LEAD 6523 Module 1 Needs Assessment for Program Planning Example

Seventy-Two Callers, One in Five Ambulance Runs: A Needs Assessment for a Community Paramedicine Program in a Rural Oklahoma County

Student Name

American College of Education

LEAD6523: Planning, Evaluation, and Accountability

Module 1 Assignment

Instructor Name

October 12, 2026

Introduction

I manage operations for a composite county ambulance service in rural western Oklahoma: four stations, nine ambulances and about 7,400 calls a year across a county of roughly 26,000 people. For several years our crews have described the same pattern: a small group of residents call 911 again and again, usually for problems that an ambulance and an emergency department are poorly suited to solve. Other rural services have responded with community paramedicine, in which paramedics with extra training visit patients at home to manage chronic conditions and connect them with care. Before proposing such a program, this paper assesses whether the need is real, how large it is and what kind of program it calls for.

What a Needs Assessment Should Do

A needs assessment, in the planning literature, identifies the gap between current conditions and desired ones, sets priorities among gaps and points toward the kinds of action that could close them; Witkin and Altschuld (1995) emphasized that needs should be defined as gaps in outcomes for a target group, not as wishes for particular services. That distinction matters here. The question is not whether the county needs community paramedics but whether frequent callers have unmet needs that some program, possibly community paramedicine, could address.

Source 1: Dispatch Records

Our dispatch records for the past two calendar years show that 72 people called 911 five or more times in a single year. Together they generated 21% of all calls, about 1,550 a year. Their most common complaints were breathing difficulty, falls, chest pain and general weakness; their most common chronic conditions, recorded by crews, were heart failure, chronic obstructive pulmonary disease and diabetes. About a third of their calls ended without transport, because the patient declined after evaluation or the problem resolved, and these non-transport calls still tied up an ambulance for an average of 52 minutes. Fourteen of the 72 called more than twenty times in a year, and their calls clustered between midnight and six in the morning, when the clinic is closed and families are asleep.

Source 2: Hospital Data

The county's critical access hospital shared aggregate figures. Last year nearly one in four of its heart failure patients, 24%, came back within a month of discharge, and its emergency department recorded more than 300 visits by patients who had been seen at least four times that year. The hospital's discharge planner noted that many heart failure patients went home without a scheduled follow-up appointment, because the only primary care clinic in the county had a wait of five to six weeks for new patients.

Source 3: Primary Care and Pharmacy Supply

The county has one primary care clinic with two physicians and a nurse practitioner, one pharmacy and no home health agency based in the county; the nearest agency, 60 miles away, covers the county only two days a week. For residents without reliable transportation, a clinic visit can require a ride arranged days in advance. Many frequent callers are not misusing 911; they are using the only health service that comes to them.

Source 4: Interviews

I interviewed six frequent callers or their family members, the hospital's discharge planner, the clinic's nurse practitioner and three senior paramedics. The callers described running out of medication, not understanding their diuretic doses, falling at night with no one to help them up and fear when breathing worsened. Two lived alone more than 20 miles from the nearest town. The paramedics described repeated visits to the same homes and frustration that they could not do more than transport. The nurse practitioner said she would welcome help monitoring heart failure patients between visits if it were coordinated with her clinic.

Assets Already in Place

A needs assessment that lists only deficits can lead planners to build from nothing what a community already has. The county has several assets a program could use. The ambulance service employs eleven paramedics, five of whom have expressed interest in expanded roles and two of whom previously worked in home health. The critical access hospital has a discharge planner willing to share lists of high-risk patients with consent. The clinic's nurse practitioner offered standing orders for basic monitoring. Three churches run volunteer driver programs for members, and the county's area agency on aging delivers meals to several frequent callers. Each of these could become part of the program's design: the paramedics as its workforce, the hospital as its referral source, the clinic as its medical direction and the volunteer and meal programs as a way to reach isolated residents between visits.

What the Evidence on Community Paramedicine Says

The research base is thin. Bigham et al. (2013), systematically reviewing the international literature on expanded paramedic roles in the community, found only a small number of studies that met their criteria and concluded that the role, safety and effectiveness of community paramedicine were poorly understood. Choi et al. (2016) described mobile integrated health care and community paramedicine as models using emergency medical services personnel to fill gaps in local health care, noted that program data suggested possible reductions in heart failure readmissions, emergency department visits and frequent-user transports, and cautioned that few studies had examined efficacy, safety and cost. The evidence justifies a carefully evaluated program, not a confident one.

Limits of the Data

The assessment has gaps of its own. Dispatch records identify callers by address and name, which had to be matched by hand and may undercount people who call from different locations. Hospital figures were aggregate, so the overlap between frequent callers and frequent emergency department users is estimated rather than measured. And six interviews cannot represent 72 people. These limits do not change the main finding, but they shape the evaluation, which will need better linked data than the assessment had.

Needs Identified and Prioritized

The four sources point to five gaps for frequent callers: unmanaged chronic disease, especially heart failure and chronic lung disease; lack of timely follow-up after hospital discharge; medication problems, including running out and misunderstanding doses; falls among people living alone; and transportation to primary care. Ranked by how many callers are affected, how serious the consequences are and how feasible a response is for an ambulance service, the first three rank highest. Falls are serious but would require partners such as home health. Transportation is a county-wide problem beyond the program's reach, though a program could reduce how often patients need to travel.

Conclusion

The need is real and concentrated: 72 people account for a fifth of the county's ambulance calls, most of them with chronic conditions and little access to primary care. A community paramedicine program focused on chronic disease monitoring, post-discharge visits and medication support, coordinated with the clinic and hospital, fits the most pressing gaps. Because the evidence for such programs is limited, Module 2 will set out the program's logic carefully, and later modules will plan an evaluation strong enough to show whether it works. The ambulance service's own role will change, too, from responding to emergencies alone to preventing some of them, which crews and the county commission will need to understand from the start.

References

Bigham, B. L., Kennedy, S. M., Drennan, I., & Morrison, L. J. (2013). Expanding paramedic scope of practice in the community: A systematic review of the literature. Prehospital Emergency Care, 17(3), 361-372. https://doi.org/10.3109/10903127.2013.792890

Choi, B. Y., Blumberg, C., & Williams, K. (2016). Mobile integrated health care and community paramedicine: An emerging emergency medical services concept. Annals of Emergency Medicine, 67(3), 361-366. https://doi.org/10.1016/j.annemergmed.2015.06.005

Witkin, B. R., & Altschuld, J. W. (1995). Planning and conducting needs assessments: A practical guide. Sage.