Related Experiment Videos
Examining the alignment between an intervention-based paramedic model of care and 9-1-1 utilization
Walter Tavares1,2,3,4, Ryan P Strum5,6,7, Lindsay Henderson5,8
1Department of Health and Society, Wilson Centre for Health Professions Education Research, Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada. walter.tavares@utoronto.ca.
Background:
Healthcare services must align with public needs and adapt to changing healthcare landscapes to be effective. Originating from emergency medicine and public safety, the paramedic model has traditionally focused on resuscitation, emergent needs and patient transportation. However, increased volume of non-emergent cases and a broadening use of paramedics suggest a potential misalignment with public utilization patterns. This study evaluates the alignment of paramedicine's model of care with the public's health requirements.
Methods:
A retrospective observational cohort study analyzed electronic patient care records completed by paramedics following patient interactions from January 1, 2017, to June 30, 2023, assessing the use of an existing model of care during paramedic responses across urban, suburban, and rural communities in Ontario, Canada. Each patient interaction was assessed for the presence or absence of interventions included in the provincial Advanced Life Support Patient Care Standards, used as a model of care framework for this region. Descriptive and inferential statistics were used to explore alignment.
Results:
A total of 1,244,537 patient-initiated 9-1-1 calls from six paramedic services were examined. Only 20% (n = 249,312) of incidents involved the existing model of care, with a distinct ordinal reduction pattern of interventions as patient acuity levels decreased. No significant explanatory differences or predictors were observed in age, sex, dispatch priority assigned prior to arrival, or location of the event. Receiving medical care was associated only with conditions of cardiac arrest, cardiac ischemia and gastrointestinal symptoms. This sample of events suggests patients access care using the 9-1-1 system mostly for non-emergency events that do not align with the current model of care.
Conclusions:
For patients who access healthcare using the 9-1-1 system, this study identifies a limited correspondence between the current intervention-based paramedic model of care and patterns of 9-1-1 utilization. These findings suggest that the existing model of care is applied in a minority of encounters. Prevailing paradigms guiding core paramedic systems may need to be reconsidered or augmented.
Related Concept Videos
01:15Methods of Documentation VI: Case Management Model
For example, a patient with a chronic illness...
01:18Introduction To Health Care Delivery System
The Institute of Medicine (IOM) advocates for a patient-centered, effective, safe, timely, equitable, and effective healthcare system. The National Priorities...
01:29Nursing Interventions II: Selecting and Classifying the Nursing Interventions
01:26Methods Of Healthcare Delivery System
Managed Care System:
The managed care system is designed to control the cost while maintaining the quality of care. The patient's care from admission to discharge is planned by the primary care provider or the case manager, also known as the gatekeeper. In a managed care system, the number of care providers is limited...
01:20Integrated Healthcare System
01:15Nursing Implementation
The five steps to implementing effective nursing care include reassessing the patient, reviewing and revising the existing nursing care plan, organizing the resources and care delivery, anticipating and preventing complications, and implementing nursing interventions.