House calls, revisited: Mobile medical team provides in-home care to help take pressure off hospitals
Virtual triage assessment centre program offers remote access to medical experts, on-site care
COVID-19 has forced a change to health care in Renfrew County, Ont., and it might just be one Canadians want to keep and other nations want to emulate.
Just over an hour-and-a-half drive from Ottawa, in Ontario's largest county, people are getting medical attention right inside their homes.
This is an idea born of fear, anxiety and disease. When the pandemic started marching around the globe, Renfrew County chief paramedic and director of emergency services Michael Nolan started looking for solutions. He knew there was a need to protect hospital emergency rooms from overcrowding, and he also realized family doctors would not be able to work solely out of clinics the way they traditionally had.
Within 12 days of the first conversation, VTAC was live.
It's a joint effort with partners from across the health care system, led by primary care physicians, community paramedics, public health and hospitals.
Dr. Jonathan Fitzsimon, the Chief of Medicine at Arnprior Regional Health and one of the physicians who helped spearhead the program, describes how it works. "If you don't have a family doctor, or if you can't access your family doctor, then you can call a virtual triage assessment centre or VTAC. It's a free phone single number — you can call us and we will link you with a family physician or nurse practitioner.
"You then get an appointment, usually within a few hours."
Patients can have their appointments over the phone or a video link. About 80 per cent of those calls can be dealt with by a physician or nurse practitioner without requiring a face-to-face visit. If a visit is required, people with the necessary expertise are dispatched.
"The difference we've got is we've linked in with our community paramedics, so we're working hand-in-glove with primary care doctors and community paramedics. We will send the community paramedic to your home," says Fitzsimon.
He stresses that people should still be calling 9-1-1 if they are experiencing an emergency, such as a heart attack or a stroke, major bleeding or severe breathing problems. VTAC is for all the other concerns that might have a person wondering if they should try to get an appointment with a doctor or go to the ER.
'I was happy at home and out of the hospital'
The effect of having paramedics essentially make house calls is profound for those receiving the care.
Renfrew resident Kim Groves is blunt, saying that he's sure his life was saved by the VTAC team. Groves tested positive for COVID-19 and was desperately sick, but was able to recover at home thanks to the paramedics, particularly Matt Rousselle, who made that so.
"I think I would've kicked the bucket if it hadn't been for him," Groves says. "I couldn't even get off the couch. I was right done."
The paramedics moved him from the couch to his bed, made him comfortable, checked his condition to ensure he didn't need more extensive treatment, and gave him an I.V.
"That doesn't happen with paramedics too often … so yeah, I was happy at home and out of the hospital," Groves says.
Proper access to the proper health services is key. It's about not leaving anyone behind, according to Nolan.
"Everybody has access to a family physician, 24 hours a day seven days a week," says Nolan.
"We've been able to prove that keeping you home while you're sick is safe, is affordable, and is in fact what the population is telling us they want the future to look like."
COVID-19 has effectively cut through the red tape and allowed good ideas to get put into action. But the funding taps could get turned off. And questions remain about how effective a plan like this would be in a large urban centre.
Even so, Nolan says the future of delivering health care can't be a matter of "back to normal." He maintains the way health care used to be delivered is not the way it should be delivered.
The future, simply, could be better.
He is constantly exchanging ideas with paramedics from other countries. The best ideas win, like the suggestion from Europe of wrapping the inside of ambulances to make them easier to disinfect. And several other nations have asked about the VTAC system and its feasibility.
"COVID is an absolute tipping point," says Nolan.
"I think it is the call to action of our generation … to make the health care system better and to acknowledge the important role that paramedics have in that journey."
What does that better health care system potentially look like?
It involves going above and beyond simple medical checks. In some cases the human contact the VTAC team provides to those who are isolated is as important to their wellbeing as the medical care.
Consider this scene that unfolded while CBC News was with a VTAC team. At a seniors residence in Renfrew County, the windows of the residents' bedrooms are decorated with signs reading We miss you, we love you. So far, COVID-19 has been kept out of the residence, but those signs remind that surviving is not the same thing as living.
With a "no visitor" policy, the appearance of paramedics like caped superheroes in their PPE is totally welcome. All inside know the paramedics are not here because something's happened, they're here to ensure it doesn't. There are more residents to be swabbed to test for COVID-19, just in case.
Since journalists can't go in, the VTAC team wore disinfected cameras strapped to their chests, and with permission of the residents we got a glimpse of interactions both loving and necessary.
Resident Stan Broski is there with his wife who has dementia. "I'm feeling fine, but I'm 88 and my legs are 108," he offers.
And he's clearly happy to see the paramedics, even if they bring that impossibly long swab.
"I've been here four years and this is the most excitement I've seen," he jokes.
He talks proudly to the VTAC team of his son who is a doctor in St. Catharines, of missing everyone he loves. And loved. "I miss my mother," he says.
Further down the hall is Joan Walsh.
"How are you, my dear? We're going to make this as smooth as possible," says paramedic Chris Day.
He has seen a lot through his job. Not long ago he sat with a patient who wanted to die at home, but was alone. Day was able to connect the family via videoconferencing and be the surrogate caring soul holding the man's hand. The family sent him a beautiful note, one of those traumatic treasures of COVID-19.
With Walsh, though, there are lots of smiles behind those masks. She seems fine — no cough or runny nose, and the COVID-19 test is quick.
"It was alright," she says.
The paramedics help her to the window and put a phone close so she can talk to us outside.
"I'm an awful book reader, so I read a lot of books," Walsh tells us.
"I have eight children," she adds, "five sons in the valley and three daughters. I tell them all the time I love them, and they tell me they love me too … I don't know what else to say."
That's all there is to say. The little things are the big things now, like care that takes its time and paramedics who go out of their way.
Now the test, to see if this Renfrew County experiment survives in a post-COVID world.