Newman: A minifesto for the Quebec pre-hospital care system v 2.0

Stanstead QC–Our out-of-hospital care system needs to be redesigned by people who are dedicated to the needs of the end-users [I despise the words ‘patient’ or ‘beneficiare’ because ‘patient’ implies you must wait before receiving care and ‘beneficiare’ implies that healthcare is a benefit – and not a basic right] and the people who actually deliver the emergency care.

We need to stop looking at prehospital care as a back-loaded system that starts when an imaginary stopwatch is triggered after someone recognizes an emergency has occurred and calls 911. The problem with this model is that the clock will continually be reset once the person in need has received treatment and has been delivered to the ER. No one is looking at ways to prevent the emergency in the first place.

How many healthcare workers come to Quebec from other jurisdictions and are held in place while exams are written and scores are compiled? Why can’t we create an EMS/CLSC-linked organization that trains people to visit clients in their homes, verify that their environment is safe, check that their meds are up-to-date, check their vital signs, even run an ECG or draw bloods to be checked at a local hospital?

Wouldn’t it be economically and socially advantageous to have a first response team specifically trained to respond to calls of a lower priority to determine whether or not those clients actually need to be attended to by the much scarcer ambulance-based medics? We need to adopt the EMS Community Care Model right across Quebec – and especially in the outlying regions where healthcare human capital is more thinly spread. I’ll bet that could substantially reduce the number of times the words “aucune ambulance disponible” are transmitted to waiting first responders.

Firefighter first response programs are performing beyond expectations. They should encompass every part of this province. Firefighters who believe in the possibilities need to engaged as emissaries for this approach – they need to become part of a core of leaders who can mentor other firefighters. I’m tired of watching naysayers rise to the top of the leadership ladders. Fire dept first response should be funded appropriately and cities and towns should start realizing that this is an investment that assures tax payers of living long and fruitful lives – and continuing to contribute to Quebec society.

There should be automatic external defibrillators [AEDs] in every public building and many of the private ones. Police officers should be equipped with AEDs. CPR courses should be a requirement to graduate from elementary school.

We should have advanced life support [ALS] paramedics on every ambulance – and when we’re done with the ambulance crews we ought to start looking at ALS firefighter medics.

We need to pay the ambulance medics a living wage that recognizes the enormous contribution they make to our lives – and not treat them as some afterthought to the system. Without them the crippled system would have collapsed long ago. And we need to begin treating our paramedics like the community heroes they are and find ways to reward their service to the rest of us; i.e., tax credits, educational scholarships, family death benefits for line-of-duty deaths.

There should never be a monopoly on saving lives or helping people in an extraordinarily difficult moment of their lives. That damned clock begins ticking when someone calls for help. The primary consideration should be who can get there quickest to render aid – not which response organization has a ‘claim’ to the territory.

Every EMS organization should take an enormous leap of faith forward, work with all of the stakeholders and establish a model that ensures everyone in the community gets the emergency care they deserve.

My family deserves the best emergency medical system available. Doesn’t yours?

Suggestion: Talk to each of your elected representatives and ask them why they believe your family deserves anything less than the best possible prehospital care. Our prehospital care system is nothing if not equitable in delivering substandard services so it really doesn’t matter who you are when you or someone you love places a call to 911.

A minifesto for the Quebec prehospital care system

by Hal Newman
Our out-of-hospital care system needs to be redesigned by people who are dedicated to the needs of the end-users [I despise the words ‘patient’ or ‘beneficiare’ because ‘patient’ implies you must wait before receiving care and ‘beneficiare’ implies that healthcare is a benefit – and not a basic right] and the people who actually deliver the emergency care.

We need to stop looking at prehospital care as a back-loaded system that starts when an imaginary stopwatch is triggered after someone recognizes an emergency has occurred and calls 911. The problem with this model is that the clock will continually be reset once the person in need has received treatment and has been delivered to the ER. No one is looking at ways to prevent the emergency in the first place.

How many healthcare workers come to Quebec from other jurisdictions and are held in place while exams are written and scores are compiled? Why can’t we create an EMS/CLSC-linked organization that trains people to visit clients in their homes, verify that their environment is safe, check that their meds are up-to-date, check their vital signs, even run an ECG or draw bloods to be checked at a local hospital?

Wouldn’t it be economically and socially advantageous to have a first response team specially trained to respond to calls of a lower priority to determine whether or not those clients actually need to be attended to by the much scarcer ambulance-based medics? I’ll bet that could substantially reduce the number of times the words “aucune ambulance disponible” are transmitted to waiting first responders.

The firefighter first response program is performing beyond expectations. It needs to be expanded beyond the Island of Montreal and should encompass every part of this province. Firefighters who believe in the possibilities need to engaged as emissaries for this approach – they need to become part of a core of leaders who can mentor other firefighters. I’m tired of watching naysayers rise to the top of the leadership ladders. Fire dept first response should be funded appropriately and cities and towns should start realizing that this is an investment that assures tax payers of living long and fruitful lives – and continuing to contribute to Quebec society.

There should be automatic external defibrillators [AEDs] in every public building and many of the private ones. Police officers should be equipped with AEDs. CPR courses should be a requirement to graduate from elementary school.

We should have advanced life support [ALS] paramedics on every ambulance – and when we’re done with the ambulance crews we ought to start looking at ALS firefighter medics. We need to pay the ambulance medics a living wage that recognizes the enormous contribution they make to our lives – and not treat them as some afterthought to the system. Without them the crippled system would have collapsed long ago. And we reward them by treating them as second-class citizens and trying to find ways to refute their CSST claims after their backs and legs fail after decades on the job.

There should never be a monopoly on saving lives or helping people in an extraordinarily difficult moment of their lives. That damned clock begins ticking when someone calls for help. The primary consideration should be who can get there quickest to render aid – not which response organization has a ‘claim’ to the territory.

Every EMS organization should take an enormous leap of faith forward, work with all of the stakeholders and establish a model that ensures everyone in the community gets the emergency care they deserve.

My family deserves the best emergency medical system available. Doesn’t yours?

Suggestion: Talk to your MNA – your elected representatives and ask them why they believe your family deserves anything less than the best possible prehospital care. Our prehospital care system is nothing if not equitable in delivering substandard services so it really doesn’t matter if you’re an MNA or not when you or someone you love place that call to 911.

Quebec’s prehospital care system and the tragedy on the ski hill

by Hal Newman

Natasha Richardson died yesterday. She succumbed to injuries suffered on a beginner’s trail at the Mont tremblant ski resort. She was 45-years-old.

Some folks have suggested that a neurosurgeon and an MRI within two hours of injury might have made a difference.

Sacre Coeur Hospital is a long haul [about 80 km – 36 miles] from the Ste-Agathe Hospital where Ms. Richardson was initially transported – that’s a very long ride in an ambulance.

I cannot help but wonder if the outcome might have been different if the accident had occurred in a jurisdiction with advanced care paramedics and an integrated helicopter medevac system that would have ensured rapid transfer to a tertiary care facility.

And that lingering doubt shows no sign of fading, especially in light of the news this morning that the first ambulance crew called to the scene left without ever even seeing Ms. Richardson.

Interestingly, when there are NASCAR or Formula One races in Montreal, there are medevac helicopters on standby to transport injured drivers from the track to one of the two major trauma centers that serve Montreal.

Sadly, that’s not the case for the rest of the year and for the rest of the people.

So, while there are Advanced Life Support paramedics based on ambulances, firetrucks, and helicopters everywhere else in the G8 – here in Quebec, the powers-that-be have decided ALS paramedics are just not necessary for the chain of survival.

That’s your chain of survival, folks. To quote Jim Duff, “It’s the system that begins with a 911 call and ends when the hospital moves you out of intensive care — or to the morgue.”

In Quebec, we don’t have Advanced Life Support paramedics because, despite the embrace of all things secular, when it comes to our provincial Emergency Medical Services [EMS] system we have placed our faith in God – and the skills of the resurrection specialists working in our hospitals’ ERs.

If God is smiling down upon you, you just might survive the ride in the ambulance that delivers you into the hands of his emissaries in the ER.

With one of your feet already firmly planted in death’s door, the nurses and physicians of the ER will do their darndest to successfully pull you back towards the light. And once you’re confirmed to be back among the ranks of the living, there will be high-fives all around in the crash room as yet another soul has been saved.

And if you die, well, you died because you were destined to do so despite the best efforts of the team waiting in the Emergency Department.

You just cannot have an effective Advanced Life Support Emergency Medical Services [EMS] system in a society that has bought a lifetime prescription to the notion of supporting a monopoly on who should save lives.

In Quebec, physicians save lives. Ambulance technicians [primary care paramedics] deliver patients to the physicians.

Perhaps one day soon we will begin placing our faith in the people who have the wisdom, experience and courage to work the frontlines of emergency medical services instead of having them continue to serve as the pick-up and delivery service for the ERs.

In the meantime, you can try praying for a miracle.

There should never be a monopoly on saving lives or helping people in an extraordinarily difficult moment of their lives.