San Francisco, CA
Strengthening community paramedicine services through action research
Organization: San Jose State University Foundation
Primary Investigator: Miranda Worthen
Research Track: Resource and Service Equity
Community Paramedicine is an innovative approach to providing complex care to communities. Community Paramedics in the San Francisco Fire Department collaborate with other agencies to help folks who rely heavily on 911 services, experience overdoses and other behavioral crises, and need more holistic care than traditional emergency services can provide. To further the groundbreaking work taking place in this city, we will develop and institutionalize metrics to measure progress towards equity in all areas of service. Through a client community advisory board, we will ensure that perspectives of those served by the division are solicited, listened to, and integrated into ongoing decision-making within the Community Paramedicine Division and its partners. Long established as a leader in the field of community paramedicine, San Francisco is poised to further pioneer strategies to hold programs accountable to their communities.
NSF Abstract
Community paramedicine (CP) has emerged as a vital component of emergency medical services, providing non-police responses to mental health crises. Community paramedics are exposed to challenging circumstances, which may lead to moral distress and injury. This scope of work requires equity-oriented practices to improve the delivery of critical services to vulnerable community members experiencing homelessness, mental health crises, and addiction. This project uses a participatory action research approach to prevent moral injury among CP first responders and improve their equity-based understanding and practices in working with vulnerable populations. This collaborative effort led by civic partner San Francisco Fire Department, research partners from San Jos? State University and the Veterans Health Administration, and with collaboration from Richmond Area Multi-Services Inc., seeks to enhance the well-being of CP first responders while improving the equitable delivery of critical services to vulnerable community members. The project?s overarching goal is to strengthen CP work to improve the wellbeing of residents of San Francisco, ultimately creating sustainable outcomes scalable across the U.S.
This study aims to address two interrelated gaps in research and innovation: moral injury and equity. While each is independently important, we theorize that they operate in a self-amplifying feedback loop, whereby witnessing inequities causes moral distress and sets the stage for moral injury. In turn, CP members who are emotionally numb and disengaged as a result of moral injury and burnout are more likely to engage in practices that, while likely unintentional, reinforce inequities by causing harm to clients, rather than intervening to reduce disparities. Although extensive research exists on the evaluation and treatment of moral injury in military veterans and moral distress among nurses, there has been no prior research evaluating, preventing or treating moral distress or injury among Emergency Medical Technicians (EMTs) or paramedics. There is also no prior research examining the effectiveness of training for EMTs or paramedics on equity. This intervention study fills a critical gap by evaluating moral distress and injury using validated scales and identifying indicators of workplace functioning for first responders that are meaningful to clients and agencies. The targeted interventions include equity and ethics conversations, individual skills training, and public education campaigns to create a supportive and trauma-informed environment within the SFFD CP Division and strengthen equity capacity. We will pilot a novel data integration strategy to improve completeness and accuracy of CP data to evaluate disparities in CP key performance indicators.
The CIVIC Innovation Challenge is a collaboration with Department of Energy, Department of Homeland Security, and the National Science Foundation
This award reflects NSF's statutory mission and has been deemed worthy of support through evaluation using the Foundation's intellectual merit and broader impacts review criteria.