Community paramedics helping those on the fringes
Paramedics usually go to the aid of people in distress, but their role is expanding in some areas of the country, with emergency medical staff now becoming front-line professionals who make house calls.
They are called community paramedics, and their mission is to help patients in the community solve some of their medical and care problems before they become full-blown emergencies.
Paramedics are often the first and only point of contact to the health care system for those who are housebound, or suffering psychological problems that prevent them from getting the care they need.
Emergency workers are able to identify these patients and "red-flag" as needing home care services such as nursing, the help of a social worker, or access to medical devices.
CTV News rode along with a team of Toronto-based community paramedics recently. On one day, we visited a 69-year-old man who had called 911 in trouble twice before.
Paramedics who came to the man's aid during one of his emergency calls noticed his living conditions were poor and that he appeared to need help. So they alerted the Toronto's EMS program, CREMS (Community Referrals by EMS).
Now, community paramedics John Klich and Debbie Wicks are paying the man a visit, with his consent. The man tells them that things are under control, but Klich and Wicks suspect the man's diabetes is poorly controlled, leading to the emergencies and 911 calls.
An inspection of his feet shows they are in danger of infection, a common complication of uncontrolled diabetes. His legs are swollen and discoloured below the knee and he has already had two toes amputated from his left foot.
With his permission, they check the man's fridge and find there isn't much food.
They ask the man if he checks his blood sugar every day and the man responds that he doesn't,. The man explains that he isn't convinced he really has diabetes.
"We really want to get him some help," Klich tells CTV News, outside the man's apartment, "because if he stops walking and his feet become bad, it becomes a whole new issue.
"He is one of these fellows that we caught him at the right opportunity: he is still open enough to get some help."
John and Debbie suggest to the man that they could have a public health nurse drop in to check his feet. They also want to send someone in to educate him about his diabetes. After a few minutes of talking and negotiating, the man agrees.
Later, CTV tags along as Toronto EMS visits a large, elderly woman, who is housebound because of her walking difficulties and who has to call 911 each time she falls and can't get up.
The team explains to the woman that there are home care services available to her that would have somebody coming in a regular basis to check on her and to offer help. They ask the woman if it's okay with her if they start a request for a referral to make that happen. She reluctantly agrees.
Later, they will make a referral to the woman's local Community Care Access Centre, who will follow up within 36 hours. They will then aim to send a CCAC coordinator within a week to the woman's home to explain the services she can access.
Michael Nolan, the president of the Emergency Medical Services Chiefs of Canada, says the aim of community paramedics is to help those people who have fallen through the cracks, those people who aren't getting help from anyone else in the community and who are relying heavily on emergency services.
"It is unsustainable to wait for the phone to ring and to respond to those life-threatening emergencies," he tells CTV News. "We believe strongly that paramedics have more to offer by being pro-active."
The community paramedics program in Toronto has already been a success, CREMS organizers say. The program has helped cut repeat 911 calls by up to 80 per cent, helping patients who usually relied on emergency medical services to manage their chronic and unaddressed care issues and finally get the regular care they need.
With a report from CTV's Avis Favaro and producer Elizabeth St. Philip