Voici un article que mon ami (ancien T.A. du début des années 90 devenu médic dans l'armée tout dernièrement) m'a envoyé. Je ne l'ai pas lu au complet mais je crois que ça parle de la vision des paramédics de l'avenir que le Docteur Marcel Boucher voulait instaurer au Québec, soit un service parallèle de paramédic de santé sociale.
Qu'en pensez-vous ? Stéphane Laberge ----- Original Message ----- From: Francois Guilbault To: Stéphane Laberge Sent: Saturday, July 14, 2007 6:11 AM Subject: Un article fort intéressant sur les paramédics en soins communautaires... en anglais Community Paramedic: The wave of the future? -------------------------------------------------------------------------------- It’s a beautiful day. It’s warm, the leaves are colourful, and life seems pretty relaxed. It is a bit foggy, the air feels damp and salty, and you can hear the waves and the foghorn in the distance. The alarm doesn’t go off, your pager doesn't buzz, ring or vibrate, your radio doesn’t even squawk, but you get in your unit, knowing it’s already stocked as per ALS standards, and drive down a bumpy country road. There is no one standing in the driveway frantically flagging you down, there isn’t a trail of broken tail lights to direct your path. But the teapot is on and an elderly lady hollers “Come in dear” when you knock on the door. You aren’t there to slap oxygen on her, take her blood pressure or start an I.V. after you pick her up from the bathroom floor where she has fallen and broken her hip, and transport her to hospital. She is in no distress. She hasn’t called 911. In fact, you are there to assess her home so you can prevent her from having a fall and breaking her hip. You are there to tell her that her scatter rugs although artfully displayed on the old hardwood floors are a bit of a hazard, that her back porch rail could use some strengthening and that her burnt out lightbulbs on the way down to the cold storage room in the cellar should be replaced. And by the way, you do know how she can get that done. Doesn’t sound like a typical Canadian Emergency News scenario? Welcome to the 21st century in prehospital care delivery. And where has this advanced delivery originated? Two very remote islands off Digby neck in Nova Scotia. Long and Brier Islands collectively have a population of about 1,200 year round with some escalation during the summer months. Many of the residents are over 65 and have the typical health concerns of an aging population; CHF, falls and home injuries, diabetes and chronic illness conditions. The islands are remote, a 50-minute trip requiring two ferries to reach the general hospital in Digby, another hour to reach the regional hospital in Kentville. Not only does that mean difficulties in accessing hospital care, for the residents of the islands, it also means they are unable to attract and maintain a family physician practice on the island. If not for some collaboration between community primary health care delivery and the local ambulance service, residents would be dependent on the mainland for not only hospital care but for family physician care as well. Nova Scotia has a provincially funded ambulance service and therefore is integrated at least to some degree with other aspects of health care delivery. To help meet the health needs of Long and Brier Island residents a 24-hour, seven-day-a-week emergency paramedic service was established in Freeport on Long Island. An abandoned clinic, once the island's physician office, was renovated to accommodate this service. With a call volume averaging approximately one call every three days, and residents still needing to leave the island to address the concerns one normally takes to a family physician, the service needed to readdress the way they did business. In 2003, a nurse practitioner, under the guidance of an off-site physician, was added to the clinic and the paramedic service began evolving into what it is today. There are now 16 paramedics who work shifts on the islands. They rotate between working two, 24-hour shifts in Digby where they are able to enjoy the typical trauma and medical calls enjoyed in a larger service area and hone their ALS skills, to working two, 24-hour shifts in Freeport where they work delivering and refining their “community paramedic tag “ skills. A day in Freeport is certainly not typical of most paramedic services in Canada. It begins by checking the ambulance unit and stock with a partner, but they also check the medication fridge for appropriate temperature control, check the triage room for stocking and the appointment book to see who they need to visit that day. From the hours of 8 until 10 a.m., Monday through Friday, the two paramedics are in the clinic drawing blood from residents who have been referred by their family physicians or the nurse practitioner for blood work. They also go out to homes throughout the community and draw blood from people unable to make it to the clinic. By 10:30 a.m. a courier arrives to ship the blood off to Digby for lab analysis. Paramedics on the island do approximately 95 per cent of the blood work drawing; the other five per cent is performed by the nurse practitioner. The rest of the day may be spent providing wound care in residents' homes, doing fall assessments, helmet and bicycle safety in the school, home blood pressure, glucose or prescription compliance checks, or visiting their adopt-a-patient (a patient, typically with CHF complaints, they visit on a regular basis to ensure they are functioning at their “normal” levels). The scope of practice for a community paramedic includes I.V. antibiotic administration, wound care, phlebotomy, glucose checks, prescription compliance, fall assessments, CHF follow-ups, flu vaccinations, B12 injections and tetanus immunizations. Paramedics also do first responder training for the three island fire and first responder departments and work closely with the local coast guard, which has a prominent role in this fishing community. At the same time, these paramedics are always on call to respond to the more traditional EMS events, such as motor vehicle accidents, injuries and medical emergencies. New protocols have been developed to guide paramedics through this community care delivery and they remain licensed under Dr. Ed Cain, the same medical director as the rest of Nova Scotia’s paramedics, with the addition of having their community paramedic “tag.” But above these skills, community paramedics are always looking for new ways to integrate with primary health and preventative health care delivery. Needs assessments done on a regular basis determine what skills and programs paramedics should bring to the islands. Steve Menzies, the Paramedic Supervisor, Operations, for the Digby and Islands Service explains one of the key methods of success is to get involved in local community health initiatives so others can see the role of paramedics in non-emergency ways. Through sitting on boards and committees, paramedics have often come up with innovative ways to extend their services into the community and provide essential services in preventive programs. Menzies is excited about the progress paramedics have made in the community and the possibilities for the future. He’s not the only one. Emergency Health Services Nova Scotia hosted the First Annual International Round Table on Community Paramedics and Rural Health Care Delivery in Halifax in July of 2005. The conference drew a lot of attention nationally and internationally and a second conference is being planned in Scotland. In the meantime, supervisors and management groups from around the world that have some form of community paramedic delivery programs have formed a core group and continue to keep in touch and strategize on how best to implement, maintain and improve this new approach to the scope of practice for paramedics. If there is any draw back to the program, it may be the fact that it isn’t a money making proposition. As Dr. Cain explains, only patients that are transferred are charged any fee by the ambulance service. In a provincially run service this is acceptable and just part of doing business. In the future, perhaps funding can be achieved through the bigger pockets of overall provincial and community health budgets. Certainly there is a cost savings, not only to the residents who no longer have to arrange transportation to and from the mainland to receive care, but from the mainland hospitals. In 2003, from February to July, the emergency department of Digby hospital saw a 47 per cent decrease in the number of visits from residents of the islands. This certainly provides a cost savings for hospital budgets and an increase in the accessibility of health care delivery for residents of the islands. The future of health care is changing. As budgets get tighter and the population ages there is a demand to provide better care in more cost efficient ways. While health change and reforms have brought centralized health care, primary care clinics and a wealth of resources, specialists and diagnostic testing within easy access to most of the population, it is perhaps easy to forget or ignore the fact that all Canadians do not enjoy ease of access to health care. The Long and Brier Island model of community paramedic delivery is most definitely a model that increases that accessibility and the efficiency of health care delivery. Out of the fog of Long and Brier Islands a new wave of paramedic care emerges. About The Author. Heather MacKenzie-Carey has experience in the Health Care Industry as an emergency practitioner, educator and consultant. She has a Health Education Degree from Dalhousie University, a diploma in Paramedicine from the Northern Alberta Institute of Technology, and a Certificate of Social Work from the University of Waterloo. She completed a Masters of Science in Risk, Crisis and Disaster Management from the University of Leicester and focused her thesis on bio-terrorism in Canada. Heather has written two textbooks; Bio-terrorism and Biological Emergencies: A Handbook for Emergency Medical Responders, and Criminal and Terrorist Emergencies: A Handbook for Emergency Medical Responders. Both are published by Pearson Canada/Prentice Hall and can be found on their website at www.pearsoned.ca. Having recently moved back to the Maritimes, Heather is the co-owner/operator of an A&W restaurant in Bridgewater, Nova Scotia, but continues to write and provide safety consultation and training services for public, private and volunteer sectors as well. For more information she can be contacted at [EMAIL PROTECTED] May 29, 2006
