Paramedics to provide in-home treatment option for palliative care patients

Thanks to a new pilot program, when eligible palliative care patients in Nipissing District and across northeastern Ontario call 9-1-1, they will soon have the option to receive treatment at home instead of visiting emergency departments.  

The one-year pilot will give paramedics more options to provide safe and appropriate treatment for patients while helping to protect hospital capacity, according to the Ontario government. 

Under the current model, paramedics are required to bring 9-1-1 patients to hospital emergency departments, even when there are other appropriate care and treatment options available in the community.

Nipissing MPP and Minister of Economic Development, Job Creation and Trade Vic Fedeli joined Parry Sound–Muskoka MPP Norman Miller to announce the pilot project, Thursday. Also on the call were the Directors of Emergency Medical Services from the nine participating northeastern Ontario regions.

The pilot "enables our world-class paramedics to support our most vulnerable patients in the appropriate care setting while avoiding unnecessary emergency department visits and relieving hospital capacity pressures," said Fedeli.

Robert Smith, the local Chief of EMS pointed to the adaptability of paramedics — most recently on display during the pandemic — as they collaborated with public health agencies to administer COVID-19 testing and vaccinations in various communities. Paramedics are already receiving education about the project, which will be overseen by Health Sciences North in Greater Sudbury. Nipissing District has received the go-ahead to launch the pilot by July 1. 

"A year ago such work was not something that was even in the paramedics' scope of practice," said Smith. "Paramedics have typically operated within extremely tight rules that mandated transport to hospital, regardless if such transport was actually necessary."

Paramedics specially trained in symptom management — including pain or shortness of breath, agitation, terminal congested breathing, nausea and vomiting — will soon have the ability to treat those palliative care patients who opt for treatment at home.

The patient "will remain in ultimate control of the care they receive," reads a government news release, "and can at any time request to be taken to the emergency department."

Because it will operate on the 9-1-1 system, added Smith, treatment is available quickly and around the clock. 

"This model not only focuses on compassionately following the wishes of the patient and the family during their end-of-life journey but it will also help to protect hospital capacity," advised Smith.

Paramedics will focus on the pain and symptom management of palliative care. According to Health Canada, "palliative care is an approach that aims to reduce suffering and improve the quality of life for people who are living with a life-limiting illness."

Northeastern Ontario will be implementing the "Treat and Refer" model of care in which specially trained paramedics treat palliative care patients on-site. Courses of treatment available include administering medication for pain or dyspnea, hallucinations or agitation, terminal congested breathing, and nausea or vomiting. 

Once the patient has been treated, paramedics would directly coordinate follow-up care with a local hospice or the patient’s primary palliative care team to provide longer-term treatment options. 

"Throughout the COVID-19 pandemic, we have seen more than ever how critical it is for patients to receive timely and effective care – when and where they need it," said Christine Elliott, Deputy Premier and Minister of Health. 

According to the Ministry of Health, the pilot project will be in place for one year, after which it will be evaluated to assess outcomes, identify where program adjustments may be needed.

"In rural and Northern Ontario paramedics have long been invaluable resources in providing wrap-around services across our vast geography," said MPP Miller. "Today’s announcement gives paramedics even better capacity to empower patients and put them in control of their care decisions.   This is going to have a huge impact on the patient’s experience and will allow them to receive care where they are most comfortable."