Paramedics bridging medical care and community support: status of collaboration between prehospital emergency care and community-based long-term, welfare, and health organizations in Japan

A research group led by Dr. Keiko Ueno, Assistant Professor at the Innovative Clinical Research Center, Kanazawa University, has revealed the status of collaboration between fire-based emergency medical service (EMS) agencies ^*1) and community-based long-term care ^*2), welfare ^*3), and health organizations ^*4) in Japan. The study identified six key practical measures essential for building a collaborative model that sustains long-term coordination between medical care and social support needs.

As population aging accelerates in Japan, the health and social issues experienced by community residents are becoming increasingly complex. Prehospital emergency care is now expected to go beyond conventional lifesaving and patient transport functions, playing a critical role in bridging medical care and community support—particularly in areas such as social isolation and difficulties accessing care services. To examine the status of collaboration between EMS agencies and local care systems, the research team conducted semi-structured interviews ^*5) with 26 paramedics from 20 fire departments nationwide. The findings demonstrate that such collaboration contributes to more efficient response operations, enhanced mutual understanding across professions, and more appropriate ambulance use. At the same time, ambiguities in coordination structures, limited staffing capacity, and barriers to information sharing emerged as major challenges. Furthermore, the study identified six practical strategies that can support sustainable inter-organizational collaboration.

This research is expected to contribute to the development of a new support model that integrates prehospital emergency care with community-based integrated care systems.

The results were published online in the international journal Prehospital Emergency Care on December 8, 2025.

[Background]

As the complexity of health and social issues faced by community residents increases, prehospital emergency care is required to respond not only to acute, life-threatening conditions but also to social determinants of health^*6), such as social isolation and barriers to accessing welfare services. In Japan, fire departments have implemented various approaches to assist individuals requiring social support—such as people living alone, those with chronic illness, or frequent EMS users—and to mitigate challenges related to hospital acceptance. However, evidence regarding practical experiences, benefits, and challenges of collaboration between fire-based EMS agencies and community long-term, welfare, and health organizations has been limited. This study used qualitative interviews^*7) to explore the benefits, challenges, and sustainability strategies related to collaboration.

[Summary of Findings]

Semi-structured interviews were conducted with 26 paramedics affiliated with 20 fire-based EMS agencies across Japan between October and December 2023. A qualitative descriptive approach^*8) identified the following:

<Benefits of collaboration>

• More efficient and flexible EMS response
• Improvement of inter-organizational communication and mutual understanding
• Promotion of appropriate ambulance use through timely referral to community resources

<Challenges to collaboration>

• Ambiguity in inter-organizational collaboration and coordination
• Limitations in the operational capacity of relevant organizations
• Insufficient interprofessional understanding and collaborative attitudes
• Limited access to patient information from community organizations
• Attention to protection of personal information

<Six practical measures for sustainable collaboration>

• Promotion of relationship building and mutual understanding
• Establishment of a sustainable interorganizational collaboration framework
• Inter-organizational information sharing infrastructure
• Clarification of the roles and response policies of fire-based EMS agencies
• Enhancement of interprofessional understanding and educational opportunities
• Securing human resources in the long-term care and welfare organizations

[Future Directions]

This study provides foundational insights for building a collaborative support model that integrates prehospital emergency care with community-based comprehensive care. Moving forward, we will continue to incorporate perspectives from healthcare, welfare, and community stakeholders to develop feasible systems for real-world implementation.

[Funding Information]

This research was supported by the Emergency Medical Promotion Foundation Research Grant Program (FY2023) and by the Japan Society for the Promotion of Science KAKENHI Grants (JP22K21081, JP23K16326, JP23H03228).

[Glossary]

*1:  Fire-based emergency medical service agencies
Core municipal organizations responsible for firefighting and EMS operations, supervising fire stations and EMS teams.

*2: Long-term care organizations
Providers of daily living and care services for older adults and individuals with disabilities.

*3: Welfare organizations
Institutions supporting people facing social vulnerabilities (e.g., community welfare councils, child & family support centers).

*4: Health Organizations
Institutions providing community health services and disease prevention (e.g., public health centers).

*5: Semi-structured interview
A qualitative interview method that follows prepared questions while allowing flexible probing based on participants’ responses.

*6: Social determinants of health
Social and environmental conditions affecting health, such as income, education, living environment, social support, and access to health and welfare services.

*7: Qualitative interviews
A method of collecting data by directly asking participants about their experiences and perspectives to understand underlying contexts and meanings.

*8: Qualitative descriptive approach
A qualitative research approach that aims to describe participants’ experiences and narratives as faithfully as possible to reveal real-world situations and issues as they are.