We are all familiar with emergency response: a person picks up the phone, dials 9-1-1, has a conversation with a dispatcher, and, ideally within minutes, a rescue team arrives. Normally, if a patient is calling in regards to his or her health, a paramedic arrives at the scene, assesses the situation, occasionally provides some form of care on the field, and takes the patient to the nearest available hospital. If a person is calling regarding a fire, a fire truck rushes over.
Recently, the Ontario government has begun to suggest changes to these long-standing protocols. Amendments to the Ambulance Act and the Fire Protection and Prevention Act are set to be tabled in the coming months:
- Currently, ambulance operators are required to take patients to hospitals. The proposed changes to the Ambulance Act would allow paramedics to take patients to primary care or community care centers (family physicians, walk-in clinics, etc.) instead of to hospitals, based on what level of care the patient requires.
- The proposed changes to the Fire Protection and Prevention Act relate to increasing responsibilities of firefighters who have paramedic training. The proposal includes allowing them to provide medical care on firetrucks, including responding to calls that relate to minor injuries and providing relief for some of the higher-priority calls.
Changes to these two key pieces of legislation are said to be implemented in full in two years, but enactment could begin as early as March 2018 in two municipalities (that are yet to be determined) as part of the Ministry of Health and Long-Term Care’s pilot project. There are talks of this being a voluntary change, taken on by each municipality by opting in to these new protocols; it is, however, important to recognize that there are several implications that these amendments will bring.
The Ontario government and other proponents of these changes argue that the new protocols will allow more flexibility in the system, which would result in reduced emergency room visits and potentially lower wait times. On the other hand, there are risks associated with not taking a person to a hospital, as opposed to a clinic or to see a family doctor because hospitals tend to have more resources, which makes them better-equipped to handle a larger variety of illnesses and emergencies.
Below are some key questions to consider:
- Would there be any safety measures in place? For example, if the incorrect decision is made or a family/community care center is unable to adequately take care of a patient, would there be standby ambulances ready to transport the patient to the nearest hospital?
- How much decision-making power would the first responders have compared to the base hospital in terms of where to take the patient?
- How voluntary would these changes be? Are there any parameters where municipalities would be forced, by law, to take on these changes?
- Who would pay for any excess costs these protocols will have – the Ministry or the municipality? Some costs that have been discussed include training for firefighters to be able to give medical care on the ground. The government would also have to consider the legal liabilities involved when an incorrect judgement is made as to where a patient should go or what treatment he or she should receive on scene under the direction of these new protocols.
It will be interesting to see how this plays out both on the government level and on the ground. We hope for clear, well thought-out guidance. DDO Health Law will be keeping a close eye on these revelations and would be happy to discuss what the amendments could mean for health care organizations.