In his uniform, with his broad shoulders and serious demeanor, David Ouellet embodies the typical image of a paramedic.
Published at 1:48 a.m. Updated at 5:00 a.m.
However, he is not a paramedic like the rest.
David Ouellet serves as a community paramedic. Instead of transporting patients to hospitals via ambulance, he visits seniors who have called 911 from their homes.
“We often overlook the fear and anxiety seniors feel about going to the emergency room,” says David Ouellet, community paramedic at Ambulances Demers.
For some seniors, when we take them to the emergency room, they believe they won’t return home. When we explain that we are there to assist them and enable them to stay home, it provides them with a sense of security and peace.
David Ouellet, community paramedic
In Quebec, only about ten paramedics provide home visits by car, without the use of an ambulance. This service benefits approximately 4,200 patients each year.
This form of paramedicine—paramedic-led care—started in Montérégie in 2019. With the aging population and crowded emergency rooms, the CISSS de la Montérégie-Centre began questioning whether it was necessary to take every elderly person who called 911 to the emergency room, especially for minor cases that could be addressed differently.
Thus, they initiated a pilot project for paramedicine, with the approval of Quebec authorities.
Rather than automatically transporting all patients aged 65 and older to the emergency room—where they could wait hours to see a doctor for non-urgent issues—a paramedic is dispatched to assess them by car.
PHOTO PATRICK SANFAÇON, THE PRESS
Community paramedic David Ouellet visits patients by car, rather than by ambulance.
David Ouellet’s vehicle often arrives more quickly than the ambulance, typically within 20 minutes. “I conduct a more comprehensive assessment of the situation and discuss it with the nurse,” he explains. Together, they determine whether the patient should be transported to the emergency room or whether they can receive a visit from a nurse at home or an appointment with a family doctor within 24 hours.
In Montérégie, this service is available for patients aged 65 and older who call 911 and are considered low-priority cases. This includes individuals who have fallen and cannot get up, or those experiencing knee, hip, or ankle pain. In practice, such patients often wait hours for an ambulance.
If the 911 dispatcher suspects a serious, high-priority case (e.g., chest pain, difficulty breathing), they do not hesitate to send an ambulance immediately.
Many of the 911 calls do not constitute “urgent” medical cases: 64% of elderly patients treated by the pilot project in Montérégie do not end up in the emergency room. Additionally, 37% of patients go to the emergency room not necessarily due to the seriousness of their condition, but because they require tests.
In recent years, Quebec has begun to adopt paramedicine practices.
This shift was overdue, especially compared to Ontario. In Renfrew County, Ontario, paramedicine has been practiced since 2008, setting a precedent.
Currently, there are three types of paramedicine operating in Quebec:
- For 911 calls, low-priority cases are directed to a nurse for triage over the phone, who attempts to address their issues without routing them to the emergency room (implemented in 13 of the 17 regions);
- For 911 calls, paramedics arriving via ambulance for minor cases can recommend resolving these issues through a nurse or doctor appointment without needing to go to the emergency room (implemented in nine regions);
- In Montérégie, Montreal, and Laval, 911 triage also assigns certain minor cases to a community paramedic, who visits patients’ homes alone, without an ambulance. This is significantly less costly for the health network compared to ambulance transport.
Paramedicine offers numerous benefits.
It helps alleviate some of the pressure on emergency rooms.
“With the aging population, we’re anticipating a surge of health issues that we’re not equipped to handle,” says Dr. Sophie Gosselin, an emergency physician and coordinating physician at the Charles-Le Moyne Hospital emergency room in Longueuil. “The emergency room will not be able to accommodate all of these visits.”
Paramedics and nurses apply their expertise to address minor cases that do not require medical intervention.
Patients receive faster treatment. In Montérégie, the response time to see a community paramedic is about 30 minutes, compared to a minimum of 8 hours in the emergency room.
Patients are treated in their own homes.
Additionally, the careers of many paramedics are extended in this physically demanding profession where lifting patients is a requisite.
PHOTO PATRICK SANFAÇON, THE PRESS
Community paramedic David Ouellet
As we age, we all experience our share of aches and pains. This opportunity is valuable for paramedics who can no longer lift patients.
David Ouellet, community paramedic
Most importantly, patients are satisfied. In Montérégie, the pilot project boasts a remarkable satisfaction rate of 96%.
Due to these benefits, Health Minister Christian Dubé intends to expand paramedicine “more broadly” based on pilot project outcomes and the “unique characteristics of each region.” According to the Minister’s office, a nurse or paramedic can attend to “health issues that do not require immediate attention,” ensuring that “transport to the emergency room is reserved for patients with more pressing concerns.”
It may be that our laws, which are inadequately adapted for paramedicine, require modernization. They currently mandate that a 911 call leads to hospital transport if that is the patient’s choice.
“Paramedics cannot evaluate the physical and mental conditions of patients,” notes Julie Nantel, a clinical nurse and advisor at Urgences-santé, which serves Montreal and Laval. “They follow protocols and must transport patients. They have no flexibility.”
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The Rise of Community Paramedics: A New Era in Emergency Care
With his uniform, his square shoulders, and his serious air, David Ouellet has the typical look of a paramedic.
Except he’s not a paramedic like the others. David Ouellet is a community paramedic. Instead of driving patients to the hospital by ambulance, he visits seniors who have called 911 in their homes.
“We often forget the fear and anxiety of seniors about going to the emergency room,” says David Ouellet, community paramedic at Ambulances Demers.
David Ouellet, community paramedic
In his words, “For some seniors, in their minds, when we take them to the emergency room, they will not come back to their home. When we make them understand that we are there to help them and keep them at home, it gives them a sense of security and serenity.”
What is Community Paramedicine?
In Quebec, there are only about ten paramedics who visit patients at home by car, without their ambulance. About 4,200 patients per year benefit from this service.
This type of paramedicine – medicine by paramedics – began in Montérégie in 2019. As the population ages and emergency rooms become overwhelmed, the CISSS de la Montérégie-Centre explored alternatives for elderly patients calling 911.
Transformation of Emergency Care
Instead of sending all patients aged 65 and over to the emergency room, where they may wait for hours, a paramedic is dispatched in a car. This innovation aims to address minor cases that can be resolved in a timely manner.
PHOTO PATRICK SANFAÇON, THE PRESS
Community paramedic David Ouellet visits patients by car, rather than by ambulance.
The Advantages of Community Paramedics
David Ouellet’s car often arrives faster than the ambulance, typically within 20 minutes. “I perform a thorough assessment of the situation, and I discuss it with the nurse,” he explains. This allows them to decide if the patient needs to be taken to the emergency room or can receive follow-up care at home.
Who is Eligible?
In Montérégie, this service is offered to patients aged 65 and over who call 911 and are deemed low-priority cases, such as those who have fallen or are experiencing non-urgent pain.
The Statistics Speak Volumes
Alarmingly, 64% of elderly patients treated in this pilot project do not end up at the emergency room. Furthermore, 37% only go to the emergency room for tests, underscoring the potential for intervention via community paramedicine.
The Growing Trend of Paramedicine in Quebec
Quebec has been slow to adopt paramedicine practices, especially when compared to regions such as Ontario, where paramedicine has been effective since 2008. There are currently three types of paramedicine in Quebec:
- Non-urgent 911 calls are directed to a nurse for assessment, operational in 13 of the 17 regions.
- Ambulance paramedics can suggest follow-ups with medical professionals instead of going to the ER, available in nine regions.
- In Montérégie, community paramedics handle low-priority cases on-site, a solution that is cost-efficient.
Benefits of Community Paramedicine
- Reduces Emergency Room Congestion: By addressing low-priority calls, community paramedics alleviate pressure on emergency rooms.
- Faster Response Times: Patients wait approximately 30 minutes to see a community paramedic compared to at least eight hours in an emergency room.
- In-Home Care: Patients receive care in the comfort of their own homes, enhancing their satisfaction.
- Longer Careers for Paramedics: This model allows paramedics to remain in the workforce longer without the physical strain of traditional roles.
Real-World Impact
PHOTO PATRICK SANFAÇON, THE PRESS
Community paramedic David Ouellet performing his duties.
“As we get older, we have our little aches and pains too. It’s a great way out for paramedics who are no longer able to lift people,”
David Ouellet, community paramedic
High Satisfaction Rates
The pilot project in Montérégie has achieved an impressive satisfaction rate of 96%, indicating strong support for the community paramedic model.
Future of Community Paramedicine in Quebec
The Health Minister, Christian Dubé, envisions a wider deployment of paramedicine based on positive pilot results tailored to regional needs. However, legislative challenges exist, with outdated laws requiring 911 calls to result in hospital transport, which may need reevaluation.
As Julie Nantel, a clinical nurse, points out, “Paramedics cannot assess the physical and mental condition of patients. They apply protocols and must transport patients, leaving little room for flexibility.” Overcoming such barriers is essential for the future success of community paramedics in Quebec.