Thank you, Madam Chair.
Good afternoon. My name is Michael Nolan and I'm the president of the Emergency Medical Services Chiefs of Canada. I'm here today to talk with you about how paramedics can contribute to the health care system, and specifically how community paramedics can strengthen the resilience of Canadians and support chronic disease self-management.
Good afternoon. My name is Michael Nolan and I am the president of the Emergency Medical Services Chiefs of Canada. I am pleased to be here today to talk to you about how paramedics can contribute more to the Canadian health care system.
Emergency Medical Services Chiefs of Canada represents over 30,000 paramedics and chiefs from coast to coast. Paramedics are the third largest health care provider group in Canada. Paramedics serve on the front line of health care in every community across the country, providing essential health care. We are a reliable and constant force, from the most rural and remote communities to our largest cities.
I appreciate the opportunity, Madam Chair, to inform you and the committee of the important contribution that paramedics make in our communities, and especially to share examples of how paramedics are working today to assist Canadians in becoming more resilient through supporting chronic disease self-management and by providing innovative opportunities to receive care in their homes and in their communities.
Community paramedicine is not a new concept. These programs have been in existence in Canada for many years. However, it is only recently, as a result of the shifting demographics and the move toward de-institutionalizing health care, that community paramedic programs have begun to gain momentum in Canada and around the world. Community paramedics are health professionals who focus their practice on providing prevention and rehabilitation care.
While in some cases this requires an expanded scope of practice applying specialized skills, it is routinely a paramedic who is working with a targeted population, such as with those experiencing a chronic disease, to improve their quality of life and reduce their reliance on our institutional health care system at large.
We know that any frail senior who possesses multiple co-morbidities is receiving care that routinely revolves around interactions with paramedics and acute-care hospitals. Subsequently, their functional status deteriorates during their hospital stay while waiting for permanent placement in long-term care. It has been estimated that 37% of these patients waiting in Ontario hospitals for a long-term care placement have needs no more urgent or complex than those of individuals who are cared for in their homes.
System redesign is identified as essential to transform the health care system to meet the needs of our fragile seniors, the majority of whom want to live in their homes—and should be able to—and be able to rely upon community support to assist with their health and social needs. An excellent example of a community paramedic program that is addressing this need is happening right here in the Ottawa Valley. The Deep River aging-at-home program supports patients with chronic disease in an effort to allow them to remain in their own homes. All of these patients are currently on the waiting list for long-term care with a diagnosis of one or multiple chronic diseases.
With community paramedics acting both as advocates for the patient and as a member of an interprofessional team, this program has achieved an 88% diversion of 911 calls and, equally importantly, a decrease in hospitalization and emergency department visits in excess of 66%. Madam Chair, it is important to note that these gains have been achieved from this client group that is also historically among the highest users of the paramedic service and the hospitals in this community.
The landscape of care within the home and community environment is certainly a challenging one. These hurdles are worsened when trying to access services as an individual with complex and often unresolved needs, invariably resulting in a high need for high-cost resources in the acute-care setting.
While not always a direct result of lack of care in the community, many chronic disease patients experience emergency department visits that often lead to a vicious cycle of readmission. Within Ontario, 15% of all patients discharged from hospital are readmitted within 30 days. That's 15%. An increased focus on effective care transition has been identified as a means to help reduce this burden. The community paramedic is absolutely a means to reduce re-hospitalization.
On Long Island and Brier Island in Nova Scotia, community paramedics collaborate with a nurse practitioner and an off-site physician, and are assisting patients to effectively manage their chronic diseases. As a result of these efforts through community paramedic clinics, there has been a 23% decrease in emergency department visits from islanders to Digby since this delivery model began in 2002.
Other innovative community paramedic programs from Nova Scotia include one in Halifax, where patients living in long-term care facilities now receive care from community paramedics on an as-needed basis. As a result, there has been a 73% treat-and-release rate, meaning that the community paramedic is able to treat them fully in the home. There was also a 27% facilitated transfer rate. This means that the remainder of patients would be seen by community paramedics, who would then schedule their diagnostic treatment and, whenever possible, treat them in the home. They go, for example, straight to the X-ray department and then return to the nursing home. They are not in an alternate level of care beds and not in the emergency department.
This program has helped over 600 patients in Halifax alone since February of this year. Hospitals in both in Parrsboro, Nova Scotia, and in Spirit River, Alberta, are now staffed overnight by paramedics, keeping the emergency departments open in these small communities and preserving limited physician resources for daytime clinics the next day.
In Saskatoon, an innovative program called the Health Bus has paramedics and a nurse practitioner moving from neighbourhood to neighbourhood in an RV-style vehicle. They see over 3,000 patients per year in Saskatoon. One third of the patients they see are children.
In Toronto, the community paramedic program targets patients with a high historic utilization rate for paramedic services, truly our “frequent flyers”. This program has achieved an 81% reduction in demand from this group by ensuring they receive appropriate community support. Of these referrals, 66.4% were for new clients to the community care access centre. So we are finding new people earlier in the system, and it's an advantage for them and an advantage for the health care system at large.
Nationally, approximately 60% of paramedic responses, Madam Chair, are for patients over the age of 60, while patients over the age of 80 represent 27% of all requests for assistance through 911.
Paramedics can and should be used to ease the increased pressure on the health care system. Paramedics perform assessments, post-surgical home care, chronic disease monitoring, health education, administration of antibiotics, and other primary care functions. Paramedics are a valuable service in your communities. Paramedics are important health care providers to meet the growing needs of seniors and other vulnerable populations.
Other benefits of paramedics increasing their role in health care include significant savings based upon a reduction in 911 calls, emergency department visits, hospitalization, and off-load delays; an improvement in the alternate level of care bed availability; a reduction in demand for long-term care beds; and ultimately, an improvement in morbidity and mortality rates in Canada. Paramedics are well positioned to lessen these cascading problems for our health care system overall.
Madam Chair and members of the committee, I sincerely appreciate the opportunity to discuss the role that community paramedics play in strengthening the resilience of Canadians and supporting the principles of chronic disease self-management.
It's important, however, to reinforce that the intent of the community paramedic programs is not to augment existing services but to enhance quality of life. Paramedics continually see chronically ill patients whose needs range from reassurance and advice on self-management to clinical interventions. Community paramedics are here in your communities to serve Canadians.
The Emergency Medical Services Chiefs of Canada ask that this committee recognize the role of the paramedic in the future of chronic disease management.
Thank you for your consideration. I will be happy to answer any questions, Madam Chair.