A Nunavut health leader on how to use paramedics to solve a health staffing crisis in remote communities

The Northwest Territories is hiring paramedics to help address nursing shortages in communities.

It’s part of a six-part plan announced last week to address a healthcare workforce crisis affecting many parts of the country.

A similar staffing shortage last year prompted health officials in Nunavut to also experiment with sending paramedics to some communities in the territory.

dr Francois de Wet is the Chief of Staff of Qikiqtani General Hospital in Iqaluit and the Territorial Chief of Staff of the Nunavut Department of Health.

He spoke to Loren McGinnis, host of The trail breakerOn Wednesday.

This interview has been edited for length and clarity.

When and how did Nunavut decide to make this decision and hire paramedics to fill staffing gaps in your health centers?

This initiative started last year, in the summer of 2021. We were facing a…small disaster in terms of our staffing for some of the health centers and we started to look for alternative staffing solutions because we were struggling to find…nurses and licensed nursing practitioners to fill the positions. That [assistant deputy minister] of Operations, Jennifer Berry, came up with the idea of ​​bringing paramedics to justice in health centers.

The first deployment was in July of last year, but it was basically a matter of necessity to maintain the level of service in our communities and that’s why we started.

How’s it going in Nunavut?

Last year’s run gave us a good opportunity to refine the system. In the end we didn’t have any [additional] Health centers were closed last year because of the various initiatives that we put forward. But…paramedics are usually there to scoop and go, so they go to a scene, pick up the patient, and take them to a health center. And of course when they are the primary contact at the health center they have to make a very thorough assessment, they have to sort of decide what the next step is.

We contracted with a company called AMS or Advanced Medical Solutions and together with them we developed a training program to sharpen the skills of the paramedics that we will use in terms of their assessment and we also introduced them to a medical instruction , which gave paramedics the ability to do some of the things that weren’t entirely within their purview.

What is an example of this?

Well, like administering medication in certain cases — not prescribing medication, but administering medication on doctor’s orders, because they have a certain amount of medication that they can give. But there are also drugs that are regularly dispensed at health centers that… may not be within their purview. And some of those things are things you would give your grandmother like Advil or Tylenol or things like that.

What are the challenges or lessons learned from this?

The big takeaway was that we needed to make sure that when the paramedics reported to either the virtual nurse or the doctor, they were providing the information needed to make a decision. Because one thing you have to understand, we didn’t throw them into the churches and say, ‘Okay, they’re going to do all the nursing.’ There were different levels of care that were still available virtually. We had virtual [licensed practical nurses], we had virtual community nurses and also doctors. So one of the big things was making sure that what is required is communicated to a doctor or nurse to make a decision regarding the care plan and we are actually working very closely with the AMS administration staff Tell them what we need.

I work in an ER myself and have been doing a couple of shifts for the past few weeks and the advice I’m getting from paramedics is entirely appropriate. Often there is already some kind of idea of ​​what needs to be done, so this has been very successful.

In the beginning there were some complaints that not all information was submitted, but that is being sorted out and it is going very well.

When you talk about supporting and training paramedics to expand or sharpen their skills… what does that look like? How did you conduct this training?

The training is conducted by AMS, but it was conducted in collaboration with us to go through: What does a provider need to be able to work in a health center? So this program was developed in partnership with AMS and they do all the training for their paramedics before they come out. The training is not actually carried out by the Ministry of Health.

Do you know the specifics of it? How long is the training or details like that?

This includes assessing the patient. How do you do a head-to-toe assessment? What are you looking for? What do you have to do? Paramedics are very skilled providers in their own right. For example, if necessary, they could perform intubations at the direction of a doctor, which regular nurses cannot do.

We’ve made it very clear that these types of high-level interventions should only be performed under the direction of a doctor or upon arrival of the transport team, but the actual training is more focused on assessing patients whose signs and symptoms people need to look for, and then also the process of how we do referrals in Nunavut, how to contact the doctor who is on call for the community, how to contact the virtual nurse or the virtual community health nurse. Part of it is skill, but it’s also a process.

Let’s address any advice you would share with the Northwest Territories Department of Health.

The best advice I can give is to know what you are taking her to the health center for. Will they take the place of community nurses there, or will they be there to add skills to the health center itself?

It sounds to me like you’re in the same position as us in terms of not having enough staff for the health centers. And we found ourselves in a very difficult position because we had to make a choice – do we close a health center without worry? Or do we bring in providers who can provide care and expand the level of care we provide to Nunavummiut? And I think from that perspective it was a hugely successful initiative.

But my biggest advice would be to know what you want to use them for. If they are to replace a community nurse you need to make sure they understand what their job is and you need to layer support on top of that because if you expect the paramedics to work alone this will fail.