Michael Nolan. Chief, Paramedic Service Director, Emergency Services Department County of Renfrew

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1 Michael Nolan Chief, Paramedic Service Director, Emergency Services Department County of Renfrew President Emergency Medical Service Chiefs of Canada 1

2 Invest in a Government Relations Program Create a National Research Framework Establish Canadian EMS Benchmarks Create a Position Paper that defines the role of the Community Paramedic in Canada Create a Canadian Mentorship Program Create a National Leadership Competency Profile 2

3 Why Community Paramedic Programs? 3

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6 CPR / AED Aging at home Heart Wise Exercise Community Paramedic Programs PACCT Referral Paramedic clinics Adhoc Home visits 6

7 Heart Wise Exercise Encourages regular, daily aerobic exercise Incorporates and encourages warm up, cool down and self-monitoring with all exercise sessions Accepts participants to exercise at low intensity Accepts participants with a known history of cardiac disease provided they have physician approval Provides health screening for all participants Has an emergency plan, phone access to Paramedic Service and an AED 7

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9 Community Paramedic Clinics There is an identified need in the community for primary health monitoring. There has been a withdrawal of family physicians. There are many communities without a hospital. Paramedics provide health teaching including blood pressure, blood sugar, medication, physical activity and nutrition monitoring. We have also partnered with the Cardiovascular Health Awareness Program to support patient teaching and data gathering. Paramedics now refer to Paramedics. Paramedic clinics Adhoc Home Visits Within the emergency deployment plan Visits for shut-in seniors Paramedic identified inclusion Referrals from the medical community Voluntary inclusion Referrals to and from the Community of Care Access Centre and the Geriatric Emergency Nurse Program Adhoc Home visits 9

10 Paramedic and Community Care Team provides access to in-home and community health services to maintain an individual s health, independence and quality of life. Community Services include: Specialized Services include: Nursing Personal support Physiotherapy Occupational therapy Speech-language therapy Social work Nutritional counseling Medical supplies and equipment Convalescent Care Respite care Child and family services School Health Support Mental Health Palliative care PACCT Referral 10

11 Paramedics Evaluating the Risk of Independence Loss The "PERIL" prediction rule uses three variables that are easily collected by paramedics in the homes of older clients to identify those at highest risk for recurrent ED use, hospitalization or death within 30 days. If a subject has a score of PERIL 2/3, 70% will have an adverse outcome within 30 days. Randomization The community paramedic study coordinator request permission to randomly assign patients to the usual-care or usual care plus which includes the addition of direct referrals by paramedics to CCAC homecare services. All patients are followed by a community paramedic study coordinator. PACCT Referral 11

12 For the researcher in you We are comparing the proportion of patients with recurrent EMS contacts within 1 month between patients who received usual care and those who had direct referral to home care services. We will use chi-square analysis. We will analyze time to first recurrent EMS contact between groups using a log rank statistic and associated Kaplan Meier plot. We will also compare the total number of repeat EMS visits between groups using a Poisson regression analysis adjusted for the correlation among observations from the same subject. Dr. Jacques Lee Paramedic and Community Care Team Referral Evaluation Repeat EMS use by patients 1, 3, 6 and 12 months Hospital admission rates 1, 3, 6 and 12 months Use of community services within 1 and 3 month Mortality within 1, 3, 6 and 12 months Functional decline within 1 and 3 months 12

13 The Champlain CCAC is thrilled to participate in this partnership with Ottawa and Renfrew County Paramedic Services. As an integral part of the health care system, paramedics are in an ideal position to identify and refer at risk clients in the community. CCAC will then coordinate an assessment of need and connect the clients with services in the community. Together we will ensure elders receive the support they need to maintain independence. Sincerely, Kimberly Peterson Senior Director of Client Services Champlain CCAC PACCT Referral The Deep River Opportunity The Paramedics Supporting Seniors aging at home program is designed to allow seniors to live with dignity and independence in their own homes. Provincially a $702 million investment over 3 years was created for that programs suited the needs of seniors choosing to live in the community could be developed. Aging at home 13

14 Aging at home goals We are providing the necessary support seniors staying in their home We are decreasing unnecessary 911 calls We are decreasing Emergency visits and hospital off-load delay We are improving the quality of life of our seniors in our community We relieve stress for the family and caregivers Aging at home Aging at home 14

15 The numbers Aging at home $54.66/resident/day Long Term Care $169.66/resident/day 24 hour access to RN 24 hour access to PSW Maintenance Housekeeping Admin support No co-payment 24 hour access to RN 24 hour access to PSW Maintenance Housekeeping Admin support The resident pays $53.07-$71.07/day Aging at home The Future CHF Assessments Diabetic assessment Mini-Mental Exam for Dementia patients Fall prevention Home safety audits Venipuncture / Blood Sampling Urinalysis Suture/staple removal Wound care Immunizations Medication compliance Antibiotic administration B12 injections Wellness clinic for families 15

16 Aging at home 16

17 CPR / AED Aging at home Heart Wise Exercise Community Paramedic Programs PACCT Referral Paramedic clinics Adhoc Home visits Michael Nolan Chief, Paramedic Service Director, Emergency Services Department County of Renfrew President Emergency Medical Service Chiefs of Canada mnolan@countyofrenfrew.on.ca Heart Wise Exercise Community Paramedic Series 17