It is well documented in the literature and demonstrated in specific implementations in Canada (Nova Scotia, PEI, Alberta), the United Kingdom, and Australia that Paramedics can have a significant positive impact on the in- home acute care management of patients who are palliative, and who may have a preference to receive care in their home. Building on this experience, CPER is undertaking a project with our partners to implement enhanced paramedic care for patients requiring a palliative care approach who access 911.

This innovative and first of its kind project will be achieved in collaboration with CPER, the Niagara Emergency Medical Services (NEMS) and the Regional Palliative Care Network (RPCN). Specific projects will involve evaluation of the implementation of palliative care education and management (medical directives) for a core group of NEMS paramedics, survey of paramedic comfort with providing this care, as well as focus groups with clinicians, families and patients. The survey of paramedic comfort will be undertaken in partnership with “Paramedics Providing Palliative Care at Home Program” in Nova Scotia as well as the Ottawa Hospital Research Institute.

Taking the lessons learned from this implementation which stated in October 2019, we plan to expand this program to other CPER services over the next year.

To date, the EC3P project has received endorsement from the provincial MAC and approval from the Hamilton Integrated Research Ethics Board. The Palliative Care Medical Directive for EC3P has been approved by the Ontario Base Hospital Medical Advisory Committee and received final approval by the Ministry of Health Emergency Health Regulatory and Accountability Branch in September 2019.

In addition, CPER is a secondary site participating in a related but separate national project supported by The Canadian Partnership Against Cancer (the Partnership) and the Canadian Foundation for Healthcare Improvement (CFHI)

Sepsis is defined as the disordered response of the body to infection resulting in organ dysfunction. We don’t yet understand why some people recover easily from infection and others have an abnormal immune response resulting in cascading organ injury.

Sepsis is the number one cause of death in hospital and has a mortality of 1 in 3. Paramedics are uniquely positioned to identify these patients early and initiate early treatment. The “FAST” Sepsis Initiative

“Team Sepsis” is a multidisciplinary collaboration at McMaster University that is investigating new tools to improve early identification and better manage sepsis patients to improve survival. The locally derived Hamilton Early Warning Score (HEWS), in conjunction with a suspected infection appears to identify twice as many sepsis patients than other traditional sepsis screening tools including SIRS, and qSOFA. The Paramedic Field Application of Sepsis Triage (FAST) initiative implemented the HEWS sepsis pre-alert tool by paramedics to use their clinical suspicion of infection with a clinical scoring system to help identify critically ill sepsis patients. If paramedics can reliably identify sepsis patients, we can explore specific treatments that paramedics can start prior to arrival at hospital (fluids, antibiotics, and more). This will open an entire new way for paramedics to help save lives.

In partnership with the paramedics from Guelph Wellington Paramedic Service, Region of Waterloo Paramedic Service, and Hamilton Paramedic Service; and the participating hospital sites in Guelph, Waterloo, and Hamilton, CPER is pleased with the ongoing participation in the “FAST” Initiative and hope to have some preliminary results in 2020.