Patients turn to emergency services because they cannot get care elsewhere.
About one-fifth of Canada’s population is 65 years or older. More than one-third of them have at least two of the 10 most common chronic diseases, a number that increases to almost half of individuals 85 and older. Meanwhile, many Canadians do not have a regular primary health-care provider (e.g., family doctor or nurse practitioner) and emergency departments (EDs) are pressed to provide timely access to care.
Community paramedicine, in which paramedics play a more active role in treating patients without transferring them to hospital, is a widely accepted solution that has been successfully implemented across the country.
In the traditional emergency-based response model of paramedicine, the goal is to stabilize patients and transfer them to an acute-care facility. However, there is a disconnect in how this model was designed and the current state of health care. Canadians have one of the highest rates of ED visits among OECD (Organization for Economic Co-operation and Development) countries. Patients turn to emergency services because they cannot get care elsewhere (e.g., inadequate access to primary care, medical imaging and urgent care options in the community). Research shows that 41 per cent of Canadians reported visiting an ED for a condition that could have been treated in a doctor’s office or clinic.
“People have changed how they use paramedic and emergency services over the past few decades,” says Amir Allana, a paramedic with experience working in Ontario and British Columbia, and a fellow with the McNally Project for paramedicine research.
“Really, it’s because people have a need, and that need is not being met by the health system. And when we see it that way, the question becomes do we try to ask the public to use services in a way that the services were designed, or do we adapt those services to the public’s need?”
Paramedics, trained in managing emergent and critical cases such as cardiac arrests, strokes and major traumas, are uniquely positioned to fill gaps in care for those with chronic health conditions through an expansion in their role.
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