Treat and release: Ontario expanding paramedic practice

In an effort to help ease offload delays at hospitals and to reduce wait times in emergency departments, paramedics will be allowed to decide what’s best for a patient.

“We want to create a treat-release or treat-refer program,” Essex-Windsor EMS Chief Bruce Krauter tells CTV News.

According to Krauter, today, paramedics are obligated to transport a patient to the hospital when they call 9-1-1 for help, regardless of the healthcare issue.

“Sixty per cent of our call volume are non-acute, non-emergent, not life-threatening,” says Krauter.

With 50,000 patient transports to hospital per year, Krauter says the numbers add up quickly.

He believes the number of non-urgent calls (approximately 30,000) could be further reduced by 60 per cent if paramedics go to a treat and release or treat and refer program.

“It gives the latitude to the paramedics to decide what facility, what organization that patient should go to and by what mode,” says Krauter, who notes there are patients who don’t need the stretcher at all. “They just walk in our ambulance and then they walk into the emergency department so do they necessarily need an ambulance?”

Krauter says paramedics would work with the patient, to decide the best course of action whether it’s referral to a primary care physician, finding a nearby pharmacy to get a prescription filled or connecting the patient with someone who can help with mental health.

“You get seen quicker, you get the care quicker, and EMS is your liaison or your conduit to get that care quicker,” says Krauter. “Right now, it’s the emergency department that's the conduit.”

Here’s his other example: “Playing soccer, I fractured my arm. I can take you to the emergency department be on offload delay for 12 hours, whereas I could have you go to an urgent care center. They do an x-ray and then set you up with a fracture clinic the next day.”

James Jovanovic, President of CUPE Local 2974 which represents paramedics supports the idea.

“I’m excited for expanded opportunities where EMS can be at the forefront of care in the province. But if the scope of our profession expands any further, investment in EMS will have to be substantial. Ontario has allowed EMS to fall woefully behind and we are seeing a shortage of available staff because of it,” Jovanovic writes.

Jovanovic points to a study out of McMaster University, which he says shows EMS transports have increased 38 per cent from 2010-2019, without an equal increase in EMS resources.

“There is no singular, simple solution, and we should be very cautious when there is anyone proposing simplistic, singular root causes or fixes,” Jovanovic states.

He further believes the province needs to recall staff who were let go because of COVID-19 vaccine mandates.

“Hospitals are maintaining their mandate policies to stand in solidarity with one another. Our healthcare is being politicized,” Jovanovic writes.

Meantime, officials with Windsor Regional Hospital believe this change in practice could have an impact on their emergency room wait times if it’s done correctly.

“The key for these types of initiatives is to make sure it's not just a one-time band-aid but that the patients actually get linked to the care they need,” says Jonathan Foster, vice president of Emergency, Trauma, Mental Health, Office of Research, Renal and Regional Cancer. “Otherwise they'll just end up coming to the emergency department the next day or the day after. If we don't fulfill what the underlying needs are.”