Researchers rethink the role of paramedics in the health system

As a paramedic, University of Toronto alumnus amir alana He routinely responds to a wide range of calls, from people experiencing a heart attack or stroke to people experiencing mental health and addiction issues.

“On any given day, you could go from acute trauma to someone who is 70 years old and just had a fall, but is otherwise uninjured,” says Allana, who recently defended her master’s thesis in the research program at health services offered by the Dalla Lana School of Medicine. Institute for Public Health Health Policy, Management and Evaluation (IHPME).

“The next call could be for someone who is in a shelter system who has a number of chronic conditions that have worsened, or who just needs a place to go. Are you trying to navigate to what extent is this a health issue versus a social issue? Is this an addiction problem? You’re switching gears all the time, and a lot of that is finding cases, triaging and navigating the health care system.”

In fact, Allana says that traditional medical emergencies represent only a small fraction of the cases she sees.

“It’s hard for newer paramedics who spend their entire education thinking about trauma and cardiac arrest, only to realize, ‘Oh, that’s only 10 percent of what I do,’” he says. “There aren’t enough educational or cultural pieces to tell them, ‘Actually, your role for the most part is diagnosis and care navigation. Your role is an extension of health services because you are mobile in the community.’”

Allana and her co-supervisor, Andres Pintoan associate professor at the Dalla Lana School of Public Health and a family physician at St. Michael’s Hospital, recently published an article in health policy, which explores how paramedics can address the social determinants of health more effectively.

Care could be improved, they argue, by equipping paramedics with tools for better social and environmental assessments. For example, the questionnaires could be used to help paramedics screen patients for risks associated with housing, income, and food insecurity. Paramedics could also address health-related social factors by working directly with community organizations such as legal aid, shelters, detox centers, food banks, and employment agencies. Allana says such an approach would require a change in paramedic education, culture and governance.

His research also looks at integrated care and how paramedics can extend primary and preventive care in home and community settings.

Allana says that the pandemic has exposed the vulnerability of the health system and provides an opportunity to think about how to restructure it in a way that leverages local agencies and services to improve outcomes.

“There are approaches to care that can be delivered in the community, but they require a rethinking of the role of primary care, community nursing and mobile care teams, including paramedics and mental health services, to address the needs of people. people in a way that you don’t depend only on doctors and nurses in a hospital,” he says.

In a study published in the International Journal of Integrated Care, Allana analyzed 108 programs around the world that use paramedics in various care pathways in the community. She found that paramedics filled gaps in care by working in the silos that exist between hospitals, social services, primary care, and public health. For example, in some jurisdictions, paramedics work with primary care teams to address flare-ups of chronic conditions such as heart failure (when the heart is too weak to keep up with the body’s pumping needs) and chronic obstructive pulmonary disorder (a lung disease that causes breathing problems). problems) by going into the community to address needs both reactively and proactively.

“Even something as simple as monitoring the weight of people with congestive heart failure can detect deterioration early,” says Allana. “Family health teams and paramedics can put systems in place to follow care plans and adjust medications. There is something in between purely scheduled primary care and highly acute unscheduled emergency care: there is a huge gap in the middle that no one fills, and many new [paramedicine] the programs are filling that.”

Allana says that ultimately a broader view of the profession is needed and that investing in the ability of paramedics to provide urgent and preventative care will strengthen the health system for all.

“Use of emergency departments and hospital services has outpaced population growth for several decades and will continue to do so. The reason for this is that you are not providing adequate care options in the community. We don’t have the capacity in the acute care system to adequately care for people. If you invest in prevention and care coordination, it will pay off in the long run and reduce the need for additional emergency coverage over time.”

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