Renfrew County paramedics leaders in innovation

·15 min read

Renfrew -- Usually when an ambulance shows up at a residence, somebody is having one of the worst days of their lives and paramedics not only have to assess and provide primary medical care, but sometimes they are one of the few people who pay a visit to an elderly or isolated person.

In Renfrew County, the role of a paramedic has gradually changed from that of a reactive first responder who attends a collision or other kind of tragedy or a host of occurrences that cannot be predetermined. However, over the last 10 years local paramedics have become much more proactive in helping to identify vulnerable people and have provided advice and primary medical services to assist in reducing the number of ambulatory visits. This in turn has led to reducing the number of unnecessary visits to an Emergency Room.

Michael Nolan, Chief of the Renfrew County Paramedic Services, has gained a well-earned reputation as an innovator in terms of the enormous challenges of providing ambulatory care to residents living in Ontario’s largest county.

Unlike the urban centres where thousands of people may live within a five-block radius, the 150 men and women of the Renfrew County paramedic service are responsible to provide ambulatory care to a year-round population of roughly 120,000 people in an area twice the size of Prince Edward Island. A large part of the area is not accessible by vehicle which is a challenge for emergency rescues undertaken by the paramedics

About a decade ago Chief Nolan noticed more and more calls involved senior citizens who were either isolated or insisted on going to one of the area’s five hospitals, resulting in the loss of a bed and the resources required to provide care.

Even with all of the challenges, paramedics have adopted a successful proactive system that was designed to service very remote areas and proactively offer wellness clinics.

The clinics provide services such as blood pressure readings, but more importantly, contact is made with several isolated seniors with no family doctor or transportation. The paramedics can provide advice to reduce the number of times a call is made for an ambulance.

The province took note of Chief Nolan’s model and have used it as part of a template for other areas seeking a modern approach.

Development of Palliative Care Model For Paramedics

In October 2020, Dr. Merrilee Fullerton, the former Minister of Health and Long-Term Care, made a visit to Renfrew to announce funding for a new initiative aimed at keeping seniors in their homes.

Renfrew County was one of five pilot sites across the province for a new community paramedicine program which would support seniors on long-term care waitlists.

The province was now examining the best way to decrease the time on a wait list for long-term care beds. In some cases, that has meant years on a wait list for beds that have not even been built yet.

The funding also allowed Chief Nolan to introduce an additional component. An internal program would be created where a designated paramedic would receive specialized training in palliative care and be a core member of a team working with the patient and their family, developing an end-of-life plan when an individual chooses to die at home rather than in a palliative care unit or hospice.

One thing the COVID pandemic did was allow Chief Nolan to dramatically speed up the integration of paramedics into the palliative care services currently offered in the area.

For him and all of the paramedics in the service, they understand the primary role of paramedics as a First Responder is to deal with the immediate situation through assessment and triage in order to safely transfer a patient to hospital.

Within the Renfrew County Paramedic Services, there are individuals devoting a greater amount of time to the area of Paramedicine Home Visits and the new palliative service for local residents choosing to die at home.

From the pool of paramedics, the leadership team identified current personnel and a core group of 10 to14 paramedics are trained to administer palliative services.

Palliative Care A New Role

On this cold late fall day, when Chelsea Lanos pulls into the driveway in an SUV with several markings identifying it as an ambulance, there are no people rushing around and waving their arms in the air pleading with her to help.

On this day, Ms. Lanos, in full uniform and carrying much less equipment, casually makes her way into the Renfrew home of Harry Sculland.

She is no ordinary paramedic. She is an Advanced Care Paramedic and a six-year veteran with the county service and along the way she has been working towards a Master of Science Degree in Critical Care, with a focus on end-of-life care and organ donation.

She is finalizing her thesis and for her, there is absolutely no better way to complete her specialized degree than on-the-job training. She is fully aware her involvement in palliative care will always have the same ending with the different patients she is working with.

“That is something that is always in the back of my mind when I spend time with them in their homes,” she said as she carried in her equipment. “Especially when I visit people like Harry. He has accepted the fact his heart will fail him one day and he is ready for that. Getting to know him and his life gives me a chance to tell others about him and his memory will live on.”

Harry Sculland is a retired electrician and a life-long biker and at the age of 88 he recently bought a Harley Davidson Tri Glide. He bought it for one reason.

“I am going to get down to Calabogie for a ride to see all the leaves before the snow hits and that is something I am looking forward to,” he said.

Despite having a palliative care plan set up, he doesn’t intend to spend his final days, or years, as he is quick to point out, worrying about the ‘what ifs.’

He has a pacemaker and has had heart issues that began in the mid-1970s with a serious heart attack. Despite having congestive heart failure, he has done his best not to slow down, but admits he lost a lot of that drive in early 2020.

“When I said goodbye to my wife Lise, I said goodbye to my best friend and the best bike mate anyone could ever ask for,” he said, glancing down to a photo album his grandchildren made for him. “Did you know she was inducted into the Canadian Motorcycle Hall of Fame?

“Her first bike was a red Harley Davidson KH model,” he said. “Not 50 yards into her first ride, she hit an ice patch, but that obviously didn’t stop her from continuing on. She was quite a lady and she fought every day to make sure she got one last ride in. With the help of a lot of good people, we made sure that happened.”

Lise spent her final days at Hospice Renfrew and Harry had nothing but good things to say about the wonderful treatment she received prior to her death.

“Top notch the folks at Hospice are and we even had a fundraiser ride in her honour and we donated all the proceeds to the hospice as a way of saying thanks. So many people came out on their bikes to celebrate her memory and to raise a little money along the way.”

It is these patients that remind Ms. Lanos of the important role paramedics play. Whether it is providing medical assistance at a car crash or visiting a man who has chosen to remain at home until his death, the role of the paramedic is an evolving one.

COVID Speeds Up Palliative Care

Ms. Lanos is only one of 14 Community Paramedics with the specialized training for the new Palliative Care Pilot Project that has been up and running for less than a year. Already it has caught the attention of the province and international organizations.

Although it may seem like a distant memory today, when the number of COVID cases began to steadily increase in March and April 2020, there were several models predicting the number of cases and mortalities into the thousands.

Chief Nolan often left teleconferences where the worst-case scenarios had hundreds of emergency cots being set up in hockey arenas across the county to become temporary field hospitals dealing with those infected with the COVID virus.

These images splashed across the television from several American cities and the chief realized there had to be a system in place to monitor the elderly and isolated individuals as statistics revealed they were the most vulnerable.

Amber Hultink was recently appointed the first female commander of a paramedic land base, and she assumed that role shortly after she returned from a one-year educational secondment.

She was seconded to the Canadian Foundation for Healthcare Improvement in Ottawa and was the lead paramedic on a national project to implement paramedics providing palliative care in the home pan-Canadian project.

“Like everyone else we were thrown into the middle of the pandemic with little to go on, but one thing was emerging in the early days and that was the senior population was getting hit the hardest,” Commander Hultink said. “We all hoped the predictions of potentially having thousands of COVID patients was not going to happen, but we had to prepare, and that meant helping residents who contracted COVID or other terminal health issues to consider the option of staying in their homes.”

So began the task of developing a working group to deal with a potential spike in residents who may choose to die in their homes, and also developing a working and evolving model to be able to react to sudden changes and adapt to whatever conditions COVID may present.

Comm. Hultink began developing the palliative program knowing the primary role was to fill a gap and to find a way to help all health care providers and patients through the pandemic by limiting the strain on limited resources.

She looked around for community partners and one of the first persons she turned to was Dr. Katie Forfar who was practicing at the Beachburg Urgent Clinic. The daughter of a firefighter, she knew the vital role of first responders and was a natural fit for the new program.

“There certainly was a shift in thinking that we were asking of paramedics, Dr. Forfar said. “They are trained to quickly assess a patient, provide immediate care and transport for further medical assistance. Now we were asking them to slow down, re-evaluate and determine if there is a viable way for them to remain in their homes and avoid transport to hospital.”

Both Comm. Hultink and Dr. Forfar were aware the working group was developing a plan on the go, but they also knew there was a possibility they may be faced with hundreds of patients who may die at home if the number of COVID patients forecast in the worst-case scenario models came true.

There would be hundreds of patients dying at home and the paramedics were the last line of resources to assist and help provide care for them.

The core group consists of a Palliative Care Coordinator, a Palliative consultant, Drs. Forfar and Declan Rowan and two senior paramedics. They developed a model which has now been employed for the last year and it is being touted as a model for other jurisdictions. The core group of paramedics completed a rigorous training module that was developed by the ad hoc working group and once completed, both Drs. Forfar and Rowan signed off on the medical requirements, with a new provision allowing paramedics to administer narcotics to alleviate severe pain or deal with those experiencing shortness of breath.

Prior to this new program, standard procedure likely would have included transfer to hospital via ambulance. However, this was one more system to reduce the strain on local Emergency Rooms.

Renfrew County is one of the few regions to incorporate palliative care into the paramedicine program.

“We have had other regions from across Canada contact us and we have shared our lessons learned, but we have also shared our successes and that is something we are all proud of,” Comm. Hultink said. “We don’t have all the answers and we are learning something new every day. What works, what doesn’t. But we keep moving forward and the paramedics who make the commitment to our palliative care unit are the ones who are helping us make the program better.”

Everyone Knows Matt

Matt Rousseau has been one of the original community paramedics serving the Arnprior and surrounding area since 2015. He is a true believer in the collaborative approach to health care and said the original Family Team model morphed into the Health Links.

“I was lucky when I started because I was born and raised in Arnprior and I am fortunate that it was a small town until just recently and more often than not when I first encounter a patient, we have met or we know somebody who knows somebody and that really helps. When we show up and just talk to them it makes a world of difference and you can learn so much about their condition just by listening to them.”

As Matt enters the home of Doug and Pat Fraser, it is like their adopted son has come home for a visit. Mr. Fraser, now 80, is a retired school principal and along with his wife, they retired to a quiet home that was specifically built so Mrs. Fraser can access all the amenities as she has been confined to a wheelchair for more than 30 years as a result of Muscular Dystrophy.

As he pulls out his equipment to check their vital signs, he quickly pulls out two needles and jokingly informs them he has two influenza injections with their names on them and it saves them a trip into town to wait in line during a pandemic.

“Matt is one of the reasons we are able to remain in our home and not be too much of a burden on the health care system,” Mrs. Fraser said. “Just a little thing like the flu shot means we don’t have to go to a busy area and potentially be exposed to COVID or somebody with the flu or a cough. For me, a simple cough can lead to much worse.”

Leaving the Fraser’s home, Matt is realistic in terms of his role.

“People like Doug and Pat (Fraser)…they are salt-of-the-earth people. They are not one of the palliative patients that we visit, but they are now in their 80s and if we can manage to help them stay at home and out of a hospital or long-term care home, then that goes a long way to freeing up our paramedics who may be called away for an emergency and we can respond appropriately.”

Like Part of The Family

Back at Harry Sculland’s home, paramedic Lanos sits with the widower and hooks him up to a portable monitor so she can check his vitals. They talk about his recent bouts of shortness of breath and dizzy spells. He admits he had to slow down his exercise regimen and he is following the directions of his longtime family physician. Ms. Lanos listens attentively.

At the same time she is subtly examining the living room and kitchen to look for signs of diminished ability to care for himself, and on this day, he appears to be alert, and in good shape given his health condition.

He points out to his backyard and says there are a few leaves left, and he does so with a big smile and draws this reporter’s attention to the area.

“I didn’t have to rake all the leaves this year,” he said. “Chelsea and her boyfriend came by one day and raked it all up for me and what do you think about that? She keeps this up and I may just be persuaded to take her for a ride on my new bike.”

He insists on showing off his new bike in the garage and admits it might seem foolish buying a brand new motorcycle at his age but he stopped worrying about what other people thought a long time ago.

“I plan to take this bike out for a drive before the end of the year and the weather gets to the point it won’t be safe,” he said. “But I am not a spring chicken, and I won’t get too many more chances for a while so I better get out there while I can.”

After he closes the garage door and walks Ms. Lanos to the door, he thanks her for stopping by and promises her he will follow her advice and cut back on some of the walking so he does not become light headed.

Placing her equipment back in the SUV, Ms. Lanos quickly checks her appointment calendar for the day and coordinates her next four visits.

“Another day when you just don’t know what is going to happen,” she said. “If you had told me 18 months ago I would be visiting people like Harry and raking his leaves and taking a photo of him and myself with a motorcycle, I would have laughed. But this palliative program allows paramedics like myself to really make a difference in a person’s life, even if only for a short time. It is something I will never take for granted.”

In early November, Mr. Sculland rolled his Harley out of his garage and made his last trek of the season down to Calabogie.

“It was a little cool, but after all, it is November,” he said.

Bruce McIntyre, Local Journalism Initiative Reporter, The Eganville Leader

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