The $1M EMS solution
Niagara’s paramedics cannot continue doing their job the way they’ve been doing it as they face huge increases in call volumes.
And Niagara Emergency Medical Services needs $1.16 million to implement changes necessary to help them cope with growing demands, which may include alternatives to rushing patients to hospital emergency departments.
“This is all about our need to do business differently,” Niagara EMS chief Kevin Smith said at a regional public health committee meeting Tuesday,
“Quite frankly, doing the same with the same is not in the future for us to be successful.”
Smith said paramedics have seen a 45.6 per cent increase in calls since 2011, and that number is poised to increase substantially in the years to come.
“In the next eight or nine years now, we’re going to be well over 100,000 calls (a year) coming in,” Smith told councillors. “That is quite a bit of growth to experience within the service.”
He said the 15,438 hours that Niagara paramedics spent waiting to deliver patients to emergency departments last year “is another real pressing reason of why we need to think about how many patients we’re actually taking to the hospital.”
Although Niagara EMS has coped with increases in the past by asking regional council for additional resources, Smith said those resource increases have failed to keep pace with call volumes. And paramedics cannot keep asking for more, “because right now what we’re doing, we’re seeing that it’s not working.”
“We need to rethink how we’re delivering services.”
Although fast response times have previously been the priority for paramedics, Smith said only about 10 per cent of patients they treat require immediate care.
“It’s not sustainable … and it’s not the right thing to do for the patients.”
For most patients, Smith said, the right thing to do “is not to go screaming to every call and not to take every patient to the hospital to receive care.”
While fast response times remain a priority for critical patients, he said EMS must also ensure paramedics are reliably available to respond immediately because “it’s not minutes, it’s seconds that matter.”
“The rest of the system is based on outcomes where we’re actually using evidence to make informed decisions about how we model the system, how we are going to respond. Every patient does not require the same linear response that the traditional system currently provides. You call, the ambulance shows up and we check you out and take you to the hospital.”
That, Smith added, is not the best use of resources “when we’re facing a mountain of challenges.”
Instead, he said, the strategy would require an “innovated use of resources to collaborate in ways in which we’ve never collaborated before, with many community partners and stakeholders.”
Smith said Niagara EMS has been working with Brock and McMaster universities, as well as Sheffield University in England, to develop a unique strategy for delivering services.
That strategy includes hiring a project co-ordinator and project manager, clinical advisers, a physiotherapist, a crisis worker, new software and training programs to help triage patients who call 911 to ensure that they receive the care they need.
“We have a unique opportunity in Niagara to change the way we deliver medical services. When we’re talking about 10 per cent of the patients we see are actually true critical emergencies, really what we’re talking about is how we can provide better mobile integrated health services,” he said.
“Niagara is set up in such a way that we have an opportunity to try things here that won’t effect our neighbours or the rest of the province … We do things in Niagara much different than the rest of the province as far as the delivery of service.”
Smith recommended tapping into the $1.275 million in the region’s ambulance communications reserve to provide funding for the strategy implementation.
Regional councillors are to consider the funding request at their March 22 council meeting.
Several councillors Tuesday suggested the province or Niagara hospitals be asked to provide the funding.
Fort Erie Mayor Wayne Redekop said the province will ultimately benefit from a program that could be implemented across Ontario. As a result, he suggested asking the province to pay for it.
“It’s in everybody’s best interest to do things differently,” Redekop said.
Considering resources that have been tied up delivering patients to hospital emergency departments, Welland Coun. George Marshall is one of several councillors who agreed with the initiative, although he was also particularly concerned about the “staggering” amount of time paramedics spent waiting on offload delays at emergency departments last year.
“How many ambulances, and we just bought a whack of them and have more people to look after them, they’re sitting there doing nothing,” he said, adding the cost estimates related to the offload delays doesn’t event include overtime costs.
Smith called the record-setting offload delays “extremely alarming.”
Although he added that the problem is not unique to Niagara, “it doesn’t make it OK.”
“This is a serious issue for us,” he said, calling it a complex issue that needs to be address through working with local hospitals.