The Future of EMS – community paramedicine

Jeff Green | Apr 26, 2012

Photo: Mike Nolan, the Chief of Paramedics in Renfrew County and current President of EMS (Emergency Medical Services) Chiefs of Canada

We all can remember the last time we saw paramedics in action. We can see them carrying their gym bags full of equipment as they tromped into our house to get to whoever was in distress. We can see them wheeling a stretcher towards a flashing white and neon green van in our neighbor's driveway.

The images get burned into our memories.

Mike Nolan, the Chief of Paramedics in Renfrew County and current President of EMS (Emergency Medical Services) Chiefs of Canada, talked to Frontenac County Council about how that image will be changing in the coming years.

It all has to do with making use of the time that paramedic crews now spend waiting for emergency calls to come in. The thrust of community paramedicine, which is something the Mike Nolan has been pioneering in Renfew County, is to make use of that time by working in collaboration with other health and home care professionals to prevent some of the need for emergency calls in the first place

Particularly in rural areas, where the time between calls can be significant, the Renfrew County paramedics have been spending some of that time holding front line clinics, and conducting ad hoc home visits to at-risk patients to provide basic medical assessments and help prevent emergency calls.

One of those clinics is a monthly drop in clinic in Griffith, a community located not far from the northwestern edge of Frontenac County.

“In Griffith a one day a month clinic has drawn 60 patient visits, on average,” said Mike Nolan. “It is staffed by community volunteers, and paramedics who are already on-call. The cost to the health care system is only some diesel.”

There are a variety of paramedicine pilot projects on the go throughout North America, including the ones in Renfrew County.

A small pilot project in Western Eagle County, Colorado has recently been evaluated for health outcomes and cost effectiveness. In Eagle County, 22 at-risk patients received a total of 65 home visits by paramedics. These visits resulted in 58 fewer physician office visits, 8 fewer paramedic transports and emergency room visits, and a reduction of 182 nursing days in long term care, a net savings of almost $200,000 in health care costs, and an improvement in the quality of life for the patients.

Some of the major impacts of paramedicine are in the treatment of diabetes, where the ability of paramedics to administer glucagons to patients reduces risk to patients and saves emergency transports and hospital admissions.

One of the key factors in paramedicine is specific training for paramedics.

“The community paramedic practices within an ‘expanded scope’, which includes the application of specialized skills and protocols beyond the base paramedic training,” according to a white paper on community paramedicine in Canada that Mike Nolan worked on.

Paul Charbonneau, Chief of Paramedic Services in Frontenac County, said, “We have now completed or soon will have a number of new bases constructed, and we have a strong service in place in Frontenac County and Kingston. This represents our future, making full use of our personnel.”

Charbonneau said that one of his Deputy Chiefs is visiting Renfrew County this week to see first hand what paramedicine is all about, and he will be initiating talks with service providers in Frontenac County to see what kinds of projects are likely to work best.

Among the programs that Mike Nolan referred to is a debt forgiveness program for paramedics to allow them to take on the training for advanced care certifications, which greatly expands the number of procedures a paramedic can perform.

Frontenac County currently employs a number of advanced care paramedics, but the northern base in Parham and the post in Ompah are not staffed by advanced care paramedics.