Research on the road: Partnering with community emergency medical services to expand access to clinical trials.

Traditional site-based clinical trials impose substantial logistical burdens that limit participation among individuals with geographic, mobility, transportation, and socioeconomic constraints, thereby undermining research equity and generalizability. Although pragmatic and decentralized trial designs seek to address these barriers, many health systems lack a mobile clinical workforce capable of conducting in-person research activities in community settings. Mobile Integrated Health (MIH) and Community Paramedicine (CP) programs, which leverage community paramedics and EMTs (MIH-CPs) to provide field-based care, may provide scalable infrastructure to support decentralized research delivery. We describe an institutional model that cross-trains and integrates MIH-CPs into research teams. Using study protocols, training materials, operational procedures, and implementation documents from five studies, we analyzed staffing models, credentialing and training processes, workflow integration, fidelity monitoring, and ethical and safety considerations. The included studies spanned pragmatic randomized and hybrid trials, and observational cohort studies across diverse clinical populations. MIH-CPs conducted recruitment, consent, assessments, intervention delivery, and data collection. Structured training, defined communication pathways, and integration with established clinical workflows supported protocol fidelity, participant safety, and operational feasibility. Embedding mobile community-based clinicians within research teams represents a pragmatic, equity-oriented strategy to expand decentralized trial capacity, reduce participant burden, and accelerate translation of evidence into real-world practice.