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changes the healthcare delivery model and innovates at the same time? Patience and persistence. It is impor- tant not to take on too much early in your process, but also have a vision of where you want your program and service to be in five years. This will take the stress off the daily grind of setbacks and slow starts. Making Connections Step two is to talk with other providers in your community. This includes your pub- lic health and social services departments. In most communities this might be 1–5 employees who do it all. Imagine their surprise when you come in and say, "We want to help you serve your clients." After you pick them up off the floor, you will be surrounded by a team that wants to embrace this concept and your team. The Right Staf and Vehicle Finding staffing to support your endeavor will be key. Not all CPs must be paramedics. In North Dakota they're using EMTs with the same education as community paramed- ics to operate within their scopes as community EMTs. Think of them as community health workers with some medical background. Distance to the patient will be another factor in how to staff your program. Vast distances that do not exist in the urban environment may mean a program is only able to treat 2–3 patients per day. This small number is acceptable in a rural setting and will help maintain skills in low-volume systems. In a rural setting you may not want to use an ambu- lance for visits. We learned that having an ambulance sit in front of a house for several hours can draw the neighbors out to make sure your patient didn't die. If you only have an ambulance, community education will be key to letting people know that an ambulance in the driveway may just be a community paramedic visit. Education Another hurdle you may have as a rural pro- gram is getting education from a college or university to become a CP. There are more than 35 colleges and universities educating CPs today. 7 This number is expected to increase in the next five years. Many colleges and universities offer distance/online options for CP. The online methodology was recently used in the California pilot program to educate over 77 CPs statewide at once. Those community paramedics are now going out to provide care in their communities. 8 The education is important, and a new test has been developed that will allow community paramedics to be certified based on a national test and model. The Board for Critical Care Transport Paramedic Certi- 2 3 4 In a rural setting, you may not want to use an ambulance for visits, so your presence does not alarm neighbors. Eagle County uses an SUV for its community paramedic visits. Photo by Sean Boggs, www.seanfboggs.com EMSWORLD.com | OCTOBER 2015 21