Blog·DR. GOLDMAN'S BLOG

Paramedics' visits to 911 'hotspots' reduce ambulance calls, study suggests

Paramedic-run clinics in low-income apartments reduce 911 calls & improve the health of the people who live there. @NightshiftMD has the results of a new study.
Jessie Lee, left, a paramedic with Toronto Paramedic Services, developed the computer algorithm that enables paramedics to discover 911 hotspots. Mike Roffey manages five community paramedic clinics in Scarborough.

As our population ages, more and more seniors call 911 to get help, increasing demand on the system. 

A new kind paramedic is helping to fill the gap. And they don't need an ambulance. That's according to a study published earlier today in the Canadian Medical Association Journal. 

These paramedics don't respond to emergencies. They're called community paramedics because they don't act as first responders to people who call 911 for emergencies like motor vehicle accidents and heart attacks.

Community paramedics do health promotion and disease prevention at special clinics. In theory, the clinics can be set up anywhere they're needed.

The study looks at a health promotion program for seniors called Community Paramedicine at Clinic (CP@clinic). It's a pilot program in which researchers set up clinics right inside subsidized apartment buildings for low-income seniors.

911 'hotspots'

The researcher deliberately chose apartment buildings that have lots of seniors with chronic medical conditions like high blood pressure, diabetes, elevated cholesterol, plus heart and lung disease.

Recently, I visited a paramedic clinic located at 50 Tuxedo Court in Toronto's east end. The building was chosen because it's what paramedics call a 911 "hotspot." That means it generates a disproportionate number of 911 calls per year.

An apartment that size typically calls 911 around 50 times a year. They're putting clinics in apartment building that call 911 100 or even 200 times a year.

By installing a clinic at a 911 hotspot like 50 Tuxedo Court, they're hoping to monitor and improve the health of residents so they don't need to call 911 as much. 

Toronto paramedics bring weekly clinics to buildings with high number of 911 calls

4 years ago
Duration 1:01
Toronto paramedics bring weekly clinics to buildings with high number of 911 calls

CP@clinic is set up as a weekly drop-in centre staffed by paramedics. No appointment is necessary. They post signs in the lobby and do walkabouts in the hallways, knocking on the doors of seniors who called 911 recently. 

Anybody who drops by the clinic gets their blood pressure and blood sugar measured. They're assessed to see if they're at risk of falling.

The paramedics also do health education and promotion on diet and exercise. They make referrals for mental health services, smoke cessation and others.

As needed, they can speak to the resident's family doctor. If they find that a senior is having chest pain or is otherwise ill, they summon an emergency paramedic to take the patient to the hospital.

Reducing demand on 911 services

Researchers from McMaster University compared the community paramedic clinics to usual care at six low-income buildings located in Hamilton, Ont. 

In the buildings offering CP@clinic, 911 calls dropped from four calls per 100 apartment units per month to just over three. That's a big drop in the number of 911 calls. The apartment clinics picked up undiagnosed hypertension in 36 patients and elevated blood pressure in 75 people with previously diagnosed hypertension.

After attending CP@clinic, the blood pressure dropped significantly. The clinics detected undiagnosed diabetes in 14 seniors and another 50 with blood sugars that put them at risk of getting diabetes within the next 10 years. There were other indicators that the clinic helped seniors take better care of themselves.

This is the first well-designed clinical trial to show that community paramedics can reduce demand on 911 services while improving the health of people who call 911.

In some parts of Canada, 911 calls are going up eight per cent a year. In rural Nova Scotia, community paramedics work alongside nurse practitioners; together, they have reduced visits to the ER by 40 per cent.

Paramedics in the Ottawa region have developed a program that provides rapid access to palliative care services so that patients with terminal illnesses can remain at home. 

Having visited many of these programs, it's nice to see paramedics using their unique knowledge creatively to meet the increasingly complex health needs of Canadians.

If a clinic of paramedics sets up a clinic where you live, consider yourself fortunate.

ABOUT THE AUTHOR

Dr. Brian Goldman is a veteran ER physician and an award-winning medical reporter. As host of CBC Radio’s White Coat, Black Art, he uses his proven knack for making sense of medical bafflegab to show listeners what really goes on at hospitals and clinics. He is the author of The Night Shift and The Power of Kindness: Why Empathy is Essential in Everyday Life.

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