BC Emergency Health Services has implemented a new process for dispatching paramedics, ambulances and other resources to patients. The aim is to get to the most life-threatening calls faster, while at the same time improving the experience for patients who don’t require transport to hospital.
The “Clinical Response Model” (CRM) went into effect on May 30, 2018. The switchover from the previous system involved IT upgrades, staff education, and careful oversight by senior staff in BCEHS operations and clinical care.
The previous system, the Response Allocation Plan (RAP), was based on the premise of “you call, we come” – the idea being that if someone called 9-1-1 for an ambulance, every response resulted in a patient transport to a hospital emergency department. The RAP provided for three types of responses: BLS 2 (Basic Life Support ambulance going without lights and sirens); BLS 3 (Basic Life Support ambulance going with lights and sirens) or HL3 (highest level paramedics and ambulances available going with lights and sirens).
But emergency health services around the world, including BCEHS, have learned through experience and research that taking a non-urgent patient to hospital, where they will be triaged just as they would if they walked into an emergency department, does not always result in the best experience for the patient.
The CRM paves the way for alternative pathways for patients, such as advice on the phone to treat a minor infection or nausea, transport to a health service instead of a hospital, or treatment by a paramedic in the home or community (known as “treat and release”). Similar response systems have been implemented in other major jurisdictions including Scotland, Wales and Australia resulting in improvements in clinical outcomes and the patient experience.
The change that stands out when you walk into a BCEHS dispatch centre is that dispatchers now have more colours on their screens, rather than just a series of words and abbreviations (some of which came from military language). The new CRM colour system bears some similarities to the colour system used in hospitals. The dispatcher’s responses are broken down from the previous three categories into six – allowing them to more accurately focus ambulances and paramedics on patient conditions where minutes, even seconds, count.
At the top of the priority is the colour purple. This category includes conditions such as cardiac arrest, respiratory arrest and total airway obstruction.
In situations at the other end of the spectrum (a non-urgent call categorized as a green/blue), the clinical response model will also support a better match of resources. For example a 9-1-1 caller who has a minor infection or nausea, may be able to resolve their problem with some advice on the phone from a nurse. BCEHS receives approximately 130,000 calls a year that don’t require transport to an emergency department.
Year one of the action plan
has seen many service improvements at BCEHS, including additional paramedics, ambulances, and improved schedules and deployment models. It also saw more staff added to dispatch, plus enhanced clinical oversight in dispatch with a new 24-hour clinical desk dubbed “CliniCall” that now includes highly-trained advanced care paramedics and nurses, who will escalate calls if required to the physicians who are part of BCEHS’ Emergency Physician Online Support program.
Year one also laid much of the groundwork for future changes, including the ability for paramedics to eventually treat patients in their home or community (referred to as “treat and release’).
BCEHS, working with stakeholders and the Ministry of Health, will continue to closely monitor the effect of the changes being made, to ensure high-quality patient care.
Over time, not only will this get patients the right care in the right place, but it will also reduce the need for other first responder agencies, such as fire-rescue services, to respond to medical calls, so they can focus on their primary roles.
The BCEHS first responder program, an important part of ensuring the best care for patients, was started to ensure basic first aid could be given in life-threatening situations until paramedics arrive. More paramedics, more ambulances, the new clinical response model, and other BCEHS improvements should result in returning the focus of first responder partner organizations to time-critical medical calls and the calls where their specialized equipment and training is needed.