Community Paramedicine coming to Tumbler

VICTORIA, CANADA - MARCH 26: BC Ambulance Services stock photography session March 26, 2013 in Victoria, British Columbia, Canada.  (Photo by Jeff Vinnick Images)

VICTORIA, CANADA – MARCH 26: BC Ambulance Services stock photography session March 26, 2013 in Victoria, British Columbia, Canada. (Photo by Jeff Vinnick Images)

Trent Ernst, Editor

The government of British Columbia is rolling out a new Paramedicine Initiative, and Tumbler Ridge is one of 73 programs that will be part of the program.

The program was launched last year on a trial basis in a handful of communities across the province in Northern BC, including Chetwynd.

Sarah Shaw has been acting as the Community Paramedic in Chetwynd. She’s just been appointed Regional Training Officer for Community Paramedicine, and will be helping run the program in the north.

She says despite the shared name, there’s a big difference between what she did in her previous job as an Emergency Paramedic and what she does now as a Community Paramedic. “A regular Emergency Paramedic is going into places when people call 911 or need to transfer a patient, say, from Chetwynd to Dawson. Pick ’em up, drop ’em off and get back out there. You go into a situation thinking clinically. An Emergency Paramedic needs to get in there, get them to the hospital and get out in case there’s another call. That’s how it’s operated. As an emergency service.”

But with Community Paramedicine, she says, the shift is towards preventative work. The long term goal, she says, is to keep people out of emergency care, freeing up doctors and nurses to deal with the true emergencies. “Community Paramedicine shifts towards preventative care. I’m going into people’s houses and checking blood pressure, to assess their house for fall risks, to check their medication, to monitor respiratory conditions, to provide diabetics with information on care so they don’t have to go into the hospital, go into the emergency room.”

In the Peace Region, Tumbler Ridge, Chetwynd and Hudson Hope will all be receiving the equivalent of one full time employee, though in the case of Tumbler Ridge, this will be spread out across two people working just over half-time hours.

This, too, says Shaw, is part of the strategy. With two people, one person can go away, say on holidays, and the other can cover. And the two people can chose to work as Emergency Paramedics the rest of the time, carrying the pager. This should also create more stability for the Emergency Paramedics as well.

In addition to the new positions, the town will also be getting a new vehicle, probably a Dodge Durango or a Nissan Rogue, so the Community Paramedic will be able to get around without tying up the ambulance.

Time for a change

Although BC’s health care system is one of the best in Canada, says an Ambulance Paramedics of BC (APBC) report, a number of issues have arisen in recent years that require innovative solutions.

“Larger communities are facing serious paramedic response time delays and Emergency Department overcrowding, as a result of population increase that has outstripped available ambulance services. Metropolitan communities have also seen a sharp increase in ambulance call volumes, in part due to residents who don’t need emergency medical care, but find it difficult to access more appropriate health care services.”

Meanwhile, smaller and rural communities are having troubles finding and keeping paramedics. Tumbler Ridge, for instance, is a Kilo station. That means that paramedics carry a pager, at $2/hour, and must be able to respond to calls within 15 minutes. A call out bumps staff members up to their full wage for a minimum of four hours.

From the other end, the province is struggling to justify the expense of full-time paramedic staffing for communities with low call volumes. “The withdrawal of locally-funded training has resulted in a steep decline in the number of paramedic applicants for rural communities and thus critical staffing shortages across the province, which leaves many communities facing long periods of time with reduced or no ambulance service.”

Community Paramedicine kills two proverbial birds with one stone. It provides gainful employment for paramedics, allowing them to use their training and expertise, while reducing demand on the emergency system.

“Financially, it keeps costs down,” says Shaw. “It frees up the ambulance, it give the local paramedics more sustainable jobs and quality hours that they can depend on, but more importantly, it’s better care for the patients. It’s bringing the care to the patient rather than bringing the patient to care. Someone who has respiratory issues doesn’t need to be moved from home to ambulance to hospital and back again. It’s actually harder on them. We can’t paint everyone with the same brush.”

It’s not a new idea. Community Paramedic programs have been rolled out in the US, UK and Australia, and are even making their way into other provinces like Ontario and Alberta. Shaw says it’s a change in the way paramedicine is offered.

“Doing Community Paramedicine, the shift is to do preventative work,” she says. “It’s been very valuable to take a step back and think about the patient long-term. Education is huge in what I do now. I spend time educating people on their disease, on osteoporosis.”

Shaw says a lot of time, people just need assurances or a little bit of help, something the emergency system is not set up to handle. “It’s not that the doctors aren’t explaining this stuff, but they don’t have time to sit down for an hour to go over all the concerns a patient might have.”

But a Community Paramedic can take the time to spend with people. “You get to learn a lot more about the disease processes and long term care,” says Shaw. “I’m happy to see this side of things.”

How it works

Shaw says she gets referred to the patients by the Doctor. “I’ll go in and assess the patient. Depending on the patient, I might have to check their blood sugar levels. Sometimes it involves sitting around having tea and talking about health concerns. Say they can’t figure out the medication, or worried about blood pressure, the Community Paramedic can take time to go there and explain.

And when she’s not actively dealing one-on-one with patients, she’s out liaising with the community. “I might go to a senior’s home and give a seminar about how to use an Automatic External defibrillator (AED). It’s helping out local people.

There’s lots of PR and community events. It’s different every day. Some days, I’ll see a lot of patients, some days I’ll give seminars. It’s different. It’s fascinating.

Shaw will continue on in Chetwynd until the actual Community Paramedics are hired, then she’ll transition on to her job as regional training officer, training all the new Community Paramedics.

She says the hiring process will probably take about six weeks, with the emphasis on hiring locally, and then, of course, people will need to be trained. “They’re expecting the program to be in full swing by October,” she says, but that may be sooner or later, depending on a number of variables.

The program is being rolled out in remote rural areas, with an eye towards expanding into larger centres later this year or early next. “This is the best place to start, because these communities need it most,” says Shaw.