Emergency Paramedic Response from the Sharp End

CLIVE ADDY

Jul 15, 2014

FrontLine’s Executive Editor, Clive Addy, recently took the opportunity to speak with Dwayne Forsman, the Chief Administrative Officer of the Paramedic Association of Canada and Greg Forsyth, Superintendent Special operations of the Ottawa Paramedic Service some questions about the evolution of their profession over the last years and get their opinions on future general needs and responsibilities. Dwayne has been a Paramedic for 37 years, in both rural and urban environments. Greg has been a Paramedic for 12 years and was a Paramedic Tactical Unit member for 7 years before advancing to his current role. Greg continues to be involved with the training and development of Paramedic Tactical Unit members and regular operations Paramedics.

Clive: In Canada, it appears that the need, scope and use of paramedics have increased significantly over the last several years. What has been your experience in this case? Where have you operated? Can you give me a brief description of your most harrowing successes and frightening moments?

Dwayne: When I started, paramedic services were little more than first aid services that could get you to a hospital fast. Today Paramedics are essentially bringing the Emergency Room to your living room. Patients who encounter a medical and trauma emergency are being stabilized in the field across Canada by highly trained Paramedics with less emphasis on a fast ride to hospital.

Greg: The overall scope of Paramedicine has changed considerably over the last 10-15 years. Not only are Paramedics bringing an increased skill set to the patient’s bedside but they are also able to provide care within certain environments that traditionally they did not enter which ultimately delayed care and put lives at risk.

We have had to deal with environments such as the presence of an active shooter, CBRNE scenes, on the water for dive operations or in support of large scale demonstrations. As a Paramedic for 12 years in the city of Ottawa, I have worked in both a rural and urban settings, although on land only.

Due to how dynamic a scene can be for a Paramedic, there have been many examples of when things got interesting. Scenes can quickly escalate to the point where you find yourself in the middle of conflict. Paramedics routinely walk into many unknowns with limited information. The potential is always there for the scene to escalate, which is evidenced by the increase in violence being reported by frontline responders across the country.

I take the most pride in successful resuscitation of cardiac arrest patients. I remember those times when I felt that we were just too far away and their down time was just a little too long prior to our arrival. We always put everything into those scenes to give the patient that fighting chance. There have been a few examples of patients that I have brought into the hospital, unresponsive with a heartbeat and was fortunate enough to have them thank me a few days later.

Clive: There seem to be very definite differences in how Paramedics are qualified categorized and certified nationally. What is the position of the Paramedics Association of Canada on these 3 issues? Doctor certification, or by provincial or local authorities, based on national or provincial standards?

Dwayne: The regulation of Paramedics is a Provincial responsibility. Paramedics are regulated and licensed within each Province. Nationally, the Paramedic Association of Canada sets the educational standards for each level of Paramedic; Emergency Medical Responder (EMR), Primary Care Paramedic (PCP), Advanced Care Paramedic (ACP), Critical Care Paramedic (CCP). Currently, there is no National Registry for Paramedics. The Paramedic Association of Canada has made the creation of such a National Registry a high priority in the next year.

Clive: When and if you need air assistance, have you had use of ORNGE, the Canadian Forces Search and Rescue, or others?

Greg: We cover a large geographical area and have required air assistance. ORNGE has been called to facilitate that continuity of care and rapid transport to the local Trauma center. I have had ORNGE land on golf courses and on major highways when time and distance was not on our side. The CF has always remained an option as our scope continues to evolve. Our Paramedic Tactical Unit and Paramedic Support Unit members provide response in remote areas with difficult terrain. In such incidents, ORNGE would not be an option whereas CF would be able to provide that assistance.

Clive: Many Canadians do not appreciate how lucky they are to live in such a resource rich, wealthy and democratic country. The emergency public health services you provide are one of many elements to ensure their well being in case of disasters of all kinds. Recently, the federal government allocated a dedicated part of the 700 MHz spectrum for communication and coordination of emergency services of all types. Where is this resource most needed from the paramedic point of view, and have you been involved in defining this need?

Dwayne: The Paramedic Association of Canada supports the Federal Governments move to dedicate the 700 MHz spectrum for emergency services. The current band that is used by most emergency services including Paramedics is at capacity. By moving to a dedicated band, Paramedics can use new technology to improve patient care such as sending data to hospitals, creating video links with physicians, the possibilities would be endless.

Clive: Nationally, do you see the need for paramedical emergency services expanding? Being better supported in one or another area?

Dwayne: The need for Paramedics continues to grow across Canada as the Baby Boomer generation moves into retirement age. Traditionally, ambulances take patients to hospital regardless of their medical problem. Hospital Emergency Rooms are overwhelmed with patients. This causes Paramedics to wait with their patients for the hospitals to accept them. Instead of transporting all patients to an ER, Paramedics need the authority to make decisions of where the patient should go, based on their medical need. Instead of an ER, maybe they should be transported to an Urgent Care Centre or a Quick Care clinic. Maybe they could be advised that their medical problem can wait until they can see their own physician, or maybe their medical problem can be treated in the patient’s home by Paramedics requiring no transport.

For the most part, urban areas are well supported; it’s the rural and especially remote areas of our country that lack support. Typically, the urban centres have the highest level of trained Paramedics whereas the rural and remote areas have the lowest level and least trained Paramedics. It is these rural and remote areas that need the most support as they have the least amount of health services. Transport times in these areas could be an hour or more. One could argue that the rural and remote regions of Canada should have the highest level of Paramedics.

Clive: What are the top three needs and challenges for the Emergency paramedic response in the Ottawa area?

Greg: I think the challenge will continue to be ensuring Paramedic availability for the next request. Many measures have been instituted such as the offload nurse program and the community paramedicine trial. As call volume continues to increase and the calls become more complex with an aging population, the overall demands on the system increase as well. We must continue to endeavour to meet these demands through technology, evidenced based advancement in training and treatment options and staffing modifications to remain ahead of the curve.

Clive: What would you wish to leave our security readers as your “final thoughts” about your trade in Canada?

Dwayne: Canadians need to know that they have an excellent Paramedic service as compared to most developed nations. Although there are some areas that need to be upgraded, over-all , they should be comfortable in knowing that when they need a Paramedic, they will be receiving the best care.

Greg: As much as the system has evolved over the past 10-15 years, I am sure the landscape will look quite different over the next 20. The demands on the hospitals, the increase in call volume and the complexity of the calls and scene dynamics will continue to shape the Paramedic response in Canada. I think the profession will continue to grow to ensure Paramedics with specific skill set make it in time to a patient’s side no matter where they may be.