IntroductionCommunity paramedicine (CP) is an evolving model of community health care program in which paramedics are serving outside their custom emergency response. The transport roles in which paramedics are facilitating the community with more effective emergency response is clearing the way for access to emergency response to populations who are medically underserved. CP programs are developing in most countries in different ways. These programs are designed for specific community problems by taking advantage of development in emergency medical services (EMS) and other social welfare agencies.During the past few years these programs are improving substantially to provide improved access to quality care service while keeping the costs low. Previously CP and EMS were focused on providing emergency services for patients in these communities that were suffering from critical health issues, in providing transport to hospitals emergency departments. They also were serving to provide transport to people with injuries or accidents.The nature of Community Paramedicine makes it more critical and expensive than other types of health care services. They are required to handle a wide group of scenarios and unpredictable issues that occur unexpectedly and need specialized treatment from professionals because these issues are sometimes life threatening. Because of this critical nature the cost associated with the field of CP is very high and needs special training and equipment to be used in critical situations. The costs concerns related to special health care has become a topic of discussion in the past few years. Increased efforts are made to ensure optimal emergency care to the patients. However, as majority of CP services rely on fire and rescue department and are funded by public agencies and not the local government, the CP services have to look for other benefactors for increased financial requirements, which are required to ensure best provision of emergency services, increased primary care for under privileged areas, and enhanced opportunities for emergency situations training and development.Evolution of Emergency Medical ServicesThe origin of EMS and CP dates back to Ancient Roman history when old or wounded soldiers were evacuated from the war and provided medical aid in the battlefield. The term paramedicine evolved when health care services started performing by non-physicians as assistants to doctors. Community paramedicine was initially refereed for health care services performed outside the hospital, although it was not restricted to emergency situations only. The modern concept of paramedicine began in 1960s in California, with the alarming increase in outside the hospital death rate. The project started in 1970 in Los Angeles County which defined the responsibilities and area of practice of emergency paramedics (Kenneth, pp.5)The emergency health care system is rapidly changing because of the efforts made by controlling the health care costs, improvement in the quality of healthcare occurred by revising the methods of information technology, and implementation of Affordable Care Act. The widening gap in the services of Community paramedicine and supply of physicians in the hospital requires attention. The number of physicians graduated from medical schools hasn’t increased in the past years. Some nations have such low production of paramedics and emergency care specialist that their quarter of total paramedics will be out of service in the next five years.Development of Community paramedicine To close the gap between demand of services and the workforce that is available for the service, it is essential to revise training methods and technology of the community para medicine field. More needs to be done to integrate the services and increase the number of available physicians. In paramedicine the expansion of roles in a under privileged community needs the increase in leverage given to paramedics to encourage them to put their best in healthcare.In recent years the field of community paramedicine is developed by the introduction of programs that help paramedics to set their goals outside their traditional emergency response. These programs are implanted all over the U.S, mainly in Colorado Minnesota and Texas, and in other countries like Canada, Australia and United Kingdom. These programs differ in the methods of financing and deliverance of healthcare. However these programs are more active in rural under developed areas as compared to urban cities (Kenneth, pp.7).Community Paramedics are used in expanded roles as they are already trained to work in stressful conditions, perform quick assessments of patients and take decisions in life threatening situations. They are trained to provide services 24/7 and are widely trusted in their work.Advancements in Community para medicineHealth services in many countries with the population growth, increase in the number of chronic diseases and shortage of available health workers are affecting healthcare service in many countries. Finding ways to reduce the risk factors are increasing the need for an improved healthcare system. A greater emphasis is needed for rural areas and more people are needed in the paramedic services. Community paramedicine programs are flourishing in all countries and the need for their implementation is necessary as a successful program builds structure that is used to create legislative changes and make a financially stable healthcare delivery system.The pilot programs started by different countries that are expected to be changing the field of Community paramedics are described below:Canada’s community paramedicine programCanada has been revising its healthcare and emergency services system for the past few years. The recent community paramedicine program of Nova Scotia was developed for two isolated islands. This program provided nurses and physicians that were responsible for community paramedic services of the two islands 24/7. They were assigned to check the community’s blood glucose level, wounded care, practiced antibiotics, performed routine blood tests and organized sessions for steps to be taken in emergency conditions. The paramedic services could be requested by members of the community or after proper inspection of the patient by physician. If any situation goes out of hands from the practice of paramedics that are immediately referred to the lead physician, and given the proper care. This program resulted in 23% reduction in emergency visits from these islands (Kelly, pp. 255-260)Another program that was implemented in Toronto was focused on health promotion and wounds prevention. The have also introduced an additional system of referring patients to additional healthcare service if they need additional care and situation is critical. This program caused a 50% reduction in emergency situations and 65% reduction in targeted patient visits to hospitals (Wray)United Kingdom’s Paramedic Practitioner ProgramUnited Kingdom introduced Ambulance systems in the province of B.C by placing ambulance service stations all over the province. Many ambulance service stations were placed in rural areas with limited facilities. Transporting patients to the hospitals was a major challenge in rural areas because hospitals are on hours distance. To transfer patients to the hospitals was difficult as emergency response resources were already limited and if they were engaged in an emergency condition the remaining goes out of emergency response coverage which caused a lot of deaths and complications in past. This problem was overcame when the province was provided with ambulance service stations that had ready to go vehicles and skilled teams that responded emergency situations in the matter of minutes and patients were given best healthcare and were transported to hospitals if situation was more critical (Lethbridge-Cejku)Technological advancements in Emergency service and Para medicineTechnology is improving every aspect of life including emergency services and para medicine. New ways are introduced in emergency services that help paramedics perform their job effectively and response to an emergency call as soon as possible. Researches are done in changing the concept of emergency services and patient care in both rural and urban areas.Below are some of the best advancements in the field of emergency services.Fast Heart attack response using smartphone:A research done by Dr. Nicolas Lalor, and his team by observing hospital routes, in which they introduced the use of WhatsApp in communication with ambulance and doctors. In which they devised a way to bypass emergency department by notifying cath lab in advance which notified the hospital of patient’s emergency situation and was sent to exact department immediately.Air Ambulance service:It is the latest concept in the paramedicine in which an airplane or helicopter is used in evacuating people. People stuck in high buildings in disaster and fire situations. And evacuating patients to hospitals in traffic situations.ConclusionThese advancements in Community para medicine are expanding access and service to patients. They offer a potentially promising solution to recover health gaps in para medicine and patient. Like the above mentioned advancements in emergency medical services further reach is needed in this field to be implemented in all countries to ensure perfect patient service in emergency. However, this field still needs development in rural and underdeveloped areas. The programs implemented in Nova Scotia and B.C province of U.K are examples of countries’ efforts in improving community para medicine service and they should be acquired in all countries as community service represent a successful nation and its care of her people.