Ambulance_09-38

Jeff Green | Sep 24, 2009

Not all ambulances run by Frontenac Paramedic Services have the same capacity to deliver emergency medical services.

There are two levels of paramedics working for the service, which serves Kingston and Frontenac County: Primary Care Paramedics (PCPs) – the provincial standard, and Advanced Care Paramedics (ACPs) – an optional higher level service.

Primary Care Paramedics can administer five different drugs, while Advanced Care Paramedics can deliver many more. ACPs can start intravenous drips and use more invasive techniques to remove objects that block airways, among a host of other treatment tools.

Currently five of the six 24-hour Kingston ambulances are staffed with one ACP and one PCP at all times, (pending staff availability) but the 24-hour ambulance that works out of the Parham base in Central Frontenac and the 12-hour ambulance that works out of Lavant Station in North Frontenac are each staffed with 2 PCPs.

In an interview with the News last week, Paul Charbonneau, the Director of Emergency and Transportation Services/Chief of Paramedic Services for the County, described how this discrepancy came about.

“In 1994 the Province of Ontario commenced a ten-year study on the value of Advanced Care Paramedics, It was called OPALS. At 18 sites in Ontario, the province paid the extra cost of establishing ACPs. One of those was at Hotel Dieu hospital, which at that time served the City of Kingston. The province covered 100% of the extra salary, drug and ancillary costs for ACPs.”

When paramedic services were downloaded in 2000 and Frontenac County won the contract to deliver service in the City of Kingston and Frontenac County, the new service took over from Hotel Dieu and the Parham ambulance. At the time, Hotel Dieu had ACPs, Parham didn't. The OPALS study was designed for services that were able to respond to calls within 8 minutes, which precluded rural ambulance services that cover large distances, and the potential advantages of ACPs to rural areas was not part of the study.

When the studied period ended in 2004, it was deemed a mixed success. For example, there was little or no improvement in outcomes for cardiac arrest patients, but there was considerable improvement for patients suffering respiratory distress.

When the study period ended, Frontenac County Paramedic Services was faced with increased costs of $180,000 each year to keep Advanced Care Paramedics working in Kingston, and it has done so.

“We have simply carried on as before once OPALS ended, with ACPs in Kingston but not in Parham. To change that would be a political decision,” Charbonneau said.

In some other jurisdictions in Eastern Ontario, however, ACPs have become the norm, even for rural service. While only two Eastern Ontario jurisdictions, Ottawa and Kingston, were part of the OPALS study, some other jurisdictions have since opted to fund ACPs on their own.

Hastings County has instituted a 1 ACP - 1 PCP system in all their ambulances, even at their rural Bancroft base. The same holds true in the Cornwall area.

Susan Brown is the Manager for Training, Quality Assurance and Program Development for Frontenac County Emergency Services. She is also a qualified Advanced Care Paramedic. She sees some definite advantages to having ACPs in all Frontenac ambulances. Aside from the obvious advantages of bring able to administer intravenous drugs on the spot there are other advantages. One she cited is treatment for diabetics.

Faced with a diabetic whose sugar level has dropped to the point where they are disoriented or even unconscious, a PCP can deliver a rather expensive drug which takes 20 minutes to take effect, while an ACP can administer a drug that costs 50 cents and takes effect almost instantly. “Aside from delivering a better immediate outcome for the patient, the likelihood of a hospital visit being necessary in these cases is diminished, leading to savings for the health care system in addition to better service for the public,” Susan Brown said.

When ACPs are required on a rural call in Frontenac County, the PCP ambulance takes the patient, and the nearest ACP-staffed ambulance heads towards the PCP vehicle. When they meet, the ACP jumps into the other ambulance, which continues on towards the hospital.

In Paul Charbonneau's view, Advanced Care Paramedics fit in with a model of health care wherein the ambulance is seen not as a “simple ride to the hospital” but more as “the hospital coming to the patient”, whether that is at their house or at an accident scene.

When the decision was made earlier this year to build a new ambulance base in South Frontenac to house a 24-hour ambulance, the ambulance service put forward a proposal to include an ACP on each shift, and that was accepted by Frontenac County Council.

But there are still no plans for the Parham and Lavant Station paramedic service to be upgraded.

“We have been focussing on the physical plant of the rural ambulance this year,” Charbonneau said, “and the cost of bringing ACP to the North is not something we have brought to the attention of county council thus far.”

There are some issues that would have to be overcome should ACPs be incorporated into the rural Frontenac service. ACPs need to use their skills in order to maintain their certification, and with lower call volumes in the rural areas, ACPs might be required to work some shifts in other locations in order to keep their status.

There is also a question of the cost of training. A PCP can train for ACP certification on a part-time basis, but they will likely have to sacrifice some shifts in order to do the training, and they must cover the cost of the training as well.

“Frontenac County has never paid for ACP training,” said Paul Charbonneau, “whenever a position has come up we have simply advertised for an ACP to cover it, and upgraded our staffing through hiring.”

In other jurisdictions, however, the employer has subsidized the training, and even more aggressive recruitment has been tried.

“When Hastings County upgraded to ACP, they did it by offering a $10,000 signing bonus for any ACP who would come to work for them,” Paul Charbonneau said.

“There are different ways that ACPs could be brought to the north end of the County. It could be done slowly, through attrition, by hiring ACPs when paramedics leave the service, or though more aggressive means.

“But everything costs money, and those kinds of decisions are up to the politicians”