The Ontario government has expanded the successful Patient Care Models for select 9-1-1 patients in 40 municipalities across the province. These patient care models ensure that paramedics have more options to provide safe and appropriate treatment for patients while helping to protect hospital capacity. These initiatives are helping to divert patients away from emergency departments and reducing repeat hospital visits, which helps reduce patient wait times and ensures these hospital beds are available for those that need them most.
The majority of the patient care models for palliative care patients being implemented are based on the “Ontario Palliative Care Network’s Competency Framework for Paramedics” which is designed to equip paramedics with the skills and knowledge to respond to palliative care needs. For example, under this Treat & Refer model, paramedics are able to provide symptom management care on scene and then ensure appropriate follow-up care is provided by a community health care provider. This model is federally supported by the Canadian Partnership Against Cancer and Healthcare Excellence Canada.
Under the Alternate Destination model for mental health and addiction patients, an eligible patient may choose to go to a Crisis Centre or Drop-In Centre, which are able to address the patients care needs with properly trained staff and in a more welcoming environment. This model provides timely access to care without taking patients to the emergency department.
| Regions or Pilot Project Lead Organization | Ambulance Services | Model Type | Eligible Patients | Description | Patient Success Stories |
|---|---|---|---|---|---|
| Central East Ontario |
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Treat and Refer Model | Palliative Care Patients | Under these models palliative care patients calling 9-1-1 will have the option to be treated on-scene for pain and symptom management, including pain or dyspnea, hallucinations or agitation, terminal congested breathing, and nausea or vomiting. Following treatment on-scene, patients have the option for paramedics to coordinate the patient’s follow-up care directly with the patient’s primary palliative care provider or with a local hospice for further treatment and wrap-around care.
Paramedics are trained to administer a range of medications to address the above symptoms:
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| Centre for Paramedic Education and Research |
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Treat and Refer Model | Palliative Care Patients | Under these models palliative care patients calling 9-1-1 will have the option to be treated on-scene for pain and symptom management, including pain or dyspnea, hallucinations or agitation, terminal congested breathing, and nausea or vomiting. Following treatment on-scene, patients have the option for paramedics to coordinate the patient’s follow-up care directly with the patient’s primary palliative care provider or with a local hospice for further treatment and wrap-around care.
Paramedics are trained to administer a range of medications to address the above symptoms:
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| Hamilton |
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Treat and Refer Model | Palliative Care Patients | Under these models palliative care patients calling 9-1-1 will have the option to be treated on-scene for pain and symptom management, including pain or dyspnea, hallucinations or agitation, terminal congested breathing, and nausea or vomiting. Following treatment on-scene, patients have the option for paramedics to coordinate the patient’s follow-up care directly with the patient’s primary palliative care provider or with a local hospice for further treatment and wrap-around care.
Paramedics are trained to administer a range of medications to address the above symptoms:
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| Health Sciences North |
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Treat and Refer Model | Palliative Care Patients | Under these models palliative care patients calling 9-1-1 will have the option to be treated on-scene for pain and symptom management, including pain or dyspnea, hallucinations or agitation, terminal congested breathing, and nausea or vomiting. Following treatment on-scene, patients have the option for paramedics to coordinate the patient’s follow-up care directly with the patient’s primary palliative care provider or with a local hospice for further treatment and wrap-around care.
Paramedics are trained to administer a range of medications to address the above symptoms:
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| Regional Paramedic Program of Eastern Ontario |
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Treat and Refer Model | Palliative Care Patients | Under these models palliative care patients calling 9-1-1 will have the option to be treated on-scene for pain and symptom management, including pain or dyspnea, hallucinations or agitation, terminal congested breathing, and nausea or vomiting. Following treatment on-scene, patients have the option for paramedics to coordinate the patient’s follow-up care directly with the patient’s primary palliative care provider or with a local hospice for further treatment and wrap-around care.
Paramedics are trained to administer a range of medications to address the above symptoms:
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| York Region |
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Treat and Refer Model | Palliative Care Patients | Palliative care patients calling 9-1-1 will have the option to be treated on-scene for pain and symptom management, including pain or dyspnea, hallucinations or agitation, terminal congested breathing, and nausea or vomiting. Following treatment on-scene, patients have the option for paramedics to coordinate the patient’s follow-up care directly with the patient’s primary palliative care provider or with a local hospice for further treatment and wrap-around care.
Paramedics are trained to administer a range of medications to address the above symptoms:
|
Patient Story 2 |
| Dufferin County |
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Alternate Destination | Palliative Care Patients | Palliative care patients calling 9-1-1 will have the option to be transported directly to a hospice that they are registered with instead of to the hospital. Paramedics are able to assess the patient on-scene, including establishing baseline vital signs (e.g. checking blood pressure, heart rate, etc.) and confirming patient consent before assisting in transporting the patient to the hospice. | |
| Guelph-Wellington |
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Alternate Destination | Palliative Care Patients | Palliative care patients calling 9-1-1 will have the option to be transported directly to a hospice that they are registered with instead of to the hospital. Paramedics are able to assess the patient on-scene, including establishing baseline vital signs (e.g. checking blood pressure, heart rate, etc.) and confirming patient consent before assisting in transporting the patient to the hospice. | Patient Story 3 |
| Alternate Destination | Mental Health and Addictions Patients | Patients calling 9-1-1 experiencing symptoms of mental health and addictions challenges, will have the option to be directly transported to and treated at a crisis centre, or other community-based care setting with patient consent. Paramedics provide an on-scene assessment for mental health and addictions patients, including determining if the patient is medically stable and to assess for appropriateness to be directly transported to a crisis centre or other community-based setting. | |||
| Middlesex-London |
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Alternate Destination | Mental Health and Addictions Patients | Patients calling 9-1-1 experiencing symptoms of mental health and addictions challenges, will have the option to be transported to and treated at a crisis centre, or other community-based clinic. Paramedics are able to provide an on-scene assessment, including determining if the patient is medically stable and conduct an assessment for appropriateness to be transferred. If the patient consents, paramedics will be permitted to transport patients directly to the Centre for Mental Health and Addictions in London, Ontario. | Patient Story 1 |
| South West |
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Treat and Refer | Palliative Care Patients | Palliative care patients calling 911 will have the option to be treated on-scene for pain and symptom management by trained paramedics who may administer medications in accordance with their approved medical directive. | |
| South West |
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Alternate Destination | Palliative Care Patients | This model enables a pre-registered patient to be transported directly to a hospice, bypassing the local hospital. The paramedic will assess the patient, and if the patient meets the approved medical directive requirements, the patient will be provided the option of going to the hospice instead of the hospital. | |
| Ottawa |
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Treat and Refer | Mental Health and Addictions Patients | A joint health professional response vehicle will respond to non-violent, non-criminal 9-1-1 calls with a presenting or complicating factor of mental health and/or substance abuse. The paramedic completes their assessment before transferring the patient over to the mental health professional for mental health and social care. | |
| Essex-Windsor |
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Treat and Refer (Mobile mental health crisis team) | Mental Health and Addictions Patients | Paramedics responding to a 911 call, assess the patient and refer to a Mental Health and Addictions Response Team (MHART) that provides mobile mental health and addictions care for moderate to low-acuity mental health and addictions patients. Once the MHART arrives, the ambulance is released back into the field. |
Please contact your local municipality for further details regarding program rollout and availability in your region. A complete listing of Ontario municipalities, including contact information, is available online at www.ontario.ca/page/list-ontario-municipalities.
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