Ontario looks to give paramedics new powers, experiment with 'fire medics'
Proposed changes would allow paramedics to take patients to non-hospital facilities
The province's proposed overhaul of the Ambulance Act could change where paramedics are allowed to take patients in mental distress or who have minor injuries, and in some cases who shows up for a 911 call in the first place.
The act, which dates back to 1990, only allows paramedics to transport patients to hospital facilities.
"We want to give them more latitude. There may be a better places than a hospital E-R," said Dr. Eric Hoskins, Ontario's minister of health and long term care. "Maybe that person doesn't need follow-up care. Paramedics should be able to treat and release."
The proposed changes, if passed, would allow paramedics to take patients to other facilities depending on their discretion. If the injury is minor, the person could be taken to a community-care clinic. If the person is in emotional or mental distress, a paramedic could decide to go to a mental-health facility.
"In the case of a person with mental illness, I would say with confidence there are many care facilities in communities that are open 24-7. Rather than take them to a hospital E-R, why not take them to a community agency they may be familiar with?" Hoskins said.
Beth Mitchell of the Canadian Mental Health Association agrees that in some instances ending up in a hospital is not the best setting for a person in mental distress.
"A lot of times what they need is someone to talk to," said Mitchell, who added in many community facilities the first person they see is a mental health worker, and if they don't see someone immediately, wait times are a half an hour at most.
"If people can get to the right place at the right time when they need it, that has to be good," Mitchell said.
For paramedics, less time spent in hospital E-Rs means more time on the road helping people, said Brian Annett, the president of the Toronto Paramedic Association. He estimates the handover time from paramedic to hospital staff takes an average of 40 minutes.
But the proposed changes won't just save health workers' time; patients may have shorter wait times as well, Annett said.
"We could potentially take them to a walk-in clinic or an urgent-care clinic where they could potentially see a doctor a lot sooner," said Annett, who added that fewer people unnecessarily transported directly to hospital may reduce overcrowding.
But not all the proposed changes to the Ambulance Act are perfect, Annett warned. His members do not support a proposed pilot program that would see firefighters with paramedic training allowed to handle low-priority calls.
Annett said the so-called "fire medics" have been tried in other jurisdictions.
"There's no evidence that having paramedics on firetrucks has any benefits to the patient," said Annett.
The proposal to have two pilot tests of firefighters with paramedic training is a big problem for the Association of Municipalities of Ontario (AMO).
"We're supportive of making it more flexible for paramedics on how they treat patients and not take them to overcrowded emergency departments. Our biggest concern is the fire medic model," said Monika Turner, AMO's Policy Director.
She said the cost of ambulance services is shared between municipalities and the province, while firefighters are completely a municipal expense. The concern is that the pilot programs will open the door to the use of the fire-medic model, which could one day see paramedic services end up on to the fire payroll.
"For the pilots the province is saying they will pay 100 per cent. Our concerns are, if you are looking to put paramedics who are full-time fighters on trucks you can see there's going to be labour relations issues big-time, because you are moving a person from one bargaining unit into another bargaining unit," said Turner.
She said while the pilot projects are voluntary, the AMO would like protection against the possibility that provincial arbitrators order unwilling municipal governments to adopt the fire medic model.
That would saddle municipalities with the entire cost, she said, adding that firefighters salaries are typically much higher than those of paramedics.
But Rob Hyndman President of the Ontario Professional Firefighters Association says the pilot project that the government is proposing is based on the model used in 80% of the large urban centres in the United States.
He also calls AMO's concerns that a board of arbitration could force the use of fire medics as 'categorically false.'
"To suggest otherwise clearly identifies a lack of understanding in the system," said Hyndman.