New policy will get N.S. paramedics back on the road quicker

Paramedics will no longer have to wait with low-risk patients until a doctor takes over their care in hospital emergency departments in Nova Scotia under a new direct-to-triage policy effective Wednesday.

The initiative from Emergency Health Services (EHS) aims to get paramedics and ambulances back on the road faster to respond to incoming emergency calls sooner. The average hospital off-load time in Nova Scotia is 82 minutes, according to the provincial Health Department.

Instead of waiting, paramedics will take low-risk patients to emergency department waiting rooms to be assessed by health-care staff in what officials are calling a direct-to-triage system.

"Our hope is this initiative results in paramedic crews being released from hospitals more efficiently to respond to medical emergencies provincewide while ensuring no disruption to quality patient care," said Charbel Daniel, executive director of provincial EHS operations, in a news release. 

Low-risk patients are defined as anyone who has normal vital signs and can sit, stand, or move independently without risk of falling. 

Long off-load times

The policy is meant to reduce pressure on the EHS system, improve ambulance off-load times, and improve working conditions for paramedics, according to a press release. 

Paramedics will continue to wait with high-risk patients, like those with suspected stroke, chest pain, life-threatening injuries, and children under 16. 

"Watching calls join the queue while you wait with a low-risk patient in hospital is hard," Kevin MacMullin, business manager for the International Union of Operating Engineers Local 727, said in a statement. 

MacMullin said off-load wait times can be anywhere from three to 12 hours. 

"Sometimes we're just so short because there's a huge volume of calls that ambulances are responding from quite a distance. We don't want that," he said. 

In recent months, the union has asked the province to help with forced overtime, missed meals, and long off-load times at hospitals, and wage increases.

Policy balances safety, timeliness

Health Minister Michelle Thompson said in a statement that paramedics should spend their time responding to emergencies.

"This policy balances the safety of patients who can wait to be seen by emergency department staff and getting our paramedics back on the streets sooner," Thompson said. 

The Health Department is increasing the EHS budget by nearly $12 million for 2022-23 and expanding medical transport service and patient transfer units for low-risk patients that do not need medical attention during transport.

MacMullin said this is a good move by the government, but the province needs to go further and increase paramedic wages to attract new recruits.

The province needs 300 more paramedics, he said.

"It is a very stressful job. It takes a toll on your mental and physical well-being for sure, and it's just heartbreaking."

Not so supportive 

Kelly Regan is the Liberal MLA for Bedford Basin. She doesn't think there's much of a difference between the 2019 direct-to-chairs policy and the new direct-to-triage policy.  

Regan said as far as she can tell, the only difference is who the paramedics report to when they go into the hospital. 

"They're just repackaging or renaming existing programs," she said. 

"This is not a brand new policy and we just don't really see how this is going to have an appreciable effect on improving health care." 

Jeffrey Fraser is executive director for the EHS branch of the health department.

He said direct to triage is an "evolutionary policy" on the 2019 direct-to-chairs foundational policy. 

Skip the charge nurse

Fraser said paramedics would consult the triage nurse instead of the charge nurse, as was the case under the direct-to-chairs policy.

"This new policy allows our professional paramedics to use some of their autonomy and not have to burden the hospital staff by chasing down a very, very busy charge nurse who he or she is managing a lot of complex patients," Fraser said. 

Fraser said paramedics will make a determination to move the patient to the waiting room.

"We're able to bypass the charge nurse," he said, noting that the Health Authority has been supportive of this approach.