MARCH 24, 2015
Page 1 of 26
MIDDLESEX COUNTY COUNCIL
COMMUNITY PARAMEDICINE
PRIMARY REPORT
MIDDLESEX-LONDON
EMERGENCY MEDICAL SERVICES
March 24, 2015
5. a - CC
MARCH 24, 2015
Background
Page 2 of 26
5. a - CC
• The Ontario health care system is presently facing unprecedented challenges most
prominent among demographics and finances
• Projected that over the next twenty years the number of seniors living in Ontario will
double and their average cost of health care being three times higher than that of the
average person living in Ontario
• Today health care in Ontario consumes 42cents of every dollar spent on provincial
programs
• Over the next twelve years it is estimated that this cost will increase to 70percent of the
provincial budget
• If the Ontario health care system continues with its past practice it is predicted that with
the 2030 population, Ontario health care costs would increase by $24billion (Ontario’s
Action Plan for Health Care. 2012).
MARCH 24, 2015
Background
Page 3 of 26
5. a - CC
• In 2010/11 there were 5,582,863 recorded visits to Ontario emergency departments
(Canadian Institute for Health Information)
• Over 271,000 (4.85%) visits made to Ontario emergency departments that could have been
treated externally
• 140,000 instances accounted for in Ontario of patients re-admitted to hospital within 30 days of
their original discharge (Ontario’s Action Plan for Health Care. 2012)
• In 2013/14 there were 5,963,027 recorded visits to Ontario emergency departments
(Canadian Institute for Health Information)
• Estimated 289,000 visits made to Ontario emergency departments that could have been treated
externally based on 2010/11 study results
• These patients could have received appropriate and optimal care outside the emergency
department at a lower cost
MARCH 24, 2015
Background
Page 4 of 26
5. a - CC
•
Paramedics are often the first, and on occasion, the only point of contact to the health
care system for some patients
•
Paramedics repeatedly respond to calls to assist patients experiencing difficulties
coping with the daily activities of living, which often require interventions beyond the
paramedic scope of practice
•
The Province of Ontario is investing to support the development and expansion of
Community Paramedicine initiatives province-wide to allow paramedics to apply their
training and skills beyond the traditional role of emergency response (Ontario
Expanding Community Role for Paramedics. 2014)
MARCH 24, 2015
Background
Page 5 of 26
5. a - CC
The right care at the right time in the right place
• Community Paramedicine programs will work collaboratively with numerous health care
agencies to co-ordinate care for patients living with complex underlying conditions.
• These programs will ultimately ensure the individual patient is receiving the right care at
the right time in the right place promoting independent living while reducing unnecessary
and costly emergency room visits.
• Through a partnership with South West Community Care Access Centre (SWCCAC),
Health Links, LHIN, CMHA, and London Police Service, and numerous other services
and agencies, the Middlesex-London EMS Community Referral Program will make
certain each individual patient will receive the right care, at the right time, in the right
place, while consecutively decreasing the number of non-transport patient calls and
emergency department visits.
MARCH 24, 2015
Middlesex-London
EMSPage 6 of 26
5. a - CC
13 stations
23 daily ambulances
~250 paramedics
Cover:
County
City
-2,824.9km2
- 420.57km2
Population:
County -72,263 (14.1% >65+)
City 366,151 (14.7% >65+)
Overall 438,414 (14.6% >65+)
MARCH 24, 2015
Middlesex-London
EMSPage 7 of 26
5. a - CC
13 stations
23 daily ambulances
~250 paramedics
Cover:
County
City
-2,824.9km2
- 420.57km2
Population:
County -72,263 (14.1% >65+)
City 366,151 (14.7% >65+)
Overall 438,414 (14.6% >65+)
MARCH 24, 2015
Middlesex-London
EMSPage 8 of 26
5. a - CC
•
In 2013 there were at least 94 individuals who contacted 9-1-1 for EMS >10 times
•
These 94 individuals resulted in at least 1082 calls in a one year period
•
High risk callers such as those with Mental Health Issues, Lift Assists, Diabetic Emergencies,
Failure to Thrive, COPD, and CHF are at risk of potential repeat calls that Middlesex-London EMS
Community Paramedicine could assist.
94 patients
10+ calls
1082
total calls
MARCH 24, 2015
Middlesex-London
EMSPage 9 of 26
5. a - CC
Calls that could benefit from Middlesex-London EMS
Community Paramedics
Mental Health
5%
Lift Assist
4% 2%
14%
Diabetic
54%
Failure to Thrive
21%
COPD
CHF
MARCH 24, 2015
10 of 26
Middlesex-London
EMSPageCall
Status Report
5. a - CC
Total Calls
80,000
79,000
78,932
78,000
77,000
Increase
of
5.9%
76,000
75,000
74,000
74,244
73,000
72,000
71,000
2013
2014
MARCH 24, 2015
11 of 26
Middlesex-London
EMSPageCall
Status Report
5. a - CC
Age Demographics Comparison
8000
7000
ePCR Count
6000
5000
4000
3000
2000
2013
1000
2014
0
Mean of 49.9% generated calls from patient >60 years
MARCH 24, 2015
12 of 26
Middlesex-London
EMSPageCall
Status Report
5. a - CC
Mental Health Calls
2,680
2,660
2,654
2,640
2,620
Increase
of
3.9%
2,600
2,580
2,560
2,540
2,555
2,520
2,500
2013
2014
Mental health account for 5.425% of total patient calls
MARCH 24, 2015
13 of 26
Middlesex-London
EMSPageCall
Status Report
5. a - CC
Lift Assist Resulting in Refusal of Service
Lift Assist
Increase
of
13.5%
904
ePCR Count
950
900
850
2014
799
800
2013
750
700
911 Calls for MLEMS
2013
2014
MARCH 24, 2015
14 of 26
Middlesex-London
EMSPageCall
Status Report
5. a - CC
Lift Assist
250
223
200
188
216
182
ePCR Count
2013
150
2014
142
138 137
113
100
66
74
73
49
50
37
22
0
Year: 31-40
Year: 41-50
Year: 51-60
Year: 60-61
Year: 71-80
Year: 81-90
Year: 91-100
70% generated calls >60 years
MARCH 24, 2015
15 of 26
Middlesex-London
EMSPageCall
Status Report
5. a - CC
Cherryhill Village Call Status Comparison Breakdown
1147
1200
867
ePCR Count
1000
479
800
600
400
200
0
117
454
Cherryhill
Blvd
343
208
180
121
Cherryhill
Circle
Cherryhill
Place
2013
Increase
of
35%
112
Westfield
Drive
2014
2014
2013
Total
MARCH 24, 2015
Page 16 of 26
COMMUNITY PARAMEDICINE PROGRAM
MIDDLESEX-LONDON
EMERGENCY MEDICAL SERVICES
5. a - CC
MARCH 24, 2015
Page 17 of 26
Community
Paramedicine
Program
5. a - CC
• Immediately engaged key stakeholders, comparable paramedic services, community
support agencies/services
• Researched existing/developing programs
• Consulted with local Base Hospital Group, Family Health Teams, Primary Lead
Physicians
• To date MLEMS has consulted/partnered with +20 external resources:
Dr. M. Lewell, Dr. M. Peddle, Dr. G. Schacter, South West Community Care Access Center,
Canadian Mental Health Association, LHSC Director of Victoria Emergency Department,
Director of LHSC Mental Health, Thames Valley Family Health Team, London Family
Health Team, London Police Service, Age Friendly London, Right at Home, South West
Local Health Integration Network Emergency Department Project Lead, 211,
thehealthline.ca, Interdev, Middlesex-London Health Unit
Guelph EMS, Hamilton EMS, Oxford EMS, Toronto EMS, Winnipeg EMS, York EMS,
MARCH 24, 2015
Page 18 of 26
Community
Paramedicine
Program
5. a - CC
3 new MLEMS CP programs have been developed to based around the following:
PREDICTION
CONSENT
ADVOCACY
MARCH 24, 2015
Page 19 of 26
Community
Paramedicine
Program
5. a - CC
Program #1
Paramedic Referral to CCAC
•
Based off the MOHLTC requirement of utilization of the PERIL assessment
•
Provides paramedics with the additional knowledge, training, and tools to identify
patients for electronic referral to CCAC for additional external support services
•
Complimented with two other assessment tools to ensure thorough and informed
decision
Paramedics Assessing Elders Risk for Independence Loss
1)
Is there any reason that might cause you to believe the patient cannot be safely discharged [or ROS]?
2)
Are the patients medications disorganized?
3)
Has the patient called 9-1-1 in <30days?
3/3 “Yes” – 93% chance the patient will have an adverse outcome in <30days
2/3 “Yes” – 54% chance the patient will have an adverse outcome in <30days
MARCH 24, 2015
Page 20 of 26
Community
Paramedicine
Program
5. a - CC
Program #2
Community Paramedicine Refusal of Service Follow-up
•
Previously any patient who refused treatment/transport and sign a refusal of
service form was provided with any follow-up
•
This program provides quality assurance for all patients who refuse
treatment/transport against paramedics advice
•
Paramedics now have the ability to make an informed decision based on the
mechanism of injury and potential adverse outcome with the patient and provide
electronic notification to the Community Paramedicine Program for a follow-up
(phone or home visit)
MARCH 24, 2015
Page 21 of 26
Community
Paramedicine
Program
5. a - CC
Program #3
Crisis Mobile Team Referral
•
MLEMS has a high call volume of patients dealing with mental health issues
•
Mental health contributes to 54% of repeat callers
•
This program provides quality assurance for those patients suffering from mental
health issues who refuse treatment/transport against paramedics advice
•
Paramedics now have the ability to make an informed decision based on specific
inclusion/exclusion criteria and activate the CMHA Crisis Mobile Team for request
to respond to the scene to conduct a crisis intervention
•
This allows mental health patients who meet the criteria to be provided with the
appropriate care in the safety of their residence
MARCH 24, 2015
Page 22 of 26
Community
Paramedicine
Program
5. a - CC
In Development
211 & London Police Service
•
Through partnership and participation with the Middlesex-London EMS Community
Referral Program, the London Police Service frontline staff will be able to identify
civilians experiencing difficulty coping with daily activities of life
•
Through this program police officers will be able to advocate and refer a person based
on criteria and be able to complete a tele-referral through 211
•
The 211 information and referral specialist will receive the police assessment of the
situation and connect them with SWCCAC, or an alternative appropriate community
based agency for follow-up
MARCH 24, 2015
Page 23 of 26
Community
Paramedicine
Program
By LPS having the capability to refer persons requiring additional
support services, collectively we will be able to:
1. Improve the quality of life of the persons
2. Increase the persons longevity of independence
3. Reduce the number of LPS request for EMS assessments
5. a - CC
MARCH 24, 2015
Page 24 of 26
The right care at the right time in the right place
MIDDLESEX-LONDON
EMERGENCY MEDICAL SERVICES
5. a - CC
MARCH 24, 2015
Page 25 of 26
5. a - CC
MARCH 24, 2015
Page 26 of 26
Thank You
MIDDLESEX-LONDON
EMERGENCY MEDICAL SERVICES
5. a - CC