Going slow on paramedics Quebec last North American jurisdiction to resist wide-scale use of advanced life support AARON DERFEL The Gazette
Thursday, April 14, 2005 Paramedics trained in advanced life support should not be deployed across Quebec because there are "insufficient data" to show that this would save more lives, a provincial government report recommends. Rather, Quebec should continue to study the effectiveness of advanced paramedics in limited pilot projects, concludes the report by the provincial agency that evaluates medical technologies. Quebec remains the last jurisdiction in North America to resist the wide-scale use of such ambulance resources. Quebec Health Minister Philippe Couillard yesterday welcomed the report's go-slow recommendations. "The government wants to introduce advanced pre-hospital care in a progressive and measured way in Quebec," Couillard told reporters. Paramedics and other experts, however, expressed outrage that more than three years after a pilot project was launched in Montreal and Laval, the report calls for yet more pilot projects. "This is state-sanctioned procrastination, whereas advanced life support is the norm in all of the Western world," said Glenn Nashen, a former emergency medical technician in Cote St. Luc. "It seems we still have to study things and not move forward. Why should the Quebec population be deprived of what is available in the rest of North America? It's infuriating." Nashen noted that a fair number of frustrated paramedics have left Quebec to practise advanced life support in the United States and Ontario. Benoit Touchette, one of 18 Urgences Sante ambulance technicians taking part in the initial pilot project, said there's no reason to delay expanding advanced life support provincewide. "I'm a little bit disappointed about this aspect of the report, because the whole population of Quebec is in need of this service," Touchette said. The report, however, provides the first official government recognition in Quebec of the importance of advanced life support in on-the-spot treatment of people suffering from severe breathing problems and cardiac-related chest pain. But the report notes that there is no evidence ALS can save the lives of those who have had a heart attack, although such an intervention is hypothetically of some benefit. The report warns against the ALS technique of intubating children and treating such trauma cases as those involved in car crashes. Diane Verreault, president of the Association professionelle des paramedics du Quebec, said she was glad that the report recommends elevating the training requirements for ALS certification. As of September 2006, paramedics must obtain a special CEGEP degree. However, she, too, found fault with the report's refusal to endorse ALS for all of Quebec. "That's the only thing that I'm disappointed in, but we have to start somewhere," she said. "If that's the way to go, I'm ready to play the game." She added that after years of a "lack of vision" on the part of the government, progress is finally being made. Verreault has agreed to join an interdisciplinary committee made up of representatives from Urgences Sante, the Quebec College of Physicians and the government to chart a course of action. The committee's first meeting is tomorrow. Couillard cautioned that the new breed of ambulance workers will face some restrictions. "There are certain areas of care which are probably done elsewhere that have been shown in the literature to be harmful to people, mainly intervention in the pediatric population ... and in trauma cases. So I'm sure you don't want us to deploy practices that are not to the benefit of the public. "Integration is the key word," Couillard added, pointing out that there is no uniform model that exists elsewhere. "In large cities in Canada, we have the advanced paramedic profile. But in most of the other areas, we have mainly the primary care of paramedic, and we want the basic training of our paramedics to be better than that basic level." But Nashen countered that in rural areas in Ontario, where there is no ALS service, trauma helicopters respond to emergencies - something that's sorely unavailable in Quebec. Couillard said he'd like to work on developing first responders in big cities like Montreal. He could not give estimates of how much his plan would cost. Dr. Reiner Banken, one of the authors of the report, said Quebec can learn from negative ALS experiences in other jurisdictions. "What our report is saying is 'yes, but' to advanced life support, and there are very many conditions attached to the 'but,' " Banken said. Urgences Sante, the company overseeing pre-hospital services in Montreal and Laval, sent 18 technicians to Ontario for training as paramedics without the government's consent in 2001. Couillard replaced the company's chief executive officer and demanded an audit last month after a report revealed the $3-million project was nearly $1 million over budget with a number of unauthorized expenses. Online Extra: Paramedics would save lives and money in Quebec, argues a former Cote St. Luc councillor and ex-emergency medical technician with Urgences Sante for 17 years. Find out more at our Web site: www.montrealgazette.com. MIKE DE SOUZA of the Gazette Quebec Bureau contributed to this report [EMAIL PROTECTED] � The Gazette (Montreal) 2005 http://www.canada.com/montreal/montrealgazette/news/story.html?id=19f2a45c-7be1-4b8a-ac84-c0e33e7e129a LE MINISTRE PHILIPPE COUILLARD ENTEND POURSUIVRE LE DEVELOPPEMENT COHERENT ET PROGRESSIF DES SOINS PREHOSPITALIERS D'URGENCE AU QU�BEC QU�BEC, le 13 avril /CNW Telbec/ - �Notre gouvernement entend poursuivre de fa�on coh�rente le d�veloppement des soins pr�hospitaliers d'urgence au Qu�bec, en conformit� avec les donn�es probantes de la litt�rature scientifique. Le rapport rendu public aujourd'hui par l'Agence d'�valuation des technologies et des modes d'intervention en sant� (AETMIS), � laquelle j'avais demand� un avis sur la question, confirme le bien-fond� de l'attitude de prudence adopt�e par le gouvernement du Qu�bec. Je rappelle que nous avions �t� plac�s devant le fait accompli par la Corporation d'urgences-sant�, qui avait form� des techniciens ambulanciers en soins avanc�s sans que ce geste s'inscrive dans une strat�gie globale relative aux soins pr�hospitaliers d'urgence.� C'est ce qu'a d�clar� aujourd'hui le ministre de la Sant� et des Services sociaux, monsieur Philippe Couillard, dans la foul�e de la publication du rapport de l'AETMIS. Comme l'a rappel� le ministre, le rapport indique clairement que les donn�es actuellement disponibles sont insuffisantes pour justifier un d�ploiement g�n�ralis� des soins pr�hospitaliers avanc�s sur l'ensemble du territoire qu�b�cois. Des donn�es pr�liminaires montrent que les soins avanc�s pourraient avoir un effet b�n�fique chez les patients souffrant de douleur thoracique et de certains types de difficult�s respiratoires. D'autre part, il n'existe aucun effet, ni b�n�fique ni nocif, de ce type de soins en situation d'arr�t cardiorespiratoire d'origine non traumatique. Dans certaines circonstances, les soins avanc�s sont par contre associ�s � des effets n�fastes, notamment chez les enfants et dans les cas de traumatismes. �Devant ces constats, il y a lieu de proc�der par la voie de projets pilotes afin d'�valuer l'efficacit� et l'efficience des protocoles de soins avanc�s, ainsi que les conditions organisationnelles propices � leur introduction. Ces projets devront mettre � profit plusieurs comp�tences des 18 techniciens ambulanciers r�cemment form�s en soins avanc�s qui, de bonne foi, ont voulu parfaire leur expertise professionnelle�, a poursuivi le ministre. Pour une �volution des soins pr�hospitaliers �A la lumi�re des travaux de l'AETMIS, le ministre a annonc� la cr�ation d'un groupe interdisciplinaire sur la d�finition des soins pr�hospitaliers avanc�s au Qu�bec, qui d�butera ses travaux au cours des prochains jours. Ce groupe sera form� de repr�sentants du minist�re de la Sant� et des Services sociaux, de techniciens ambulanciers, de membres issus du Coll�ge des m�decins, de l'Association des m�decins d'urgence du Qu�bec, et de repr�sentants m�dicaux travaillant en contexte pr�hospitalier. Son mandat consistera � d�finir la nature et le contenu des soins avanc�s requis, en tenant compte des besoins identifi�s et des ressources disponibles. Le groupe devra �galement d�terminer les modifications r�glementaires ou l�gislatives n�cessaires � l'instauration des modalit�s de soins �ventuellement retenues.� Monsieur Couillard a aussi annonc� l'acc�l�ration des travaux men�s avec le minist�re de l'Education quant � l'instauration d'une formation coll�giale en technique ambulanci�re, qui pourrait �tre offerte d�s l'automne 2006. Le nouveau programme visera notamment un rehaussement de l'exposition clinique, des comp�tences techniques et des habilet�s relationnelles. Par ailleurs, la formation continue des techniciens ambulanciers qui oeuvrent d�j� dans le r�seau de soins pr�hospitaliers sera �galement am�lior�e. �Ces mesures fourniront de meilleures garanties � la population quant � la qualit� des soins�, a pr�cis� monsieur Couillard. De plus, le ministre accueille favorablement la recommandation de l'AETMIS concernant la formation de la population g�n�rale en r�animation cardiorespiratoire (RCR). Il a soulign� que des travaux sont d�j� en cours au sein du gouvernement afin, notamment, de rendre disponible une formation de base � un large �ventail d'�tudiants du niveau secondaire. �Conform�ment aux recommandations contenues dans le rapport de l'AETMIS, nous entendons mener ce dossier en fonction d'objectifs rigoureux de pertinence, d'efficacit� et de qualit�. Je compte sur la collaboration de tous les partenaires impliqu�s afin de poursuivre de fa�on harmonieuse, dans le respect de notre cadre l�gislatif, le d�veloppement des modalit�s optimales de soins pr�hospitaliers avanc�s sur le territoire qu�b�cois. Les soins pr�hospitaliers d'urgence font partie int�grante des soins de sant� offerts aux citoyens du Qu�bec et notre gouvernement a l'intention de poursuivre leur d�veloppement�, a conclu le ministre. --- URG-L Pour modifier votre adresse de courriel sur URG-L, envoyez un avis a [EMAIL PROTECTED] en indiquant votre nouvelle adresse ainsi que l'ancienne et le nom de la liste.
