Toronto EMS Creates a New Kind of Paramedic

Paramedics aren’t usually called upon until after someone’s had an accident or an injury, but the Emergency Department of a hospital ranks among the most expensive of places to treat a patient.

Toronto EMS

To ease that demand, Toronto’s EMS program has decided to try something different: visit people’s homes before their need becomes an emergency. Under the city’s Community Paramedicine Program, emergency workers note the living conditions of patients who are, for example, housebound or suffering psychological problems and flag their cases for follow-up. Later with the patient’s permission, Community Paramedics pay them a visit. They interview the patient; sometimes they examine the patient or take a look at the patient’s prescription medications and help to arrange more regular care through community nursing, social workers, or hospital outpatient services.

 Toronto’s EMS

For many people whom are marginalised or living on the fringes of society, paramedics are their first -or even sole- point of contact with the health care system as they rely on emergency services to manage their chronic or unaddressed health care issues. Many of these people whom have fallen through the cracks in the system have become so used to their isolation that they have to be convinced or cajoled into accepting the services that exist for them. By turning paramedics into front-line medical professionals who make house calls, organizers of the program say Community Paramedics have helped to reduce repeat 911 calls by 80%.

“It is unsustainable to wait for the phone to ring and to respond to those life-threatening emergencies,” said Michael Nolan, the president of the Emergency Medical Services Chiefs of Canada. “We believe strongly that paramedics have more to offer by being pro-active.”

The program is gaining attention in other parts of the country as well. “It’s about keeping people healthy so that they don’t need the emergency services; they never deteriorate to that point.” said Penny Price, Alberta Health Services’ Health Integration Manager.

At the moment, there is no program like this in BC, which presents an interesting possibility.

In 2009, BC’s paramedics held a job action mainly over what they considered unacceptably low wages. At times, a junior BC paramedic’s pay can be as low as $2/hour while standing by between calls. In Toronto the starting wage for a paramedic is around $27‑$30/hour.

If you took an average of the various arguments flying back and forth in 2009, you’d probably find supporters of the paramedics saying that this financial position is untenable for junior and part-time paramedics trying to build a career in emergency health care. In response, you’d find detractors saying that the union’s overall proposed wage hike was enormous from a percentage standpoint (31%) with unjustified pay levels (the union claimed it was seeking wage parity with the Vancouver Police). Eventually the strike was broken when Victoria legislated the paramedics back to work with a 3% pay raise.

If Toronto’s success with its community program were to be repeated in BC, it seems there would be a substantial savings in emergency healthcare money and resources, the public would enjoy more comprehensive care, and the paramedics would have an opportunity to retool their wage structure.

Whether or not it represents a potential win-win scenario for paramedics and the BC Ambulance Service brass lies in a couple of questions: would those who opposed the paramedic’s demands reconsider if the paramedics offered services like the one in Toronto alongside their regular duties? To those who supported the paramedics (and the paramedics themselves), do you think it would be fair to ask them to take on programs like this as a condition of a more substantial wage increase?

H1N1 Paves the Way for Possible Universal Flu Vaccine

A study published by researchers in the Journal of Experimental Medicine suggests that scientist are nearing an understanding of influenza viruses that could lead to a universal flu vaccine.

Universal Flu Vaccine

Before a vaccine was available in 2009, the team analyzed antibodies found in nine patients whom had been infected during the first pandemic wave of H1N1. They found five antibodies that proved cross-protective against a number of influenza variants including the 1918 pandemic strain and the avian flu, H5N1.

Universal Flu Vaccine

Sample structure of a flu virus. The hemagglutinin proteins are labelled “HA”

Flu viruses possess a lollipop-shaped protein structure called hemagglutinin. The protein at the “head” of the lollipop allows the virus to latch onto and infect other cells. Since all viruses require this structure to reproduce, flu drugs and vaccines focus on identifying this protein to the immune system so that it can fight infection. The genius of the flu virus is that this protein readily mutates so that the virus appears to the immune system to be completely different from one flu season to the next.

Two years ago, researchers found that the stalk of the protein –the lollipop’s “stick”– does not mutate and is generally the same for all flu viruses. Because the H1N1 strain was so different from other flu viruses, it’s likely that the immune systems of those infected made antibodies for the only part of the virus that it recognized: the hemagglutinin stalk. “Previously, this type of broadly protective, stalk-reactive antibody was thought to be very rare,” said Jens Wrammert, a member of the research team. But in the H1N1 patients, they were “surprisingly abundant.”

According to Patrick Wilson, who also worked on the project from the University of Chicago, these antibodies could demonstrate “how to make a single vaccine that could potentially provide permanent immunity to all influenza.”

The US National Institutes of Health is now running human tests on a two-step vaccine process that uses stalk-reactive antibodies to prime the immune system before a regular flu shot. Reuters