To the editor:
There has been a lot of recent media coverage about the state of emergency services and concern about EMS response times.
As a paramedic working in the Thunder Bay District, I can tell you first-hand there is no simple solution.
A common suggestion is to simply add more ambulances, but this does not address one of the key issues, offload delays. The general public may not be aware of what an offload delay is but it is a common problem Ontario wide, not just in Thunder Bay.
An offload delay is a situation where an EMS crew brings a patient to the hospital, yet there is no bed at the hospital for this patient.
The EMS crew remains responsible for this patient until a bed becomes available, thereby effectively taking that EMS crew out of service.
Adding more ambulances does not address this issue because if an offload delay is in effect, as each 911 call comes in, more ambulances will be out of service waiting to transfer care of the patient to the hospital. Thunder Bay Regional Health Sciences Centre works very hard to minimize offload delays, however, the hospital often operates at full capacity where there are simply no beds available.
Offload delays do not apply to very critical patients, only to patients who are urgent enough to require medical care, but not so urgent that they need to be seen by a physician immediately.
These patients who require a moderate level of care would greatly benefit from the services of a PA.
PAs are physician assistants, highly skilled health care professionals who can perform patient histories, physical exams, order and interpret tests, diagnose and treat patients.
PAs work as part of a health care team, under the supervision of a physician. Physician assistants have been part of health care teams for 50 years in the United States and have been part of the Canadian military for 30 years.
Civilian physician assistants in Ontario are a newer concept; in 2007 Health Force Ontario began a pilot project introducing physician assistants into service.
In Ontario there are currently two physician assistant education programs, McMaster University and the Consortium of PA Education, which is a collaboration with the Northern Ontario School of Medicine, the Faculty of Medicine at the University of Toronto and the Michener Institute of Applied Health Sciences.
The Consortium of PA Education program is geared towards rural, remote and underserviced communities like Thunder Bay. A PA is educated and trained similar to a medical student, but in a condensed 24-month program with a general primary care focus.
Upon graduation a physician assistant is comparable to a medical resident. The physician assistant will assume the scope of practice that parallels that of the supervising physician.
A PA can work in any clinical setting where a supervising physician would work such as a family health team, a clinic or in a hospital.
The addition of a physician assistant to a medical team will reduce wait times, increase efficiency and allow the physician to take on more patients and focus on high risk and complicated patients.
I happen to be slightly biased as I am a current student in the Consortium of PA education program.
I am also a Thunder Bay resident who recognizes that the health care system locally needs more support which is why I enrolled in the PA program. Because the PA program is completed in two years, communities have timely access to highly skilled health care providers who are extremely cost effective at less than half of the salary of a physician.
This means that two physician assistants could be hired for the same cost as one physician, doubling the amount of patients that will be assessed.
It is my humble opinion that physician assistants can offer a great service to both the Thunder Bay Regional Health Sciences Centre and Superior North EMS.
A physician assistant can treat the patients who often end up on offload delay, these moderate level of care patients are excellent candidates for the services of a PA.
Moderately urgent patients can be promptly treated and discharged, in effect a physician assistant can keep beds clear for critical patients in the emergency department and help clear EMS stretchers so that paramedics can return to service in the community where they are required.
For more information about physician assistants please see the Canadian Association of Physician Assistants website at: http://capa-acam.ca.
Victoria Lemay-Stirrup,
Thunder Bay
