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Seeing the future of paramedicine in community-based care

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Three years after its launch, EHS Operations community paramedic Brian MacDonald has come to see the Cape Breton Community-based Paramedic Program in a unique way. 

“It’s a stool with (multiple) legs and (each of the) legs are equally important,” MacDonald said, describing the collaborative care provided by a team with varied expertise, including a community paramedic, clinical support telecare nurse, and online medical physician.

Since December 2018, the program has seen community paramedics perform in-home services and clinical support telecare nurses provide virtual care services up to 72 hours after being discharged from the Cape Breton Regional Hospital and Glace Bay General Hospital in-patient units or Emergency Departments.

Subsequent phases of the program have included services on the surgical floors of the CBRH with additional phases planned in the future.

The program operates via a referral-based system where patients are referred to the program by a doctor, nurse practitioner, nurse or respiratory therapist.

Each referral is clinically reviewed by a clinical support telecare nurse and visits are scheduled in consultation with the referrer, patient or substitute decision maker. 

“We don’t see them face-to-face, but we give them a call at an appointed time, and we go over everything that they basically need to know,” said Erin Murray, who has worked as a clinical telecare nurse with the program for a year.

“We answer their questions about what they’re experiencing with their illness, we give suggestions for ways that they can improve and manage their illness at home.”

MacDonald, who has been a paramedic for 38 years, calls the program “slow medicine”, a marked difference from the acute emergency care ground paramedics routinely provide.

“You’re looking at the patient holistically, you’re looking at more than just their illness,” he said. “That’s the primary reason you’re there, but you’re looking at their quality of life, making their lives a little better, a little safer.”

Together, the team – including paramedic, nurse, doctor and referrer – reviews the individual care needs and then builds a care plan through consensus, an evolution of the program since its inception.

“I think that is one of the greater things we arrived at, where this program landed,” said Dr. Andrew Travers, the EHS Provincial Medical Director. “That wasn’t by design, we didn’t plan it, but it is an example of how a medic, a nurse, and a doctor all came together differently and they come up with a plan.”

Care plans discussions are collaborative and include the referrer, happening in real time and sometimes within full view of the patient and/or their family. 

“And it’s good, they’re seeing this collaboration unfold,” Travers said, citing lessons learned from Collaborative Emergency Centres across Nova Scotia.

“It’s a different place, but it’s a care plan that’s driven by consensus, and so there’s this roundtable, a conversation,” he added.

“And if one of (us) wasn’t comfortable with the plan, then it would be ‘ok, we need to revisit this’. You want to pay attention to that intuition that the nurse has or the medics has or the doctor has.”

Murray said using this collective expertise better serves the patient.

“Having the (team) work together, we’re able to get a big picture of what’s going on in that patient’s life,” she said.

“We’re able to advocate for the patient on (multiple) different levels, but basically with the goal of bringing it together as one.”

Patients and their families are taking notice of that unique model of care and paramedics are hearing about it, MacDonald said.

“I’ve never seen positive feedback like we’ve had on this program. We’re seeing the results of that now because patients are going to see their doctors or other specialist or they’re ending up back in the hospital and they’re demanding community paramedics come back,” he said. “They’re actually naming us by name and saying ‘we want the community paramedics to come back and see us again’.”

Travers sees this as the future of paramedicine, as healthcare providers look for new and innovative ways to meet people’s needs.

“There’s input into the healthcare system, then there’s output from the healthcare system, then there’s this example of keeping patients out of the system. And that’s what I think the new EMS model is going to be,” he said.

“I’m glad to be part of that whole group that’s going to grow in this paradigm.”

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