The future of health care has arrived — but is the Ontario government paying attention?
By: JEMS – Elizabeth Payne
Is this the future of health care? And is the Ontario government paying attention?
The drone hovered before carefully dropping its payload — a small defibrillator — on target. Nearby, three paramedic executives from Germany watched the demonstration closely.
Drones, which have delivered medicine to flood victims and given rescuers a birds-eye view of stranded homeowners in recent months, are just part of what drew the Germans to Renfrew County to see local paramedics at work.
They recently spent a week training with paramedics and taking notes. In addition to learning about the extensive use of drones, the Germans followed community paramedics doing their rounds visiting chronically ill patients in their homes. They also learned about technological innovations such as a specially designed electronic health records system for community para-medicine.
The Germans are not the first to make the trek to the Ottawa Valley to learn from local paramedics. Renfrew County paramedics have helped rewrite the book on what it means to be a paramedic in a largely rural community. They have addressed challenges and changed local health care in the process.
The world is paying attention. But is the Ontario government?
Renfrew paramedic officials and politicians are concerned that changes announced by Ontario’s Progressive Conservative government earlier this year could mean the loss of what makes the local paramedic service special.
Not only are its programs designed to meet specific needs of Renfrew residents and tackle difficult health and geographical challenges, but they are considered among the most innovative in the world.
In Renfrew County, about an hour-and-a-half’s drive northwest of Ottawa, the paramedic service functions as a kind of wire that connects and energizes all the components of the local health system. Their work in the community reduces hospital visits and stays by some of the highest-needs residents; supports family medicine teams to help them function with large numbers of patients, as is common in rural areas; and has technology to help remote residents remain in their homes and to deal with emergency situations. All that, in addition to the more traditional roles of responding to 911 calls, stabilizing sick patients and getting them to hospital.
Still, the future for Renfrew paramedics, and paramedics around the province, is unclear.
The Ontario government has announced it will amalgamate the 52 municipally run paramedic services across Ontario to create 10 regional services. Along with amalgamation will come upgraded communications systems, says Health Minister Christine Elliott, who promises it will result in a more efficient and effective system.
“By better integrating dispatch and paramedic services, the ministry will improve coordination and ensure that resources are being used for frontline patient care in a model that is sustainable for the years to come,” said health ministry spokesman Mark Nesbitt in a statement.
Renfrew paramedic officials say they want to make sure the government knows the kind of work being done across the county and in other parts of the province before it makes massive changes.
Chief Mike Nolan argues that the Renfrew paramedic services is achieving exactly what the province wants with its reset of the health system. Renfrew’s innovative community paramedic program has reduced 911 calls by 24 per cent among a population of chronically ill residents who have been frequent 911 users in the past. The result is improved individual health outcomes at a lower cost to the health system.
“The program that we are running in Renfrew County fulfills and, in many cases, exceeds the interests of this government in reforming the health-care system,” says Nolan.
Nolan says Renfrew County officials want to inform the province that there are models of care in place — in Renfrew and elsewhere — that should be expanded across the province.
His concern is that amalgamation will water down paramedic programs to “the lowest common denominator” which will mean the loss of innovation, technological advances and local relevance.
Nolan and others are hoping to lead changes to paramedic services across the country and see those innovations expanded.
Renfrew paramedics have already helped drive change in paramedic services across Ontario and around the world.
When it comes to community paramedics, Renfrew County is known as one of the leading programs in the world, says Sebastian Lange, one of the visiting Bavarian paramedics. Renfrew has also seen experts fly in from Ireland, England, Australia, New Zealand, the U.S., Turkey, the Netherlands and several other Canadian provinces to learn about its paramedic model.
The county is the largest, geographically, in the province — stretching from Ottawa to Algonquin Park — and, like many rural parts of the province, serves a population that is older, has lower socioeconomic status and is more likely to have chronic disease than more urban parts of the province.
Its use of technology is, in part, an answer to some of those geographic challenges.
The Renfrew County paramedic services pioneered the use of drone technology to assist first responders. It has worked closely with Transport Canada and is the only paramedic organization in the country that has permission to use drones beyond the line of sight, says deputy chief Brian Leahey, who is in charge of the program. Leahey is also a pilot.
Drones are used frequently by Renfrew paramedics, for a variety of tasks. They can deliver supplies, and defibrillators, to remote areas faster than paramedics can get there. In fact, paramedics are looking at keeping a permanent drone on location to deliver defibrillators to more isolated parts of the county.
Recently, drones have also been used to assess emergency situations — including in flood zones or accident scenes. The unmanned aerial system, as it is known, works closely with the service’s remote access team, and others.
The community paramedic program tackles demographic challenges in Renfrew County by making house calls and doing remote monitoring of some of the sickest patients in the area.
Bill Craig is among its clients.
Craig, 64, of Arnprior, is a diabetic and kidney transplant patient who was a frequent user of 911 services until the community medicine program began monitoring him 24/7.
Community paramedics would visit him at home regularly to check his blood pressure and blood sugar, among other things.
“I have found it really beneficial,” says Craig. “When they leave here, they don’t just leave, they follow-up with your family doctor and they research different things.”
Paramedics have even travelled with Craig to visit his endocrinologist in Ottawa to better understand his medical needs.
Craig says he feels more secure under the watchful eye of the community paramedic program. Paramedics have discovered him, more than once, in a diabetic coma when they came for a visit.
The service works with family health teams and other medical professionals, remotely monitors some patients and is available 24/7.
Community paramedics monitor some high-needs patients with electronic systems that send digital information back to the paramedics, such as blood pressure and weight.
Paramedics are alerted when readings are abnormal or when readings have been missed, which can trigger a visit to the patient at home.
Community paramedics also operate mobile clinics around the county that offer medical services where seniors are.
“It’s kind of like a barber shop, in that we go to where the seniors are playing euchre and set up the corner,” says Nolan.
People bring their medications and are given help keeping track of them. The paramedics take blood pressure, offer electro cardio grams and blood tests. “It is not uncommon that we pick up patients that have high blood pressure.”
A group of 20 community paramedics see more than 1,500 clients regularly. They monitor up to 150 patients in their homes — most of them among the five per cent of patients who use 80 per cent of health services, including Craig.
“They tend to be socio-economically challenged, which is an indicator of the challenges they face managing their health,” says Nolan. “For many of these people, to take a taxi to go to the lab to get blood work done and to go home is a choice of whether they are going to eat that day or not, or turn up the thermostat.”
Community paramedics keep in close touch with their clients’ family physicians.
Jeff Dodge, a former Ottawa high-tech CEO who became a Renfrew paramedic as a second career, has been key to developing some of the Renfrew paramedic organization’s high-tech expertise.
Working with the Quebec-based software company Prehos, the paramedic service developed an electronic records system for community paramedics. It went live in Renfrew County last year and is now used by the majority of paramedic services in Eastern Ontario.
Using the system, community paramedics have access to client records on tablets and can share notes and data with family doctors.
Dodge, who makes home visits as a community paramedic, recalls writing a note to a client’s doctor after one of his visits. “Before I left the house, the doctor had it.”
Renfrew’s community paramedic program has reduced 911 calls and emergency room visits, improved paramedic response times, and reduced hospital admission rates and length of stays when clients had to be admitted, according to analysis. It also improved and increased communication among clients and their health-care providers.
The program has saved money and improved the quality of life of clients, according to research conducted to measure the program’s value.
Nolan thinks the work being done by paramedics in Renfrew contains valuable lessons for the Ontario government, which has vowed to make changes to help relieve an overburdened health system.
“We think we have a unique position in the community to solve many of the problems presented as hallway medicine.”
This entry was posted in Community Paramedicine Articles
. Bookmark the permalink