Region considers paramedicine program

By Dave Flaherty/The Oshawa Express

In lieu of a mobile health unit, the region is reviewing an alternative method to deliver care to populations at risk.

At its most recent committee of the whole meeting, regional council supported several motions brought forward by Oshawa Councillor Dan Carter.

Carter’s motion supported the development of a community paramedicine services program for “at-risk and hard-to-reach populations in identified priority neighbourhoods across Durham” with a targeted implementation of this year.

Capital and operating costs tied to the program would be part of the 2018 budget.

There have been regular talks around the creation of a mobile health unit since last fall, with an initial staff report delivered in February.

But council requested more information on potential operating costs and examples of similar projects across the province.

Mobile health units currently exist in the regions of York, Simcoe, Peel, and the cities of Toronto, Hamilton, Thunder Bay and St. Thomas.

Services of these health units vary in scope, ranging from needle exchange, treatment of sexually-transmitted infections, addiction services, and oral health care, among others.

Funding sources vary by region as well.

Some examples include local LHINs and public health units, community agencies and/or government grants.

Durham medical officer of health Dr. Robert Kyle noted that no organizations have come forward with in-kind support or contributions as of yet.

Two agencies, the Aids Committee of Durham Region and John Howard Society, offered support through staffing.

However, this is contingent on funding coming from an external agency.

Kyle noted the Central East LHIN is only able to commit to a “planning partnership” at this time.

A mobile health unit would require $150,000 to $300,000 to purchase an appropriate vehicle.

Final purchase costs would depend on the level of service provided and required retrofits.

Annual operating costs, which would cover equipment and supplies, staff resources, and vehicle maintenance, were estimated at approximately $320,000.

Through the community paramedicine model, three advanced care paramedics would provide primary care outreach to priority neighbourhoods to assess and treat non-acute patients.

Operational costs associated with the paramedicine program are pegged at $408,000.

This would cover $386,000 in salary and benefits, $3,000 in vehicle maintenance, and $21,000 in training and education expenses.

A rapid response vehicle could be purchased for $42,000.

Should the vehicle be an older model, maintenance costs could jump to $12,000 per year.

Durham Region Paramedic Services Deputy Chief John Moir explained it would not be considered an emergency response vehicle under provincial legalisation.

“It would not have flashing lights. If we came across a more critical situation, we’d call an ambulance for transport,” Moir stated.

Details under such a program are still to be finalized.

According to the staff report, potential candidates for the program include sex workers, individuals experiencing mental health and addictions issues, and those at risk for infectious diseases.

Potential services include foot care, crisis intervention, sexual disease testing, referrals to mental health and addictions treatment, and needle exchanges just to name a few.

Clarington Councillor Joe Neal believes these services deviate from the mandate of the public health department.

“I think we are wading into providing primary care. I think this is something Lakeridge [Health] should be doing instead of our department,” Neal said.

Kyle agreed that a paramedicine program would “definitely” take his department into the realm of primary care.

However, he believes the inclusion of paramedics in the program would counter some of that risk.

He pointed out paramedics may potentially be paired with a nurse or nurse practitioner, and support will also come from the region’s social services department.

Looking at the potential costs, Neal also had his doubts.

“This is way, way under-costed. I see this as totally open-ended, where costs will be way more than what is in the report,” he said.

While agreeing with the intention of the program, Oshawa Councillor Amy McQuaid-England was concerned with its scope.

It is foreseen that the paramedicine program would serve seven priority areas identified by the region’s Health Neighbourhoods program, five of which are located in Oshawa.

For McQuaid-England, the program needs to cover the entire region to be successful.

“By only having seven priority neighbourhoods, we are excluding Clarington and the northern municipalities,” she said.

Carter said he is hopeful the program will be able to go beyond just those seven neighbourhoods.

“If we seek and see other areas where individuals require assistance, my hope is the fluidity of the paramedicine mobile health program can help them,” he says.

Kyle cautioned that expanding the scope of the program would lead to higher costs.

“A broader area and the more clients you are serving will have an impact on the financing of this program.”

In thanking his colleagues for their support, Carter admitted the result “doesn’t have everything” he had hoped for “but it’s a good start.”

“I believe with this paramedicine program, we will be able to help individuals who are in desperate need,” he added. “I realize there are many different complications in putting this together. I think this particular initiative is the best we can do at this particular time.”

Carter said he hopes a full “funding strategy” for the potential program will be available to council at its June meeting.