White Coat, Black Art

Paramedics hone in on 911 'hotspot' buildings to help isolated residents

Toronto paramedics set up regular clinics in buildings that have a high volume of 911 calls in the hopes that a dose of prevention can improve residents' health and reduce the number of non-emergency calls being made. And experts says there's an added benefit: The regular visits improve residents' health by combating loneliness.
Community paramedic Erin Stankevicius takes the blood pressure of Sara Ponnampalam (seated). Ratnajothy Paramjothy (standing) looks on.
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One resident had severe asthma, another suffered from mental health challenges, a third was dealing with high blood pressure.

But they all had something in common: They live in a high-rise apartment building and when they needed medical care, whether it was an emergency or not, they dialled 911.

It's not an uncommon occurrence — with more than 400,000 emergency calls each year, the Toronto Central Ambulance Communications Centre responds to a lot of home calls — and many are not medically critical.

It's not the best use of paramedics' time or resources.

"[In] one of the five buildings, there were more than 200 calls [in one year],"  paramedic Jessie Lee told White Coat, Black Art host Dr. Brian Goldman.

Toronto paramedics bring weekly clinics to buildings with high number of 911 calls 1:01
Lee, who is also a systems engineer, developed a computer algorithm that can determine which callers are likely to make repeat calls to 911 for what might be considered primary care.

Lee's data pinpointed several buildings that were "hotspots" for 911 calls. Armed with that information, Toronto paramedics took action, setting up clinics in five buildings operated by Toronto Community Housing, in co-operation with Central East Local Health Integration Network (LHIN). 

"For most apartment buildings, we see between 30 and 50 911 calls in a year," paramedic Mike Roffey said, adding that the buildings Lee pinpointed saw three times that many calls.
Community paramedic Erin Stankevicius speaks with 50 Tuxedo Court resident Sivamany Sivapantham. Taking the time to listen is one of the great benefits of the on-site clinic.

For the past six months, Roffey and other paramedics have set up regular clinics in some of the buildings that had a high volume of calls, in the hope that a dose of prevention could improve residents' health and reduce the number of non-emergency 911 calls being made.  

Many of the residents who live in the buildings are elderly, often socially isolated with a number of health issues. 

One of the buildings Lee's data honed in on was at 50 Tuxedo Court in Scarborough, in the city's east end.
Annie Tse explains a blood pressure reading to Lin Heung Kong. Tse is a mental health case manager for the Hong Fook Mental Health Association. In addition to arranging mental health services, Tse often acts as translator for residents who speak Cantonese and Mandarin.

Knocking on doors

The clinic is set up on the 16th floor of the building's common room, and operates for about four hours once a week. In addition to offering a space for patients to get a blood-pressure check, ask about aches, pains and shortness of breath, or get advice, paramedics knock on the doors of frequent callers.

"You get to see people when they're not in crisis," said Erin Stankevicius, a paramedic who makes weekly visits to Tuxedo Court.

"You can sit down and have a lot more meaningful conversations and really figure out exactly what they need."
Jessie Lee, left, is a paramedic with Toronto Paramedic Services. She has a degree in systems engineering at the University of Toronto. Lee developed the computer algorithm that enables paramedics to discover 911 hotspots like 50 Tuxedo Court. Mike Roffey is a veteran paramedic and superintendent of the Community Paramedic Unit. He manages the five community paramedic clinics in Scarborough.

Sara Ponnampalam has been coming to the clinic each week. She has high blood pressure, diabetes, thyroid issues and back problems. She said she's called 911 in the past. Now her regular visits to the clinic help her manage her health.  

"The last two weeks I [went] to a diabetes class. We are getting knowledge," she said.

According to Stankevicius, it's not just about health. Visiting potential ER patients at home means that paramedics get a window into other pressing problems.
Ratnajothy Paramjothy gets her blood pressure checked by community paramedic Erin Stankevicius. Paramjothy lives at 50 Tuxedo Court, and comes to the community paramedic clinic once a week. Sometimes she acts as interpreter for fellow residents who don't speak English.

"A lot of them are proud, too. They don't want to tell people they can't afford food," she said.

From Stankevicius' view, the program is working. She cites the case of one resident who has mental health challenges, who would call at least once a week.

Now he's calling infrequently and visits the clinic in his building.

"He says that he's been doing a lot better … I think, just him getting to know us — that familiar face — is making it easier to come to clinic, too," she said.

"Maybe it's helping with his need or want to go and call 911 as a primary resource."

'Something to look forward to'

The social aspect of the program is "huge," Stankevicius said. Rather than sitting alone in apartments, the residents have a place to meet up.

"I think, (they are) sitting at home alone, lonely, not having anything to do. This gives them something to look forward to," she said.  

While the team requires a full year of data to determine whether the program is a success or not, Roffey is already seeing the benefits.

"We did identify one client who had severe asthma. She called EMS 19 times in a six-month period," Roffey said.

She was identified by the frequent caller program and got connected with additional community-based services that she didn't know were available to her.

After that, "she only had four EMS calls post the home visit."

That anecdotal success is supported by research. 

As part of her research, Dr. Gina Agarwal of McMaster University developed the model for the paramedic clinic at 50 Tuxedo Court -- and 55 more similar clinics across Ontario.
Dr. Gina Agarwal is a family practice doctor and a health services researcher at McMaster University in Hamilton, Ont.. She developed the community paramedics clinics model to address the needs of marginalized communities that generated a high volume of 911 calls. There are now 55 clinics operating in apartment buildings across Ontario.

Her research indicates that the program results in a 25-percent drop in 911 calls. Residents who attend the paramedic- run clinic change their lifestyle over time which means they reduce their risks of chronic diseases like diabetes leading to better health outcomes.

Unexpectedly, the clinics "have been measured to increase significantly the quality of life of the individuals living in the building," said Dr. Agarwal.

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