Community Paramedicine

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Community Paramedicine
Long Brier Islands, Nova Scotia
Rural EMS Summit at the Lake Coeur DAlene, Idaho
May 21, 2008
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• Greetings from

Nova Scotia
Canadas seacoast...
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(No Transcript)
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Only one urban centre...
Historic
Halifax
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(No Transcript)
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Community Paramedicine

• Stewart Cape Breton, NS
• Tilden Lawrence, KS
• Stewart Physician
• Tilden Anatomist/Admin.
• Stewart EHS Director
• Tilden IRCP member

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Community Paramedicine

• Collaborative model using
• Community paramedics
• Nurse Practitioner
• Off-site physician

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Long Brier Islands

• Island access by ferry
• 1,240 year-round population (summer increase)
• From Brier Island transport to hospital is a
  minimum 50-minute trip on two ferries

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THE LONG AND BRIAR PROJECT...
1,240 residents Two islands Two ferries
Regional hospital 1 hour distant
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EHS 3-Year Pilot

• Phase One 24/7 paramedic coverage (ambulance
  base established on Long Island)

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EHS 3-Year Pilot

• Phase Two Paramedics administer immunizations,
  perform screenings (blood pressure checks),
  accept non-emergent calls (diabetic checks)

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EHS 3-Year Pilot

• Phase Three
• Nurse Practitioner employed on island
• Paramedics participate in wound care, flu
  clinics, falls prevention assessments, community
  prevention education sessions

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EHS 3-Year Pilot

• Paramedics were taught
• Phlebotomy
• CHF assessment
• Urinalysis assessment
• Suture/staple removal
• Diabetic assessments
• Medication compliance

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Development of Program

• Provincial Medical Director developed and
  approved all medical policies and protocols
• Project coordinator hired to develop program
  curriculum and negotiate clinical practicum times
  with the Hospitals and Home Nursing Groups.
• Project coordinator developed and
• implemented a Continuous
• Quality Control component

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Curriculum Schedule

• Program theory classroom 8 hours
• VON Field Practicum (Homecare Nursing) 8 hours
• Minimal 20 phlebotomies in Lab (competency based)
• Dressing change practicum with Clinic Nurse
  Practitioner 4 hours
• Total hours 24 30 hours based on competency
  level.
• Program Reference Manual, module based, has also
  been developed.

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Community Introduction

• Community Needs Assessment (survey)
• Town hall forums
• Pamphlet on new services
• Newspaper articles

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Community Access to Services

• Patients request visits
• Family physicians request services
• Nurse practitioner refer patients

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Example of Services

• An elderly Islander was having large fluctuations
  in blood glucose levels due to medications for
  non-insulin dependant diabetes. The patients
  physician changed the dosage to better regulate
  the blood glucose and decrease the fluctuations.
  Paramedics completed a week of daily house visits
  to check the blood sugar. Subsequently, the
  patients medications dosage was successfully
  altered without the patient having to travel
  daily to the hospital for a blood glucose check.

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Community Programs

• Adopt-a-Patient
• Patients with ongoing needs adopted
• Paramedic establishes regular visit schedule
• Bicycle helmet safety
• CPR and first aid training
• Car seat installation

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Program Outcomes
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Program Outcomes
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Thank you!
Ronald D. Stewart, MD Dalhousie University School
of Medicine Professorships Anesthesia, Emergency
Medicine, Community Health, Epidemiology Roles
Cape Breton family physician to Director, Los
Angeles Trauma Program Other interests Landmine
eradication, tobacco control, international
medical education, medical humanities
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Thank you!
Ronald D. Stewart, MD Dalhousie University School
of Medicine Awarded Dalhousie Faculty of
Medicines first Gold-headed Cane Award
honouring a physician whose life and
teaching best exemplifies the traditions of the
science and art of Medicine.