Jacques Champagne waits for the ambulance, sitting in the lobby of the Montreal homeless shelter where he lives. The day before, he had a bad fall and waited 14 hours in the emergency room. “I had x-rays and I have nothing,” said the 74-year-old man, who walks with a cane. But he still has pain in his knees and he is worried. He asked someone at the shelter to call 9-1-1.
The ambulance never arrived. Urgences-santé deemed Mr. Champagne’s case non-urgent. The central dispatched to the refuge, located in the former Hôtel-Dieu, a white intervention vehicle. On board, no stretcher. Only a paramedic ambulance technician, equipped with a semi-automatic monitor-defibrillator, an oxygen bottle and all the emergency necessities.
As soon as he arrived on the scene, paramedic and Urgences-santé instructor Pascal Lavoie took Mr. Champagne’s vital signs. He asked him regarding his fall, his leg pain and his medication. He then contacted a nursing colleague from the plant to carry out a “co-evaluation”. The latter questioned the patient on the telephone and recommended, following consulting Mr. Lavoie, self-care: ice and Tylenol.
It was Tuesday night last week. The duty accompanied Pascal Lavoie on the field. A first foray into the world of community paramedics at Urgences-santé, the largest pre-hospital services organization in Quebec.
Since September, the public company serving the territories of Montreal and Laval has been deploying a new program to reduce the number of transport of non-emergency cases by ambulance.
According to Urgences-santé, more than 220 emergency room consultations have been avoided so far: patients have been redirected to other resources such as a medical clinic, a pharmacy or even a dentist. A hundred other transports did not take place, because the users went to the hospital by other means, indicates the organization.
“So far, the redirection rate of co-evaluated calls to a means other than ambulance transport is around 75%,” says Julie Nantel, planning and programming officer at Urgences-santé.
Given such success, the program was extended to 18 living environments for seniors at the end of January. The goal? Avoid transfers of elderly people by ambulance to hospital when possible.
According to nurse Catherine Gendron, patients are “often” surprised not to be transported by ambulance following a call to 9-1-1. “But I’ve never had so much gratitude in 15 years [de travail] giving a patient an appointment [dans une clinique médicale] the next day at 9 a.m.! she said, smiling.
Jacques Champagne is “entirely satisfied” with the service received. “It’s good, because they take the time to discuss, to find a better way [de nous aider] says the itinerant with a lit look, who wears a massive silver chain around his neck and bracelets on his wrists. “At the hospital, they told me absolutely nothing [sur ce que je devais faire pour gérer la douleur]. They paid me a taxi, because I didn’t have any money on me. »
A limited program, for now
Some 200 Urgences-santé paramedics are trained to do joint assessment with a nurse. But only three intervention vehicles – sometimes two – are assigned daily to this service.
During his shift, Pascal Lavoie saw three patients. “Often, the issues that are less urgent have lasted longer or are recurring,” explains the tall, calm-looking man with long hair gathered in a hat. “To fully understand the need, it requires more in-depth questioning. »
That’s what he did when he met a 67-year-old Montrealer with chronic back and leg pain. When we arrived, the pensioner, who had worked physically all his life, said he had been standing for three days! He was unable to lie down or sit up and had not slept. His reddened eyes showed great fatigue.
Pascal Lavoie conducted a co-assessment with a nurse — a paramedic does not have the power to assess a patient alone. Ambulance demand was maintained and priority increased.
“As the nurse said, he can’t sit down, so he can’t take a taxi,” said Pascal Lavoie, once back in his vehicle. “But he can’t be lying down. What is he going to do in the ambulance? Him, his belief was that I was going to be able to give him medicine. We don’t have fentanyl for the pain. Certainly, he mightn’t spend another night up.
Emergencies anyway
Community paramedics sometimes deal with emergency situations. During his first intervention, Pascal Lavoie expected to take care of a man in his sixties with a wound due to a fall. However, the patient (a homeless person living in a shelter) had rather a pasty mouth, an altered facial expression and a sagging arm. Signs of a possible stroke.
Placement of electrodes on the chest and abdomen, glucose test, blood pressure measurement… Pascal Lavoie quickly asked the patient several questions. “The sky is blue in Cincinnati, can you repeat that sentence? Do you know what date it is? ” Negative. An ambulance was urgently called; she was there in less than five minutes.
“When a paramedic calls for an ambulance, it comes first,” says Pascal Lavoie. However, he points out that, contrary to what many people think, patients who arrive at the hospital by ambulance are not necessarily seen more quickly. If their problem is non-urgent, they will go to the waiting room.
Pascal Lavoie believes that the population must be “taught” “how to use the health system”. But the pre-hospital system must also be rethought, according to him.
Even today, he laments, a call to 9-1-1 translates into “an ambulance and a transport”. “That’s not what people need. The health system is struggling to set up front-line services. Co-assessment, for us, in prehospital, means doing our part in this reorganization. »
