Health Committee on May 14th, 2019

[The Chair, Liberal, Bill Casey]

I'll call the meeting to order. Welcome to meeting 144 of the Standing Committee on Health. We're going to start a new study today.

Mr. Lobb.

[Ben Lobb, Conservative, Huron—Bruce, ON]

Mr. Chair, I don't wish to delay the meeting. I want to bring something to the committee's attention. I will be very brief. I know we're getting near the end of the parliamentary session, but I think it's worth it to have at least one meeting in regard to medical marijuana facilities for a person. The issue is around bending the rules.

There are two what I'll call illegal medical marijuana grow-ops in my riding. One has 2,000 plants in it, if you can imagine, and another has an entire greenhouse full. These are for individuals with prescriptions, who are growing it for themselves. This is an issue coast to coast. I'm sure most constituents have this issue. It's a twisting of the rules, a loophole. I'm not saying I'm against medical marijuana. All I'm saying is that I think the committee should bring attention to this and maybe have officials and police in, because I think it is a very important issue of public health. The odour in the communities I represent is quite bad in these developments, and they do not adhere to the same rules as a licensed facility.

I don't want to delay any longer. I want to bring it to the attention of the committee. I'm sure some of my colleagues have the same issue. It is a public health problem, as well as definitely twisting the rules or a loopholes in the rules.

Thank you.

[The Chair, Liberal, Bill Casey]

I appreciate your bringing it to our attention.

We have committee business at the end of today. We can bring it up and talk about it a little more there.

Did you have a comment?

[Marilyn Gladu, Conservative, Sarnia—Lambton, ON]

Yes, I have a quick comment on that. I wanted to let you know that in multiple instances across the country people are not complying with the odour regulation of both medical cannabis and regular cannabis or the security or the number of plants.

I have forwarded numerous complaints to Health Canada from Langley—Aldergrove, from Dave Tilson's riding, Jamie Schmale's riding, my riding, Leamington, a whole bunch of them. The problem is Health Canada is telling us to call the police. The police are saying they can't enforce Health Canada's regulations and Health Canada is not enforcing the regulations. So there is definitely something to talk about.

[The Chair, Liberal, Bill Casey]

All right. We'll talk about this in committee business. You certainly brought up an issue that I think is prevalent.

Back to violence faced by health care workers. This is going to be another interesting study for us. We welcome our guests today.

On behalf of the Canadian Association of Emergency Physicians, we have Dr. Alan Drummond, co-chair, public affairs committee.

On behalf of the Canadian Federation of Nurses, we have Linda Silas, president.

On behalf of the Canadian Support Workers Association, we have Miranda Ferrier by video conference from Guelph.

On behalf of the Paramedic Chiefs of Canada, we have Randy Mellow, president. Now we're going to find out if you're really mellow.

Everyone has a 10-minute opening statement. We'll start with the Canadian Association of Emergency Physicians, Dr. Drummond.

[Dr. Alan Drummond, Co-Chair, Public Affairs Committee, Canadian Association of Emergency Physicians]

That's more than I anticipated, so thank you very much.

The Canadian Association of Emergency Physicians is the national specialty society for emergency medicine in Canada, with over 2,500 members.

With the birth of our specialty approximately 40 years ago, our primary focus was on education and training to identify and treat life- and limb-threatening emergencies. Over the ensuing decades, our role has changed. Emergency physicians now bear daily witness to failed social policies that result in increasing visits to our departments by patients with substance abuse—including alcoholism—poverty, marginalization and violence. The latter, in particular, is of grave and increasing concern to both our members and our nursing colleagues.

Health care providers have a fourfold higher rate of workplace violence, and 50% of all attacks on health care workers occur in the emergency-department setting. Our nursing colleagues in particular bear the brunt of much of this violence. Most of the assaults on emergency department personnel were by patients or visitors, and the degree of physical violence has been increasing.

It is both under-reported and underappreciated. Studies have shown that only about 30% of violent incidents in the emergency department are reported to higher authorities.

The root causes and contributing factors to violence have been well described. There's a very extensive literature base. As with many problems that beset the emergency department, many contributors lie outside the department itself, and are societal and cultural in nature.

Chronic oppression, with racism, poverty, inequity and social exclusion, lead to substance abuse, mental illness and violent behaviour.

All are important, but substance abuse, and in particular the increasing incidence of crystal meth use in the western provinces, has many of our western colleagues particularly concerned.

As the population ages, complex presentations of the elderly in the emergency department, coupled with prolonged waits for care, as a result of crowded hospitals, lead to an increased risk of delirium and violent acts by the elderly.

While violence in the community is certainly a driver for violence in the ER, it is not the sole driver. There are factors intrinsic to our departments and to our hospitals, including overcrowding and increased wait times, that lead to immeasurable stress for our patients and their families, as they wait eight, 12 or 24 hours to be seen. We have insufficient—in our view—nursing staffing ratios, leading to poor communication and poor basic care of the patient who's been deemed to require admission. They wait in the hallways, and it's totally unacceptable.

We also have poor environmental design, all of which lead to an increased risk of violence in the emergency department.

With respect to the effects, multiple studies and reports have shown that exposure to violence in the ER has a deleterious and demoralizing effect on staff, most notably nursing staff. Occupational strain, impaired job performance, fear of patients and future assaults, decreased feelings of safety and reduced job satisfaction have all been commonly identified.

It also leads to absenteeism, lost-time injuries and prematurely shortened careers. Workplace violence in the health care sector also has a large and well-quantitated economic effect.

This is a national problem that requires a national solution. I know that many of you believe that health care is a provincial responsibility, and it largely is, although you're paying part of the health care tax dollar. However, you could be very helpful, I think, in helping develop a template of best practices to be shared with your provincial colleagues.

Violence in the emergency department, as I stated, is a symptom of a much bigger problem—broadly societal—with racism, poverty, substance abuse, gang and personal violence and inadequate upstream mental health resources for the mentally ill and, of course, those with substance abuse. This is a societal issue, and is beyond the immediate control of emergency physicians.

Within the hospital and the emergency department per se, however, we can consider the following. While individual staff members can contribute to safety through their practice and behaviours, ultimately, the legal and moral responsibility to provide a safe workplace falls to the employer, and thus to a hospital's administration, from board to departmental leadership.

These are a few of the major considerations and the literature is quite extensive, so I will keep this relatively short.

There should be an increased focus on appropriate facility design, with a limited number of controlled entry points to the emergency department with the capability to rapidly lock down the department.

Monitoring is often an afterthought, but there must be a visible security presence 24-7 with adequate backup available in response to an actual or potential incident. It's always the last thing to happen, usually after the incident has already happened.

Regarding skills and attitudes, all emergency department personnel should receive training in non-violent de-escalation to defuse the situation.

There should be clear policies and procedures in place with regular staff training to cover how staff should respond to a high-risk situation, including and regrettably, the active shooter protocol, which is now a part of many urban hospitals.

There should be care plans. Security as well as the clinical staff should have a system for tracking the high-risk individuals and identifying them on return, as well as ideally suggesting a safe approach individualized to a person's behaviours and known clinical issues.

There should be an incident reporting system, as well as a process for incident review. There needs to be a clear line of accountability for all aspects of emergency department safety for our nursing colleagues, patients and ourselves.

We hear the phrase zero tolerance. We believe that—and this is really quite important to stress—violence in the emergency department is first and foremost a medical symptom which requires an assessment to diagnose the etiology. Intoxication, psychosis and mania, dementia and delirium, brain trauma and tumours are all potential causes of violent behaviour.

Violence can also be reflective of a much bigger socio-economic problem, as previously discussed. We support zero tolerance of violence in the emergency department and every incident requires an institutional response, but the phrase “zero tolerance” cannot be used as an excuse to evict or ban patients who have not been properly assessed. This only makes us complicit in a culture of stigmatization and inequity. We believe violent patients deserve the very best possible assessment and care from their ED providers. Their individual social circumstances must be considered in their ultimate care plan. The zero tolerance lies with zero tolerance of an administration that turns a blind eye to the issue of safety in a department.

Thank you very much.

[The Chair, Liberal, Bill Casey]

Thank you very much.

We will now go to the Canadian Federation of Nurses Unions, Ms. Silas.

[Linda Silas, President, Canadian Federation of Nurses Unions]

Good afternoon, everyone.

Thank you for inviting me on behalf of CFNU. We represent over 200,000 nurses across the country. My name is Linda Silas. I am a proud nurse and a proud New Brunswicker. Thank you to the committee for doing this study. I remember testifying here on other issues. When violence in the workplace was mentioned, it was a surprise to everyone, so we are very pleased to see this.

Workplace violence is a growing epidemic among health care workers as staffing levels heavily decline, patient acuity increases and weak security protocols fail to offer adequate protection. From a Canada-wide survey, 61% of nurses reported abuse, harassment and assault on the job during the last year. A recent survey here in Ontario said that 68% of nurses and personal support workers experienced violence on the job. We know that these numbers are unacceptable.

CFNU members across the country recently shared with me different examples. I literally sent an email to my board telling them I was appearing at the committee on May 14 and asking for any examples that came to mind. Last June a nurse in Newfoundland and Labrador was stabbed multiple times with a pen. Last fall a nurse supervisor in P.E.I., working in a long-term care facility, was punched over and over in the throat and tripped and pinched by a resident. This March, in my own hospital in New Brunswick, a nurse was attacked and strangled for 11 minutes by a patient's spouse before security showed up. Of course, she is still off. In Nova Scotia, violence in some facilities has reached a point where the nurses have begun pursuing charges against patients and family members who strike them. Earlier this month in Manitoba, on three consecutive days a nurse was punched in the stomach by a patient.

Studies in Manitoba also talk about ER, as Dr. Drummond mentioned, where 30% of ER nurses have been physically assaulted once a week in the last year. Last year, a nurse in Saskatchewan was brutally assaulted by a patient to the point where one more blow to his nose would have been fatal. That was March 2018 and he is still not working. He will probably never work again. In March of this year, a patient's visitor brought a gun into a hospital in Alberta. The last time Dr. Drummond and I testified together in front of you, it was about gun control.

We deeply appreciate the support provided by MP Doug Eyolfson for supporting the e-petition that the CFNU recently submitted on violence against health care workers. I cannot emphasize enough how important it is for Canada to tackle this crisis, not only for the health care workers from coast to coast to coast who signed the e-petititon but for all Canadians. As we frequently say in nursing, when nurses and health care workers aren't safe, patients aren't safe either. Nurses are even more susceptible to violence in the workplace than any other type of workers who work directly with the public. There were more than 4,000 incidents of serious workplace violence against nurses—serious enough to prevent them from going to work—reported in the last five years. That number—4,000—is higher than for police and firefighters combined. In order to tackle this mounting crisis, we need to go to the heart of the problem. For this we need to have an occupational health and safety lens in both staffing and training.

On January 17 of this year, a nurse and a security guard were assaulted at the Southlake community health centre in Newmarket, Ontario. The nurse, a 33-year-old mother with young children, was struck in the face and suffered skull fractures and a brain bleed. Between April 2018 and December 2018, an eight-month period, we saw 170 violent incidents reported by staff in the same hospital. Nurses describe the hospital as bursting at the seams.

We're calling on the federal government to undertake a comprehensive study in health care human resource planning to determine the current and future shortage and to equip governments across the country with tools to address this shortage. The federal government can, once again, lead by example. lt can implement the highest recognized, comprehensive violence-prevention programs and infrastructure, including hands-on de-escalation training, appropriately trained in-house security, communications devices for staff, wellness programs focused on the physical and mental health of health care workers, and the flagging of patients with a history of violence.

We are calling on this committee to recommend that the federal government legislate national minimum standards of security training for health care environments. To ensure that positive training programs are put in place in a harmonized fashion, minimum standards must exist for health care environments across the country through appropriate legislative changes.

Further, security must be part of the circle of care and viewed as an integral part of the care team. The CFNU is advocating for a revision to the Criminal Code through Bill C-434 as a tool to deter violence against health care workers. The bill amends the Criminal Code to require courts to consider assaults on health care workers as aggravating circumstances for the purposes of sentencing. A similar provision already exists for police officers and transit workers. We commend MP Don Davies for introducing this bill and urge this committee to recommend that Parliament adopt Bill C-434. The CFNU is calling on the federal government to enforce the Westray law, which holds employers criminally responsible for negligence causing physical injury to workers.

Currently, standardized national statistics on workplace violence do not exist. The Canadian lnstitute for Health Information, CIHI, which collects and reports facility-level data, needs to publicly report data on facility-level violence in the workplace.

ln closing, Canada's nurses are appealing to members of this committee to amplify your voice in the committee's report to the federal government. We are calling for a comprehensive federal study on health human resources planning; targeted federal funding to enhance protections for health care workers through violence-prevention infrastructure and programs, with community police included as an essential partner within joint health and safety committees; the adoption by the federal government of best practices around violence prevention in federally regulated health care settings; the legislating of minimum national standards for security training in health care environments; support from this committee for Bill C-434 and the promotion and use of the Westray law by Crown prosecutors in cases involving health care workers; and federal funding toward CIHl's collecting and reporting of data on facility-level violence in the workplace.

Thank you.

[The Chair, Liberal, Bill Casey]

Thank you.

Now we'll go to the Canadian Support Workers Association, with Miranda Ferrier by video conference.

[Miranda Ferrier, President, Canadian Support Workers Association]

Thank you very much.

My name is Miranda Ferrier. I am a personal support worker. I have worked in long-term care and home care settings in Ontario for many years as a front-line personal support worker. I'm also the founder and president of the Canadian Support Workers Association and the Ontario Personal Support Workers Association.

Unfortunately, violence faced by health care workers is nothing new. Over the last 20 years, the incidence of violence against support workers has increased to the point where this profession, and consequently health care in Canada, is now firmly past crisis. In Canada, support workers occupy a very unique role in health care in that they are responsible daily for providing Canadians with the most personal and intimate care. They become a constant for these Canadians and, many times, a part of their family.

Support workers face violence on the job daily. This has become so prevalent that it is now viewed as the norm. Is this right? Absolutely not. However, we believe that it will take a small change in our health care system to help rectify this issue for the support workers.

Right now support workers are responsible for caring for up to 15 residents per shift in long-term care homes, or more, in some cases. They also care for up to 16 clients a day in home care across our province.

One of the situations that comes to my mind occurred in August of last year, near Toronto, Ontario. One of our member personal support workers was stabbed on the job, while working in home care, by a grandson of a client. She survived, but that just shows how we are at such a critical and crisis level.

No matter where they work, the system is constantly plagued by short-staffing due to two reasons. There is no professional acknowledgement, as personal support workers and support workers across our wonderful nation are not regulated, and there is no accountability. As a result, the support workers in Canada are professionally isolated, lack the tools to advocate for their own safety and must contend with a profession that is 600% more dangerous than being a police officer or firefighter. On the flip side, they can be fired for abuse, walk down the street and get hired as a support worker again without any recourse. Add in the levels of burnout across our nation and we have our current situation.

In order to properly address the issue of violence faced by support workers, the provinces and federal government must allow the support worker to have the same professional respect offered to all other members practising health care in Canada. This professional recognition is not only long overdue, but it would end the pervasive culture of fear so prevalent in health care. Our Ontario association has long been lobbying and advocating for self-regulation of the support workers, even receiving an endorsement from the Canadian Nurses Association.

The presence of this culture of acceptance has resulted in a situation where the support workers are simply unable to report incidents of abuse for fear their employment will be terminated and their professional reputations ruined.

In order to effectively address the issue of violence faced by support workers, the Canadian Support Workers Association and the Ontario Personal Support Workers Association are formally calling on this committee to endorse and formally recommend to provincial health ministries that the Canadian Support Workers Association and its provincial chapters form the self-regulatory body for the support workers across Canada. This action would promote a recognition of the value that these workers provide to health care in Canada through effective and confidential whistle-blower protection. It would end the professional regulatory gap that allows for the continued tolerance of abusive behaviours towards the support workers and those in their care. It would provide assurance that there will be a sustainable and stable workforce to care for Canada's most vulnerable for decades to come. We are currently losing support workers at a rate of 33% quarterly.

Self-regulation will create a respected profession, which will provide the safety net and accountability so desperately needed for our most vulnerable in all of our communities across Canada.

This model of self-regulation has proven successful partially in Ontario, with our association there representing over 32,000 personal support workers. We have had no abuse claims to date.

Thank you very much for giving me the time.

[The Chair, Liberal, Bill Casey]

Thank you.

Could you define “support worker”?

[Miranda Ferrier]

They are called something different in every province across Canada. A support worker is also called a health care aide, personal support worker, personal care attendant, personal care aide. The list goes on. We're called something different everywhere. We work in the front line in long-term care homes, home care, community care, sometimes in hospitals and acute care settings. We're unregulated.

[The Chair, Liberal, Bill Casey]

Thanks very much.

Now we'll go to the Paramedic Chiefs of Canada, with Randy Mellow.

[Randy Mellow, President, Paramedic Chiefs of Canada]

Good afternoon, Mr. Chair, and members of the committee.

I would like to start off by thanking you for the invitation to appear here today and for the opportunity to contribute to a crucially important discussion on violence faced by health care workers, and specific to my community, violence faced by paramedics.

It's my distinct honour to be here today as the president of the Paramedic Chiefs of Canada. That's an association that represents paramedic chiefs and service chiefs across all of our provinces and territories.

I was to present today with the Paramedic Association of Canada as well, which represents our practitioners. Unfortunately, they were not able to be here. But we share this message that we're bringing to you today.

We're pleased to participate in this national dialogue on this important issue that's crucial to the safety of paramedics in Canada on the front line, in our communications centres and in our hospitals, and by extension, the safety of Canadians.

We can't address this issue without also including the paramedic service organizations, their leadership that works with paramedics each and every day, as well as the families that need to be included in this dialogue, as they are such important social supports to paramedics.

In Canada, there are over 40,000 paramedics who stand ready to respond to people in need and to save lives. Unfortunately, each day, as they perform these tasks with compassion and dedication, these same individuals are at very high risk of being victims of violence and abuse. Regrettably, paramedics are often the target of physical and verbal violence, bullying, threats, sexual assault and sexual harassment. Physical violence includes, but is not limited to, pushing, punching, scratching, kicking, biting, slapping and the use of weapons. Acts of violence and abuse may come from patients, the families of the patients and even bystanders at emergency scenes. Sadly, all too often paramedics are victims of violence by the very patients they're trying to care for.

Internationally, studies have found that between 55% and 83% of paramedics have experienced threats or violence during the performance of their duties annually. In a 2014 study of Canadian paramedics, 75% reported experiencing violence of some sort, 74% reporting multiple forms of violence annually. Of the 1,676 paramedics who participated in this study, 67% reported verbal abuse, 41% reported intimidation, 26% reported physical assault, 4% reported sexual harassment and 3% reported sexual assault. Sadly, these paramedics reported that they felt violence was part of the job.

Violence experienced by paramedic personnel has many consequences. It has been linked to psychological injury in the form of stress, anxiety, post-traumatic stress and burnout. Violence has been linked to physical injuries, resulting in time lost from work in between 17% and 32% of the cases. It has also been linked to the intent to leave the profession early. Violence against paramedics jeopardizes the quality of patient care that paramedics strive to deliver. It also leads to immense financial loss in the health sector, not to mention the indirect and direct costs to the paramedics themselves and their families.

Violence and abuse against paramedics in unacceptable. The Paramedic Chiefs of Canada supports a zero tolerance position on all forms of violence and abuse in all areas of the Canadian paramedic community. There's an immediate need to intervene on this crucial issue.

Our association recommends that interventions to prevent violence need to occur at multiple levels.

First, we feel we need to sponsor and support research. Research is necessary to obtain a better understanding of the scope of the problem, to evaluate the impact of violence on personnel and to assess means of mitigation, as we heard earlier today. Currently, there is only one peer-reviewed article that examines the issue in Canadian paramedics. This is insufficient.

Second, evidence-informed strategies must be developed and training provided for the management of violent patients and situations for front-line personnel.

Third, we must increase public awareness of the human and financial impacts of this issue among health care workers and paramedics.

Fourth, consideration must be given to changes in policy and legislation—as we also heard earlier—to protect paramedics and health care workers through increased punitive measures where appropriate.

We certainly welcome the opportunity to work with the federal government and partners to assist in coordination, research and communication to ensure the safety of all paramedics and health care workers is addressed.

Thank you.

[The Chair, Liberal, Bill Casey]

Thanks very much.

[Marilyn Gladu, Conservative, Sarnia—Lambton, ON]

Is that a vote call?

[The Chair, Liberal, Bill Casey]

Okay, it seems we just had a vote called. We'll need unanimous consent to continue. Will we go on for a few more minutes?

Oh, it's a quorum call. It will shut down. They'll find some members.

It's amazing to me that we have to have this study, but hopefully we'll be able to help.

We're going to start our first round of questioning with Dr. Eyolfson, for seven minutes.

[Doug Eyolfson, Liberal, Charleswood—St. James—Assiniboia—Headingley, MB]

Thank you, Mr. Chair.

Thank you all for coming. I've met some of you before, and it's good to see you all again.

I brought up the motion to have this study. This was important for me. I've had a number of colleagues assaulted in their careers. I was assaulted twice in the emergency department, and on both occasions, not only was I expected to finish my shift, but I was actually expected to come in for my next shift. They couldn't find coverage, and they said it's too bad, but you have to come in.

Dr. Drummond, you mentioned that the employer is legally responsible for the well-being of their employees. Do you think it's acceptable for any employee who has just been assaulted to be told you have no choice, that you have to keep working and you have to show up the next day?

[Dr. Alan Drummond]

Of course not.

You know, I work in a small town; the good doctor worked in an urban environment in Winnipeg. In my view of the world, I tend to look at what happens in my little department in Perth, Ontario as a manifestation of what happens in the bigger picture. I can tell you that in our small town, which sees about 30,000 patient visits per year, we often have about three nurses on staff at any one point in time. We're chronically understaffed; it's chronically difficult.... There's no acceptance of illness, because it puts the onus on somebody to fill in that shift. Many of them feel incredibly stressed by their sense of community and commitment to work through illness, through family stress, through psychological difficulties.

In our department, where we have a fantastic, supportive team—intercollegial—many of our nurses are getting fed up with the degree of—I'll be polite, because I'm in mixed company—nonsense that happens on a day-to-day basis. It's true that we don't tend to see a lot of the significant violence, such as you might have seen in Winnipeg, but every day there is verbal abuse, grabbing, kicking, scratching—not always by patients, sometimes by their families—and the nurses are traumatized.

Some of our best nurses, who've been with me for nigh on 10 or 20 years, are thinking that they've had enough now and they're going to leave, because there just isn't enough accountability from the hospital to address the problem. They do feel, as my colleague from the personal support workers mentioned, that if they raise the issue, there will be retribution or their problems will not be taken seriously; therefore, they remain silent. It has become that staff feel it's a normal part of the job, but it is not.

In answer to your question, the obvious answer is no, it's not acceptable.

[Doug Eyolfson, Liberal, Charleswood—St. James—Assiniboia—Headingley, MB]

All right, thank you.

I kind of thought that was going to be your answer. But as you say, it seems that in the medical and nursing professions there's an attitude that is, for lack of a better word, macho. You know, if you can't take the heat, get out of the kitchen. You're right, there is that mindset that if you're sick or injured, so what; you're supposed to rise above it. I think we have to evolve beyond that.

Ms. Silas, you talked about staffing issues. As you probably know, in Manitoba it's made the news a lot, and I witnessed this first-hand when I took a family member to the emergency department last weekend. We have severe staffing issues. I was there during a night shift when literally all of the nurses had been coming off a day shift and were mandated to work an additional eight hours overnight. Of course, this leads to short tempers, to fatigue, to errors. It leads to upset patients.

Do you see an increase in violence toward staff that seems to be correlating with the shortages of staff in departments?

[Linda Silas]

Yes. That's the short answer. But it has gotten worse. We saw in the 1990s a restructuring of our health care system. Now we have a very acute health care system. If they're not there, as per your witness on personal care workers, they're in the home with any help they can get. It's like a boiling pot. The fuse gets very short for everyone in the system. This is a health and safety issue. That's what we need to look it. It's about training, training, training; staffing, staffing; and safety—police officers or corrections. You have to put that into it.

I'm starting to show my age here, but the first campaign we had for no violence in the workplace was in 1991. We had big hearts in the workplace and, you know, “no violence here” or “zero tolerance”. Like, sorry, but that's BS. Right now I can take a taxi in New York City that has a big sign in it saying that if you attack the taxi driver, there will be a criminal charge. That's what I want posted in the hospitals and in home care. No more little hearts. If you touch a health care worker, you're going to jail. It's as simple as that. We will staff our health care system appropriately to make sure. Prevention is number one, but if we can't prevent, we will throw them in jail.

[Doug Eyolfson, Liberal, Charleswood—St. James—Assiniboia—Headingley, MB]

Okay. Thank you.

Mr. Mellow, I have some experience with EMS. I was the medical director of Manitoba's land ambulance program for six years. I also flew for our provincial air ambulance system, which involved some ground transport. I've spent a lot of time in the back of ambulances and known a lot of paramedics. Would you agree that the public does not appreciate how dangerous being a paramedic can be?

[Randy Mellow]

Absolutely I would agree with that. I don't think the public has a good understanding of the dangers of our jobs. As I quoted at the start, the number of injuries we're seeing is phenomenal.

I operate a small ambulance service here in Ontario. It's not very big. It's in Peterborough. It's just a couple of hours away from here, a small rural area in cottage country. In the past two years, two paramedics were sexually assaulted and one paramedic had a knife reportedly drawn on them, all resulting in cases that are in the courts right now. People don't understand how dangerous the job can be, just as it can be in other health care professions.

One issue we have is that we are two people who are quite often out by ourselves, with no security and no one else to respond. Especially in rural Ontario, where it can be many minutes before we have police who can arrive at the scene, it's very difficult. Our legislation mandates that we must actually see a dangerous scene and confirm it to be a dangerous scene before we can legally stage and not go into that scene. It places paramedics in danger intentionally to confirm that the danger exists. These things need to change. We need to review not just the public's opinion but our governments' view of this as well.

[The Chair, Liberal, Bill Casey]

Thank you.

Now we go to Ms. Gladu.

[Marilyn Gladu, Conservative, Sarnia—Lambton, ON]

Thank you, Chair.

Thank you to our witnesses.

I want to start off by talking about the prevention aspect. CIHI collects some data, but do we know who is perpetrating the violence? Do we know the breakdown of people? How many are patients and how many are family? Is there a breakdown for drug addicts and for people with mental health issues? Do we have any kind of data on that?