Sheldon Hirschfeld is looking forward to providing a different kind of practice at a very different pace than he has seen through his first three decades as a paramedic.
“After 32 years of running, you actually get to spend some time getting to know the person you are helping,” said Hirschfeld. “When you are in an ambulance, you could spend a half hour with a person and when you would be asked what their name was you wouldn’t remember it. They were ‘the guy with the chest pain’ or the ‘the guy with the abdominal pain,’” he said. “Here, you get to know them. You get more time with them, so there is more of that trust relationship you get to establish.”
Hirschfeld is talking about the new Community Paramedicine Services program in Prince Albert, being piloted by the Saskatchewan Health Authority in partnership with Parkland Ambulance. The program’s goal is to provide optimal care for clients within their own residences which will reduce emergency room visits. Launched in June, the program is initially working with five personal care homes in the city – Green Hill Lodge, Good Shepherd Villas, River Breeze Retirement Complex, Kopera’s Care Home and Nelson’s Care Home.
Sheldon Hirschfeld, community paramedic in Prince Albert, puts a blood pressure cuff on Dolores Thorpe, a resident of Green Hill Lodge personal care home.
Hirshfeld and fellow paramedic Brody Anderson alternate shifts to support the service, available between 8 a.m. and 8 p.m. seven days a week.
Syma Hussain, facility manager of Green Hill Lodge, said she’s already seeing the value of the program at her 24-resident personal care home. “Residents can be anxious about having to go and perhaps be admitted to the hospital, or if they have to wait for long periods for something less urgent. The community paramedicine program helps us when we have someone who we think needs to be checked, but don’t believe it is serious enough for a trip to the hospital. We can call for the community paramedic and they can come and take a look at them.”
Hussain said Green Hill staff members have called for the program’s services several times. Each time, the community paramedic was able to assess and provide treatment without requiring the resident to go to the hospital.
“For the person, it’s not taking them out of their environment where they are comfortable and where they are at ease. So now, when they are ill, there’s not always that fear of going to the hospital,” Hirschfeld said. “Now, we are working to keep them at home. We function with the other members of the care team in the home, and with the doctors, home care. It’s all part of the puzzle that helps keep them in their home.”
Hirschfeld and Anderson took additional training to serve as community paramedics prior to the program’s launch. Among their news skills is the ability to do blood draws which are then taken to a laboratory where they are treated as urgent tests. This is another way the program reduces the burden on the care home resident and their family
Pat Chuey, administrator at Good Shepherd Villa, an 80-bed personal care home, said her team is excited about the additional support from the community paramedics.
“If we have to take a resident to the emergency department, it can be very traumatic for them, even if their own need is not as urgent,” said Chuey. “They can often be confused when they come back, which can be a problem for our staff to help settle them back into their environment.”
Chuey said something such as intravenous antibiotics can mean either several trips to, or a stay in, hospital. It also puts pressure on an individual’s family to either help provide transportation or be with them at the hospital. The community paramedic can provide that service, which helps keep the resident at home.
Hirschfeld is excited about his new role and the relationships he can develop with patients.
“In the emergency setting, or the ambulance setting, we assess the patient and it dictates their care and then we hand off care,” he said. “In this role, we do the assessment, discuss with the physician, and then we take a more active part in the care plan. It’s not just in that moment but could also be what we are doing two hours from now, or two days from now, to care for this person.”
Although the pilot program is in its infancy, the results are promising. In the first month after its launch on June 25, there were 39 calls for the community paramedic’s services. Of the 39 clients assessed, only two needed hospital care. There is ongoing evaluation of the year-long pilot project, including the adding more personal care homes during the pilot.
Community paramedicine programs are active in many areas of Saskatchewan.
How does this program work?
Clients, families and personal care home operators involved in the program will be provided with information and contact numbers to reach the community paramedic.
The community paramedic responds to a call from a client/family member or the client care provider in a personal care home.
The community paramedic provides a home visit and assesses the client. In consultation with the most responsible physician/practitioner, a decision is made to either treat the client at home or transfer them to the local hospital.
What is the community paramedic’s role?
After the initial assessment, the community paramedic collaborates with the most responsible physician/practitioner and client care provider at the personal care home.
If deemed appropriate, the community paramedic will initiate the plan of care and begin treatment in the home.
If it’s established the client requires a higher level of care, then the community paramedic arranges for immediate transport to the appropriate facility.
If non-emergency transportation is required, the community paramedic can facilitate between the family physician and designated service to arrange a co-ordinated transfer. This minimizes wait times and delays.
What services can be provided through this program?
Assessment and treatments
Diagnostic collections, including phlebotomy, blood cultures, urinalysis
Intravenous therapy, including cannulation, fluid therapy and administration of antibiotics and medications
Respiratory treatment, including nebulization and oxygen therapy
Palliative care supports
How much does a community paramedic visit cost the client or family?