Diverting and triaging patients who call 911 for emergency medical care away from hospitals and allowing paramedics on firetrucks, instead of putting more ambulances and paramedics on the road, is fraught with risks, warn paramedics with the Canadian Union of Public Employees (CUPE) responding to an announcement today by the Ontario Liberals to change the province’s emergency medical response system.
CUPE paramedics believe these changes will result in “negative outcomes for patients and Ontarians in a medical emergency trauma and we’ve consistently advised the Liberals against a costly and risky change to emergency medical service delivery that would let municipalities put paramedics on firetrucks. To improve response times, what’s needed is increasing the capacity of ambulance services to put more paramedics on the road. That’s something that would cost much less than putting paramedics on firetrucks and save more lives,” says CUPE Ontario president Fred Hahn.
CUPE which represents the majority of paramedics – about 6000 paramedics and dispatch/communication officers province-wide – is perturbed that Premier Kathleen Wynne would make this “partisan announcement in such a clearly biased venue in a room full of firefighters. Paramedics don’t support this change because they think it will put patients at risk. Paramedics aren’t alone,” says Hahn. “Many municipalities are opposed because if implemented fully, they will ultimately bear the increased financial strain since half of their costs for ambulance paramedic services are funded by the province while fire costs are not provincially funded. Municipalities will be paying the full cost of this Liberal paramedics on firetrucks scheme.”
At the annual meeting of Ontario’s firefighters union today, the Premier also announced significant changes to emergency medical response intended to keep patients out of hospitals and “which could have detrimental repercussions for patients who call 911,” says Michael Hurley president of CUPE’s Ontario Council of Hospital Unions (OCHU/CUPE).
Currently paramedics are bound by law to take patients to hospital. The province intends to change that, it appears, so that patients could be released to already stressed primary care providers, outpatient clinics and other forms of community-based care. Known as ‘treat and refer’, this model would divert patients into cheaper forms of health care in the community. This idea is not in our opinion motivated by better patient outcomes, but rather on cost-containment and this government’s plan to continue to downsize hospital care, says Hurley.
These proposals to change EMS delivery could have serious consequences for patients.
For one says Hahn, many firefighters work 24-hour shifts. Research shows that such work hours have serious consequences on an individual’s judgement when critical life/death decisions are being made. There is no fully qualified oversight and quality assurance system in place with respect to the medical functions that would be performed by firefighters performing EMS duties.
While some aspects of patient triage would be useful in ensuring that an ambulance-based paramedic service is dispatched to medical emergency calls rather than a fire department, the release of patients into under-resourced community settings is “taking risks and putting additional stresses on paramedics to diagnose medical symptoms that may not be readily apparent at the onset of answering a 911 call, says Hurley.
CUPE is encouraging the province to hold meaningful consultations with paramedics about expanding cost-effective ambulance based emergency medical care, and not advancing on the profound changes to EMS proposed today.