By Gillian Slade on September 14, 2018.
Local EMS are embracing the idea of paramedics providing in-home medical care, quite often avoiding trips to hospital for the patient.
The EMS community response team program was launched in Medicine Hat at the end of July. There were 67 events/calls in the first 30 days, with 95 per cent of patients able to avoid a trip to the hospital. The remaining five per cent had more complex needs that required hospitalization, says team leader Gareth Hughes.
The response team of three operates from 7 a.m. to 7 p.m. every day, but at the beginning of November will expand to five working from 6 a.m. to 10 p.m.
Medicine Hat is one of the last cities in Alberta to come on line with the service. Initially called “community paramedics,” it was announced in February by Alberta Health.
Dr. Anthony Jeraj saw value 15 years ago in the community response team concept. He notes it has been done in California for about 20 years.
“It is something that I have always wanted,” said Jeraj, who has many patients in seniors’ residences. “Probably in the last two weeks I’ve kept 10 people out of the hospital … It’s fantastic.”
Patients are “ecstatic” and call it “phenomenal,” he says.
The team administers urgent medical care only in supportive living and long-term care seniors’ residences. They do not respond to emergencies. The service is usually triggered by a registered nurse at the seniors’ facility or by the patient’s physician.
On arrival, team members do a full assessment of the patient after hearing background information from the registered nurse. They have access to online Netcare medical records of the patient and are also in telephone contact with the patient’s doctor, or a team of doctors specifically available to the team.
They make recommendations to the doctor based on the assessment, says community response paramedic Jenn Bomersine. The doctor prescribes and it is administered by the team.
Together with the physician they develop a collaborative care and a follow-up plan, says Hughes. If an antibiotic in an IV is prescribed this is likely to take place over three days and typically the patient receives a follow-up visit within 24 hours.
A typical visit can last two-and-a-half to three hours, said Hughes.
The response from seniors’ residences has been overwhelmingly positive.
Bomersine says often one of the contributing factors to a senior not being well is dehydration. An IV can make a significant difference in a short time. In addition to administering IVs, antibiotics, collecting lab specimens for testing, they do urinary catheterization, wound care, oxygen, nebulizer therapy and ECGs. Even blood transfusions will soon be available.
Often family members of the patient are either present or talk to the team on the telephone, too, says team member Hanna Lee. Patients often express surprise and delight that they will not need to go to hospital.
For Bomersine, who has been a paramedic for a number of years, the decision to upgrade her skills and join the team was a result of observing the number of times she was taking someone to hospital, although it did not really meet their needs.
It is an area of health care not done before and is an opportunity to be on the leading edge of comprehensive health care without going to the emergency department, she said.
To qualify for the community response team, a paramedic receives two months classroom instruction with advanced cardiac assessment training, geriatric assessment care and pharmacology, to name just a few. They then work with another team for a period of time.
“The training we were required to do for this job was out of the world,” said Bomersine.
The system could work for the public in general, not just seniors’ in residences, Jeraj suggests.
Hughes also sees the value of this, purporting it could come in future.
Some of the issues to resolve first would be determining how the service is triggered. It would not work through the 911 system. Jeraj wonders if perhaps the community response service would have to be requested through a physician.
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