programs rely on grants or patchwork funding streams; stable reimbursement models are still evolving.
  • Role strain: Acting as medic, counselor and advocate can increase the risk of burnout if teams are understaffed or unsupported.

Community paramedicine also depends on strong partnerships. Without local clinics, public health departments, mental health agencies and social services willing to coordinate care, paramedics can end up isolated—asked to solve problems that really require a village.


How Communities Can Build or Strengthen a Community Paramedic Program

Every county is different, but experiences from Yancey County and similar programs point to a few practical steps for communities interested in this model.

1. Start with data and local voices

  • Review 911 call data to identify frequent callers and common nonemergency scenarios.
  • Talk with hospital discharge planners, primary-care clinicians and social service agencies about gaps they see.
  • Engage community members, especially older adults and people with chronic illnesses, in listening sessions.

2. Define the scope and partnerships

  • Decide whether the focus will be on post-discharge care, chronic disease management, behavioral health, or a combination.
  • Formalize agreements with local clinics, mental health providers, public health departments and social services.
  • Clarify communication channels so paramedics can quickly consult clinicians when needed.

3. Invest in training and support

  • Provide education in primary care, chronic disease management, motivational interviewing and cultural humility.
  • Offer training in recognizing social determinants of health and navigating community resources.
  • Build in ongoing supervision, mentorship and mental health support for paramedic staff.

4. Plan for sustainable financing

  • Explore state Medicaid waivers, value-based payment models and partnerships with health systems that benefit from reduced emergency use.
  • Use early data to demonstrate return on investment for local governments and hospital partners.
  • Avoid relying solely on short-term grants when designing long-term services.
Group of healthcare and community workers planning together at a table
Successful programs are built on collaboration between EMS, clinics, public health, and community organizations. (Representative image)

If You Live in a Rural Area: How to Make the Most of Local Resources

Not every county has a community paramedic program yet. Still, there are practical steps individuals and families can take to use emergency services wisely and stay as healthy as possible within the limits of their local system.

  1. Learn what services exist in your county.
    Check with your local EMS agency, health department or hospital to see whether community paramedic or mobile health services are available.
  2. Talk with your primary-care clinician about 911 use.
    Ask when you should absolutely call 911 versus when a clinic or telehealth visit might be better.
  3. Prepare for emergencies in advance.
    Keep a written list of medications, allergies and diagnoses in an easy-to-find spot; share it with family or neighbors.
  4. Address small problems early.
    If breathing, blood sugar or mood symptoms are changing, reach out to a clinician or nurse line before it becomes a crisis.
  5. Build a neighbor network.
    Especially in areas without cell coverage, knowing which neighbor can drive, who has a landline, and who checks in on whom can literally save lives.

Looking Ahead: A More Neighborly Model of Health Care

Programs like the Community Paramedic initiative in Yancey County point toward a future in which health care is less about buildings and more about relationships. Instead of waiting for people to arrive in crisis, the system comes to them—especially in places where geography and poverty have long kept care at arm’s length.

There are no quick fixes. Community paramedicine alone cannot undo decades of hospital closures or shortages of primary-care clinicians. But it offers a pragmatic, humane way to stretch the reach of existing resources and to honor the reality that health doesn’t happen only in exam rooms; it happens in kitchens, on front porches, and along back roads.

If you work in health care, public service, or local government, you can:

  • Ask how EMS and community paramedics can be included in broader health planning.
  • Support funding and legislation that recognize community paramedicine as an essential service.
  • Invite paramedics to the table when designing programs for chronic disease, behavioral health, or aging in place.

And if you are a patient, caregiver or neighbor in a rural community, remembering that “health care” might include the paramedic who checks on you after a storm, or the one who knows exactly how far that old bridge is from the main road, can be reassuring. You are not as alone as you may feel.

Paramedic standing next to an ambulance in a rural landscape at sunset
In many rural counties, community paramedics are becoming the steady, familiar face of a changing health system. (Representative image)

The next time you hear a siren—or see a paramedic’s SUV parked quietly outside a farmhouse—you might be witnessing not just an emergency response, but the quiet rebuilding of a community’s safety net.