Community Paramedic and Hear-and-Treat Pathways

Overview#

Not every emergency call needs an ambulance and an emergency department. Many low-acuity calls can be safely resolved over the phone by an advanced paramedic, or with a community paramedic visit, with referral onward to the right service and a clear safety-netting plan logged against the canonical incident.

The Community Paramedic and Hear-and-Treat Pathways module gives the control room and field clinicians a structured way to resolve clinically suitable calls without dispatching a full ambulance. A clinician completes a phone-based assessment (Hear-and-Treat) or a community paramedic attends in person (See-and-Treat) for cases such as falls without injury, low-acuity primary-care needs, or mental-health crisis with safety-netting. Outcomes flow into onward referral to GP, out-of-hours service, social care, or a mental-health team, with structured follow-up booking and avoidable conveyance reduced.

Last Reviewed: 2026-05-05 Last Updated: 2026-05-05

Key Features#

• Hear-and-Treat Phone Assessment: An advanced paramedic completes a structured clinical assessment over the phone and resolves the call without dispatching a vehicle when clinically appropriate.

• See-and-Treat Community Paramedic Visit: A community paramedic attends in person for cases such as falls without injury or low-acuity primary-care needs, treating on scene rather than conveying to ED.

• Structured Onward Referral: Outcomes can be referred to a GP, out-of-hours service, social care team, or mental-health service using a single referral capture flow.

• Safety-Netting Plan with Patient Communication: The plan back to the patient (warning signs, what to do, who to call) is recorded as a patient-facing communication artefact alongside the encounter.

• Canonical Incident with Non-Conveyance Disposition: Even when no ambulance is sent, the incident and patient encounter are still created and logged, with disposition reflecting the chosen pathway.

• Callback Linkage for Re-Contact: If the patient calls back, the new incident is correlated to the original through the incident correlation graph so the clinical context is not lost.

Use Cases#

• Falls Without Injury at Home: An older person who has fallen without injury is assessed and lifted by a community paramedic, with a falls-prevention referral to social care rather than an ED conveyance.

• Low-Acuity Primary-Care Need: A caller with a non-urgent primary-care issue is assessed over the phone and routed to a GP or out-of-hours appointment with a clear time window.

• Mental-Health Crisis with Safety-Netting: A caller in mental-health crisis is supported by a clinician, referred to the appropriate mental-health team, and given a written safety-netting plan with re-contact criteria.

• Avoidable Conveyance Reduction: A clinically suitable call that would otherwise result in an ED arrival is resolved with a referral and follow-up, freeing crews and ED capacity.

• Frequent-Caller Continuity: A patient who calls repeatedly is assessed in the context of prior encounters so the response reflects the longitudinal picture rather than treating each call in isolation.

Integration#

• Control Room Triage and Dispatch: Pathway suitability is offered as a disposition option directly from the triage workflow, with a clean handoff to the on-shift clinician.

• Field Clinician Mobile App: Community paramedics complete See-and-Treat assessments and capture referrals from the field using the existing responder mobile screens.

• EPCR and Encounter Record: Hear-and-Treat and See-and-Treat outcomes are written into the patient encounter alongside conventional ambulance encounters so reporting stays unified.

• GP, OOH, Social Care, and Mental-Health Systems: Referrals are emitted in a structured form so partner services can ingest them through their existing referral channels.

• Back-Office Clinical Audit View: Resolved pathway outcomes flow into a back-office chart view so clinical leads can review non-conveyance quality and safety.

• Incident Correlation Graph: Callback incidents are linked to the original through the incident correlation layer so clinicians see the full sequence of contacts.

Open Standards#

• HL7 FHIR R4 CarePlan: the chosen community pathway is represented as a structured care-plan resource that can be exchanged with partner clinical systems.

• HL7 FHIR R4 ServiceRequest: onward referral to GP, out-of-hours, social care, or mental-health teams is expressed as a standard service-request resource.

• HL7 FHIR R4 Communication: the patient-facing safety-netting advice is captured as a communication resource so the spoken or written plan is preserved with the encounter.

• SNOMED CT: pathway disposition and referral are coded against the standard clinical terminology used across UK and international clinical systems.

• ICD-10: outcome coding aligns with the standard diagnostic classification used for clinical reporting and audit.

• JRCALC 2024: community paramedic clinical decision support follows the published Joint Royal Colleges Ambulance Liaison Committee guidelines.

• NCAS (UK reference): pathway audit patterns align with the National Care Audit Service reference model used for community pathway reporting.

• CloudEvents 1.0: pathway outcomes and referrals are emitted as standard event objects (argus.pathway.hear_and_treat, argus.pathway.see_and_treat, argus.referral.created) so downstream systems can consume them through a common envelope.