Paramedics’ visits to 911 ‘hotspots’ reduce ambulance calls, study suggests

As our population ages, more and more seniors call 911 to get help, increasing demand on the system.

Jessie Lee, left, a paramedic with Toronto Paramedic Services, developed the computer algorithm that enables paramedics to discover 911 hotspots. Mike Roffey manages five community paramedic clinics in Scarborough.

Dr. Brian Goldman, CBC Radio May 28, 2018

As our population ages, more and more seniors call 911 to get help, increasing demand on the system.

A new kind paramedic is helping to fill the gap. And they don’t need an ambulance. That’s according to a study published earlier today in the Canadian Medical Association Journal.

These paramedics don’t respond to emergencies. They’re called community paramedics because they don’t act as first responders to people who call 911 for emergencies like motor vehicle accidents and heart attacks.

Community paramedics do health promotion and disease prevention at special clinics. In theory, the clinics can be set up anywhere they’re needed.

The study looks at a health promotion program for seniors called Community Paramedicine at Clinic (CP@clinic). It’s a pilot program in which researchers set up clinics right inside subsidized apartment buildings for low-income seniors.

911 ‘hotspots’
The researcher deliberately chose apartment buildings that have lots of seniors with chronic medical conditions like high blood pressure, diabetes, elevated cholesterol, plus heart and lung disease.

Recently, I visited a paramedic clinic located at 50 Tuxedo Court in Toronto’s east end. The building was chosen because it’s what paramedics call a 911 “hotspot.” That means it generates a disproportionate number of 911 calls per year.

Toronto paramedics bring weekly clinics to buildings with high number of 911 calls 1:01 CBC

CP@clinic is set up as a weekly drop-in centre staffed by paramedics. No appointment is necessary. They post signs in the lobby and do walkabouts in the hallways, knocking on the doors of seniors who called 911 recently.

Anybody who drops by the clinic gets their blood pressure and blood sugar measured. They’re assessed to see if they’re at risk of falling.

The paramedics also do health education and promotion on diet and exercise. They make referrals for mental health services, smoke cessation and others.

As needed, they can speak to the resident’s family doctor. If they find that a senior is having chest pain or is otherwise ill, they summon an emergency paramedic to take the patient to the hospital.

CP@clinic is set up as a weekly drop-in centre staffed by paramedics. No appointment is necessary. They post signs in the lobby and do walkabouts in the hallways, knocking on the doors of seniors who called 911 recently.

Anybody who drops by the clinic gets their blood pressure and blood sugar measured. They’re assessed to see if they’re at risk of falling.

The paramedics also do health education and promotion on diet and exercise. They make referrals for mental health services, smoke cessation and others.

As needed, they can speak to the resident’s family doctor. If they find that a senior is having chest pain or is otherwise ill, they summon an emergency paramedic to take the patient to the hospital.

Reducing demand on 911 services
Researchers from McMaster University compared the community paramedic clinics to usual care at six low-income buildings located in Hamilton, Ontario.

In the buildings offering CP@clinic, 911 calls dropped from four calls per 100 apartment units per month to just over three. That’s a big drop in the number of 911 calls. The apartment clinics picked up undiagnosed hypertension in 36 patients and elevated blood pressure in 75 people with previously diagnosed hypertension.

After attending CP@clinic, the blood pressure dropped significantly. The clinics detected undiagnosed diabetes in 14 seniors and another 50 with blood sugars that put them at risk of getting diabetes within the next 10 years. There were other indicators that the clinic helped seniors take better care of themselves.

This is the first well-designed clinical trial to show that community paramedics can reduce demand on 911 services while improving the health of people who call 911.

In some parts of Canada, 911 calls are going up eight per cent a year. In rural Nova Scotia, community paramedics work alongside nurse practitioners; together, they have reduced visits to the ER by 40 per cent.

Paramedics in the Ottawa region have developed a program that provides rapid access to palliative care services so that patients with terminal illnesses can remain at home.

Having visited many of these programs, it’s nice to see paramedics using their unique knowledge creatively to meet the increasingly complex health needs of Canadians.

If a clinic of paramedics sets up a clinic where you live, consider yourself fortunate.

Evaluation of a community paramedicine health promotion and lifestyle risk assessment program for older adults who live in social housing: a cluster randomized trial, Gina Agarwal, Ricardo Angeles, Melissa Pirrie, Brent McLeod, Francine Marzanek, Jenna Parascandalo and Lehana Thabane. CMAJ May 28, 2018 190 (21) E638-E647; DOI: https://doi.org/10.1503/cmaj.170740

ABOUT THE AUTHOR
Dr. Brian Goldman is a veteran ER physician and an award-winning medical reporter for CBC Television’s The Health Show and The National. Brian has a proven knack for making sense of medical baffelgab. On White Coat, Black Art, he takes listeners past medical bluff and bluster and shows what really goes on at hospitals and clinics. He is the author of The Night Shift and his new book The Power of Kindness: Why Empathy is Essential in Everyday Life. More from Dr. Brian Goldman

Source CBC Radio

Also see
‘My doctor thinks it’s super’: Paramedic house call program cuts down on ER visits in CBC News
When paramedics visit seniors, emergency room trips go down in McMaster University
Paramedics hone in on 911 ‘hotspot’ buildings to help isolated residents in White Coat, Black Art, CBC Radio
Paramedic-run health sessions in low-income apartments reduced number of 911 calls, improved health in EurekAlert! American Association for the Advancement of Science AAAS

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