I started my first day of fire academy with excitement, hope and very sweaty palms. Thirteen of us had made it through the public safety hiring gantlet. I imagined being a firefighter would involve responding to heart attacks, house fires and high-speed car crashes. And over the next decade, I went on nearly 7,000 911 calls in Portland, Oregon, and we did save heart attack victims, put out house fires and pull people from car wrecks. But a feeling of helplessness displaced any sense of heroism once I began to realize how much misery was hidden from view.
Most 911 calls are not for life-threatening emergencies. They may be calls for regular back pain, diabetes-related issues or just feeling ill. Nearly every shift, we would be called to pick someone up from the floor, from the toilet, from the floor beside the toilet. I never imagined so many people fell and truly could not get up. Some of the toughest calls involved performing CPR on people we’d regularly responded to, watching them slowly decline in isolation. We couldn’t meaningfully improve their lives, but maybe we could get their hearts thumping again. We watched people die from preventable diseases, from exposure, from being alone and poor. Often, it felt like we were the only people who crossed their thresholds — that the only human touch they knew was through gloved hands.
I live in rural Clackamas County, in what’s become wildfire country, and commute to the city, driving past trailers with soft wooden porches, houses with blackberries creeping under the siding, lived-in vehicles. I pay more attention to these homes now. I know there are people hidden behind their doors and bramble thickets, caught in the same eddies of decline as the 911-callers in Portland. Every wildfire, heat wave or ice storm brings new fears they will be overlooked during a “Go Now!” evacuation order, left in a sweltering aluminum-sided trailer with home oxygen concentrators failing when the power goes out.
Someone does have the job of helping the medically underserved residents of this 1,900-square-mile county: Jamie Breunig, a community paramedic with the County’s Department of Public Health Emergency Services.
A feeling of helplessness displaced any sense of heroism once I began to realize how much misery was hidden from view.
When gaps in social and medical services swallow people whole, community paramedics offer preventive care and connection to essential resources. These programs are appearing across the country in response to the growing realization that some people rely on 911 for primary health care, managing chronic disease or simply meeting basic needs. The programs ease the strain on an overwhelmed system and expand health-care access, especially in rural communities like mine.
I first met Breunig in 2022, when we worked together responding to non-urgent 911 calls. We connected over the weight of how sick our community’s residents were. Breunig is smooth and methodical at emergency scenes, but when she speaks about how we could better serve the forgotten, her eyes light up. Community paramedicine is “the perfect fit,” she said, “a chance to work upstream, focus on more preventative care and help create a healthier community through meaningful, lasting support.”
Over 90% of the people she serves are experiencing homelessness. She does medical assessments, cares for wounds, assesses suicide risk, vaccinates people, schedules doctor appointments. She goes where people congregate, concentrating on the urban corner of the county bordering Portland.
During extreme heat events, she said, older adults without air conditioning as well as unhoused locals use the county cooling shelter. There’s a shuttle for folks without cars in more rural parts of the county, but she worries that not everyone knows how to access it. She does what she can to spread the word.
This type of community care is essential. If done well, it is also invisible: It’s harder to count deaths that were prevented than the lives that are lost.
In June 2021, a heat dome caused temperatures to soar to 116 degrees in Portland. Nearly 100 Oregonians died. Most were elderly, lived alone and lacked air conditioning. After a decade with the fire department, I spent a year doing outreach to people who frequently called 911; one of them, who ticked all three of those boxes, was transported to the ER during the heat dome. Her cat died after the ambulance took her away. So did the neighbor down the hall. Community paramedics like Breunig, however, can arrange early transportation to cooling shelters for patients, and even their pets.
As I worked with people with high 911 use, I soon realized that, to a person, each wanted someone to talk to, someone to listen. Community paramedics provide connection as well as medical care, centering relationship-building as a way to improve health outcomes.
This type of community care is essential. If done well, it is also invisible: It’s harder to count deaths that were prevented than the lives that are lost.
For the three years that it was funded by the American Rescue Plan Act, the Healthy Rural Oregon Grant helped implement community paramedic programs across Oregon. But as federal support disintegrates, here’s a list of what’s in jeopardy: expanded access to rural health care, improved weather forecasting to trigger early warning systems, federal aid after natural disasters, money to fight wildfires, support for low-income residents to heat and cool their homes, and funds to extend broadband and improve communication, a crucial service during natural disasters.
Changing weather patterns add a new layer of urgency: Vulnerable people need access to climate-controlled environments and realistic evacuation plans as well as to health care and social services. When these needs are not acknowledged, our communities risk splintering between those who have the resources and are healthy enough to survive climate fluctuations, and those who are too poor, too dispossessed or burdened by disease to withstand the shock. We seem to forget that we cannot be disentangled from each other.
Two hundred miles up the Columbia River, on the other side of the Cascade Mountains, Jessica Marcum is the lone community paramedic for Umatilla County’s Fire District 1, serving the rural city of Hermiston and its surrounding areas. She sees herself as a jack of all trades, filling in gaps in health care, social services and communication. She visits people at home, drawing blood for labs and performing welfare checks; she reads electrocardiograms, coordinates care with doctors and responds to 911 calls.
Marcum emphasizes how important it is to go to her patients’ homes. Sometimes she’s able to speak to their doctors directly. “Patients don’t always know how to navigate the health-care system or what information to provide when they are contacted by their doctor,” she said. “Home visits allow community paramedics to see the whole picture, identify potential issues, and provide concise and pertinent information to providers for continuity of care.”
Above all, she sees herself as a connector, someone who can move between first responders, patients, providers and community resources and ensure that people are not overlooked or forgotten. “These are people who have worked hard all their life,” Marcum said.
Community paramedicine is adaptable because it has to be: “If you’ve seen one program, you’ve seen one program,” she said, half-joking. Every community has different needs. But the 911 system is not enough — and leaders in semi-urban Clackamas County and rural Umatilla County realized this and decided to do something different.
One thread binds these different programs and their different locations: an unwillingness to leave anybody behind.
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This article appeared in the August 2025 print edition of the magazine with the headline “No one gets left behind.”
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