Innovative end-of-life care: Renfrew County Paramedic Palliative Care Program
Personal Stories | August 18, 2023 | Dying With Dignity Canada
In grade 12, Amber Hultink had her sights set on a career in health care – or as a chef. When her offer to the St. Lawrence College for the Primary Care Paramedic Program came in, she accepted, loved the program and graduated in 2008. In spring of the same year, Amber was hired by Renfrew County Paramedic Service and started her career as one of the first of four Community Paramedics for the ‘Aging at home’ program. The program targeted the top 32 people on the Long Term Care (LTC) waitlist in Deep River and worked to wrap services around those patients to keep them safely out of LTC. After her involvement in that successful program, she returned to school to complete her Advance Care Paramedic in 2010.
Fast forward to 2018, Amber was seconded to Ottawa for the Canadian Foundation of Health Care Improvement (CFHI) – now Health Care Excellence Canada – and was a paramedic lead on a pan-Canadian project implementing paramedics providing palliative care across Canada. “The experience introduced me to a variety of experts in paramedicine and palliative care, data and research, as well as what works in other regions of the country that we’d like to apply in Ontario,” Amber explained. “It was eye-opening, humbling and an excellent opportunity for me and Renfrew County.”
Amber returned to Renfrew County just as the global pandemic due to COVID was developing. Based on her education and experience in Ottawa, Amber was able to implement a Paramedic Palliative Care Program within her community. In July 2020, she was named the first female commander for the Paramedic Services in Renfrew County, and her portfolio has included community paramedicine.
Since the pandemic the Community Paramedic Program has tripled in size. “Because of my time at CFHI, I had access to information from seven jurisdictions from the proposal to implementation phase, and we had a great team here to get the program off the ground. We needed to work out how to implement it within the framework of our province and region and align all the community organizations such as Home Care, Care Coordination, or family physicians who offer palliative care.”
So how does this all work? In Amber’s region there are 9-1-1 Emergency Paramedics and approximately 40 Community Paramedics. “Community paramedicine is where we knew we could have the most impact. All our Community Paramedics are trained and then we provided education to our 9-1-1 Paramedics so they can call in a Community Paramedic if a palliative approach to care would better suit the patient. The Community Paramedics are all Advance Primary Care Paramedics who are onboarded through an orientation program that includes a primer to palliative education and engagement with other stakeholders such as a palliative consultant, a care coordinator and so on.”
The Renfrew Country Palliative Care Program mostly deals with acute, episodic symptom management. “What we know through research is that the patient and their care givers can have all the supports they need, but they are still sometimes calling 9-1-1 because the patient’s condition changes and the family panics, understandably. Our aim is to avoid 9-1-1 calls and emergency room visits and potential subsequent admissions for those who want to stay at home and are well supported. From the data that we have pulled, 67% of interactions result in emotional support and guidance, often normalizing what they are seeing. There are some medications we can provide, and we sometimes support the people providing the on-going palliative care.”
Through developing this program in her region Amber says that they have had great success in integrating and building meaningful partnerships with home community care which has increased health care efficiency, and the patient experience is better because they perceive that everyone is on the same page. “On average, we do about two palliative interactions as Community Paramedics per week. A majority of them would have resulted in a 9-1-1 call or transport to the hospital; instead, we keep them where they want to be, which is home. It’s truly fulfilling work; it’s a privilege to be part the care for these folks.”
Amber made a point of explaining that there were so many people involved and committed to getting this program off the ground, “It took a lot of people, from multidisciplinary backgrounds, having faith in what we were trying to do and to focus on what is really best for the patient.”
Note: Other jurisdictions who have implemented similar programs include, Alberta Health Services, the provinces of Nova Scotia, British Columbia, Newfoundland/Labrador, Saskatchewan Health Authority, Manitoba Inner Lake region, the City of Ottawa, York Region Paramedic service, and Medavie Health Services in New Brunswick.