It may be a single paramedic who responds the next time you need help — part of a program in Nova Scotia that is working to reduce the number of trips the emergency department makes for non-urgent cases.
The Single Paramedic Emergency Advanced Life Support and Basic Life Support program (SPEAR) is now being used as one way for Emergency Health Services to better prioritize calls.
“There was a coverage gap and we had patients waiting an inordinate amount of time,” said advanced care paramedic Rob Groom.
“The need was to get paramedics to these patients so they weren’t waiting so long that their condition deteriorated and there was a poor outcome. It was all about patient safety.”
Two years ago, Nova Scotia’s ground ambulance operator — Emergency Medical Care Inc. (EMCI) — built a virtual care team in its dispatch centre that includes a physician, a nurse and a paramedic who support SPEAR paramedics attending calls.
“We took a look at the call volume and the types of calls that we get and realized that about 70 per cent of our calls are not ‘true emergency’ in the sense that they require lights and sirens and a rush to the emergency department,” said Charbel Daniel, EMCI’s executive director of provincial operations.
Calls deemed less urgent were overcrowding emergency departments with ambulances having to take everyone to the same destination, even when the ER wasn’t necessarily what each patient needed.
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“Now when the calls come in, they’re reviewed,” Daniel said. “If it’s a non-urgent call, or what we consider a ‘low-acuity call,’ we’ll hold that call and then we’ll send a single responder to go and work with that patient and find an alternate disposition.”
While some of the SPEAR-attended calls do still end with an ambulance transfer, more than half of single-paramedic calls don’t require emergency department visits.
“For the paramedics, I would say that there’s a huge amount of buy-in,” Groom said. “For patients, it’s an adjustment, right? This is a completely new situation. Once we get there and explain the whys, they quickly warm up to the idea.”
EHS could have up to 10 SPEAR units available at a time — mainly focused in parts of Halifax Regional Municipality, Truro, Cape Breton and Kentville.
“We do, on average, about 700 calls a day. About 30 per cent of our emergency calls are now not transported to the EDs,” Daniel said.
“They’re either treated and released, they’re provided an alternate disposition — but something that truly enhances the patient experience.”
That means that somewhere between 100 to 200 patients daily are diverted from emergency rooms through the initiative.
“I think there’s an increased sense of accomplishment, you feel like you’re doing the work that you were trained and hired to do,” Groom said.
“You alleviate some of the stress on the health authority and you get some ambulances out back a little faster, hopefully, and then the paramedics that are in the ambulance get to focus on the folks who are the sickest.”
Groom said being on-scene and able to do an assessment to figure out the urgency of the situation allows him to call on a transport unit if necessary, or create an alternate plan for later transport if possible.
While encouraged that EHS is working hard to evolve and adjust to the demands of the system, he is apprehensive about deviating the standard of care for Nova Scotians.
“Ideally, we want these patients to get where they need to be in a timely fashion,” Groom said. “So, this is the EHS response to challenges that are beyond our control.”
Daniel said he thinks EMCI is on-pace to keep up with the province’s growing population as EHS tackles a call volume that grows annually by between three to five per cent.
“We’re cautiously growing the program as we continue to move forward,” Daniel said. “Mainly in the urban centres, but there is a vision at some point to go a lot broader across the province.”
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