Managing healthcare needs has been a pressing concern for decades now. We knew as the Baby Boomers started to reach advanced age, the reality of caring for such a large generational population would be an enormous financial and logistical nightmare. Never did we anticipate a global pandemic to further stress the system. With rapid changes and adaptations being made to just scrape by, every healthcare profession has had to step up and take on a larger role. Nurses and doctors are coming out of retirement to help fill the need left in hospitals and long-term care homes. But what about paramedics? Paramedics are no strangers to the pressure being faced during this pandemic. In Peel alone our expertise on donning and doffing personal protective equipment had us rapidly trained on nasopharyngeal swabbing and sent in to long-term care homes to test for Covid-19. And the creation of specialized teams to perform high-risk aeroslization procedures ensures patient and paramedics can stay safe. With all of these new uses for healthcare professionals being discovered out of pure need, how will this shape the future of these professions?
For paramedics, we’ve already started to discover new ways to fill gaps in the healthcare continuum. The idea of community paramedicine has been developing slowly over the years. Different services around Ontario customize the idea to address specific needs in their own community. Hamilton Paramedic Services ran a pilot study placing two paramedics in low-income seniors housing complexes to assess hypertension, diabetes, and fall risks to improve seniors’ lifestyles and increase their access to hands on care. The outcome led to 1/3 of all residence taking part, encouraging an active role in health management by the residents, as well as a framework for identifying risk and referral to appropriate resources instead of inappropriate use of the 911 system (Agarwal et al., 2015). But application of community paramedicine is inconsistent. Patterson et al. found that application of a community paramedicine model in rural settings were predicated on the system having enough emergency coverage to offer non-emergency care (2016). And thought community paramedicine shares the same characteristics of home visits and development of non-emergent care plans, the different application of intervention across different services means drawing correlations is difficult (Leyenaar et al., 2019). Though many have touted the economical benefits of the model, such claims have not been substantiated, as research in the area has not been sufficient (Choi et al., 2015). The result is that, despite best efforts, paramedics’ role in non-emergency community-based settings needs more exploration. Debates about additional training and staffing issues plague the concept from being an effective tool in the paramedic arsenal at this time. Current standards for Ontario paramedics can be found here.
Paramedicine also suffers from an inherent identity crisis, not just amongst ourselves, but also from the allied agencies and the community at large. Paramedics are an inherently new invention compared to nurses and doctors, firefighters and police. We also dance a fine line between the two, by being both first responders as well as healthcare providers. A recent article by Toronto Life titled The Influentials 2020 commended the front line workers who have steered Ontario’s capital through the pandemic, with special highlights on TTC workers, nurses, ER doctors, firefighters, and grocery store managers. Though paramedics were not left out entirely, a small nod to ‘ambulance drivers’ was mentioned in the preamble. It should be noted that calling a paramedic an ambulance driver is the equivalent of calling a nurse an orderly. We have become more than first-aiders with strong backs. We are highly educated and rigorously trained professionals with many layers of legal and medical standards. What we lack is an appropriate public perception. If the public does not know that we provide life-saving medications and skills that stave off death, how will they know to call us when the time arises? Many paramedics share concerns that without a regulatory college we cannot even claim to be ‘professionals’. This article by Chris Farnady highlights what self-regulation is, and how it can affect paramedicine as we know it. An article by a Toronto Paramedic with a doctorate in Health Science shares his input on the idea of professionalism in the paramedic field, and why paramedics are the consummate professionals in a young field with untapped potential. More articles on paramedicine, its advances, and how to keep paramedics safe can be found on the Canadian Paramedicine Magazine website.
It goes without saying that healthcare will continue to advance, and the professions within it will either adapt or fall by the wayside. Paramedicine as a practice has advanced by leaps and bounds over the last 20 years, despite still being in its infancy as a profession. Paramedics have not necessarily found a role within healthcare, but made one; joining emergency first response with healthcare at a time when it is needed most.
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