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Riding along with Renfrew County paramedics as palliative care becomes a greater focus

Renfrew County paramedics still respond to all emergency situations, but many of them are taking on a much more proactive and clinical role with residents, which includes delivering palliative care for those who choose to die at home.

This is part one of a three-part series by Bruce McIntyre.

Usually, when an ambulance shows up at a residence, somebody is having one of the worst days of their lives and the paramedics not only have to assess and provide primary medical care.

But sometimes they are one of the few people that pay a visit to an elderly or isolated person.

In Renfrew County, the role of a paramedic has slowly changed from solely that of a reactive first responder who attends to a collision or a house fire or a host of occurrences that cannot be accurately predetermined. Over the last decade, local paramedics have become much more proactive in helping to identify vulnerable people and have provided advice and primary medical services to assist in reducing the number of ambulatory visits.

This, in turn, has led to reducing the number of unnecessary visits to emergency rooms in the region.

County paramedics innovating

Michael Nolan, Chief of the Renfrew County Paramedic Services, has gained a well-earned reputation as an innovator while taking on the challenge of coordinating ambulatory care for Ontario’s largest county.

Unlike urban centres, where thousands of people may live within a five-block radius, the 750 men and women of the Renfrew County paramedic service provide 24/7 ambulatory care to a year-round population of roughly 120,000 people in an area twice the size of Prince Edward Island.

A large part of the area is not accessible by vehicle, which is a challenge for emergency rescues undertaken by the paramedics. More often than not, they rely on drones, ATVs and boats to lead those medical rescues.

It took him a few years, but Nolan was able to equip his force with the outdoor rescue equipment necessary to create a specialized all-season rescue unit made up of paramedics who are trained to quickly respond to isolated medical rescues. Most are accomplished swimmers, hikers or kayakers who have spent hours rock climbing and doing other specialized training needed to overcome barriers such as canyons, mountains, rivers and unwanted surprises nature may throw in the way.

About a decade ago Nolan started tracking 911 calls in some of the most isolated areas within his catchment. He noticed a trend that was growing so quickly that if continued unchecked, it could seriously compromise the ability for paramedics to respond to emergency calls in a timely manner.

More and more paramedics were responding to non-emergency calls from seniors who were either isolated or insisted on going to one of the area’s five hospitals. Some were habitual 911 callers with no real health risk, but they were beginning to fill valuable hospital beds, and they required trained health care workers and resources to provide care.

These early alarm bells were ringing years before the word COVID became part of our everyday language.

The old way of delivering paramedic services had to adapt and change with this new reality.

As a result, the paramedic service adopted a proactive system that is designed to service areas very remote, and proactively offer wellness clinics. The clinics provide services such as blood pressure readings, but more importantly, contact is made with several isolated seniors who have no family doctor or access to transportation.

The paramedics can provide advice to reduce the number of times a call is made for an ambulance. The province took note of Nolan’s model and have used it as part of a template for other provincial areas seeking a modern approach

Development of palliative care model for paramedics

In October 2020, Dr. Merrilee Fullerton, Ontario's former minister of health and long-term care, made a visit to Renfrew to announce funding for a new initiative aimed at keeping seniors in their homes.

Renfrew County was one of five pilot sites across the province selected for a new community para-medicine program, which supports seniors on long-term care wait lists.

The province was now examining the best way to decrease the time on a wait list for long term care beds. In some cases, that has meant years on a wait list for beds that have not even been built yet.

The funding also allowed Nolan to introduce an additional component. An internal program would be created where a designated paramedic would receive specialized training in palliative care and be a core member of a team working with the patient and their family to develop an end-of-life plan when an individual chooses to die at home rather than in a palliative care unit or hospice.

One thing the COVID pandemic did was allow Nolan to dramatically speed up the integration of paramedics into the palliative care services currently offered in the area.

Within the Renfrew County Paramedic Services, there are individuals now devoting a greater amount of time in the area of para-medicine home visits and the new palliative service for local residents choosing to die at home. There are now 14 paramedics who trained to administer palliative services.

Palliative care, a new role

On this cold October day, when Chelsea Lanos pulls up into the driveway in an SUV with several markings identifying it as an ambulance, there are no hysterical people rushing around and waving their arms in the air, pleading with her to help. On this day, Lanos, in full uniform and carrying much less equipment, casually makes her way into the Renfrew home of Harry Sculland. 

Lanos is no ordinary paramedic. She is an Advanced Care Paramedic and a six-year veteran with the County of Renfrew Paramedic Service, and along the way she has been working toward a Master of Science Degree in Critical Care, with a focus on end-of-life care and organ donation.

She is finalizing her thesis, and for her, there is absolutely no better way to complete her specialized degree than on-the-job training.

She is fully aware that her involvement in palliative care will always have the same ending with the different patients she is working with.

“That is something that is always in the back of my mind when I spend time with them in their homes,” Lanos said. “Especially when I visit people like Harry. He has accepted the fact his heart will fail him one day and he is ready for that. Getting to know him and his life, gives me a chance to tell others about him and his memory will live on.”

Sculland is an 88-year-old motorcycle enthusiast who recently bought a Harley Davidson Tri Glide, and he bought it for one reason.

“I am going to get down to Calabogie for a ride to see all the leaves before the snow hits and that is something I am looking forward to,” he said.

Despite having a palliative care plan set up,he doesn’t intend to spend his final days, or years, as he is quick to point out, worrying about the ‘what ifs.’

He has a pacemaker and has had heart issues that began in the mid-1970s with a serious heart attack, but despite having Congestive Heart Failure, he has done his best to not slow down.

He admits, however, that he lost a lot of that drive in early 2020.

“When I said goodbye to my wife Lise, I said goodbye to my best friend and the best bike mate anyone could ever ask for,” he said glancing down to a photo album his grandchildren made for him. “Did you know she was inducted into the Canadian Motorcycle Hall Of Fame?"

“Her first bike was a Red Harley-Davidson KH model,” he said. “Not 50 yards into her first ride, she hit an ice patch, but that obviously didn’t stop her from continuing on. She was quite a lady and she fought every day to make sure she got one last ride in. With the help of a lot of good people, we made sure that happened.”

It is these patients that remind Lanos of the important role paramedics’ play. Whether it is providing medical assistance at a car crash or visiting a man who has chosen to remain at home until his death, the role of the paramedic is an evolving one.

Part two in this series will look deeper into paramedics treating residents in isolation.

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