Paramedics may sidestep rural emergency rooms in trauma cases

Wayne Thibodeau
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Western Hospital in Alberton is the only rural emergency room in Prince Edward Island still operating 24 hours a day.

Changes being implemented this month will allow paramedics to sidestep rural emergency rooms and take patients experiencing trauma directly to one of Prince Edward Island's two referral hospitals

Until now, paramedics were encouraged to take most patients to the nearest emergency room.

The exception was stroke patients. They have been redirected to the stroke unit at the Queen Elizabeth Hospital since it opened in 2010.

Jamie MacDonald, acting director of medical affairs with Health P.E.I., says research shows the best outcomes are delivered when a patient receives care at a major trauma centre, one which has access to specialized tests, like CT scans, and access to specialized services, like a surgical ward.

"The focus is really what is best for the patient," MacDonald told The Guardian.

"It's not about, ‘we don't want to go to this hospital or that hospital.' That's not it at all. It's about the particular patient, how stable are they? What is their outcome? And where is the best place to take this person to achieve the best outcome for that patient?

"That's really what these policies are all about."

MacDonald said hospitals in Charlottetown and Summerside are equipped to deal with the additional patient load.

However, she added, it won't be a huge influx in new patients since many trauma patients end up at these hospitals anyway.

Four Island hospitals continue to deliver emergency room services.

The Island's two referral hospitals are the Queen Elizabeth Hospital in Charlottetown and the Prince County Hospital in Summerside.

Two rural hospitals, Western Hospital in Alberton and Kings County Memorial Hospital in Montague, also operate emergency rooms.

Opposition Leader Olive Crane said this decision will further erode services at rural hospitals. She made reference to an internal report prepared for the province, which called for two emergency rooms in the province, in Charlottetown and Summerside.

"We just came through an election where the premier said he was going to maintain emergency services in rural hospitals, obviously he's not," said Crane.

Health Minister Doug Currie said the changes were made to improve patient safety and he denies it will further erode services at rural hospitals.

"We just came through an election where the premier said he was going to maintain emergency services in rural hospitals, obviously he's not," Opposition Leader Olive Crane

"It's got nothing to do with sustaining or delivering services in hospitals. It's making sure the trauma patient is given the most appropriate care by the right provider in the right situation."

Pat Murphy, MLA for Alberton-Roseville, said he's not concerned about the changes.

Western Hospital in Alberton is the only 24-hour rural emergency room left in the province.

"I've heard concerns at the doors," said the Liberal MLA.

"Our government is certainly well committed to rural hospitals in Prince Edward Island. I don't think there is anything to be worried about."

What is important, MacDonald said, is for patients to realize that care begins as soon as the paramedics arrive on the scene.

Care continues to be given while the patient is on route to either Charlottetown or Summerside.

There are now 130 paramedics in P.E.I.

About 40 of them are Advanced Care Paramedics.

The province's goal is to continue to add to the number of Advanced Care Paramedics until there is at least one in every ambulance.

"The new ambulances are very well equipped ... and with the increased training that the paramedics have received patients can feel comfortable that time in the ambulance is not just transport time."

Twitter.com/GuardianWayne

 

 

Trauma

What does Health P.E.I. consider a major trauma, whichmay prompt a paramedic to sidestep a rural emergency room and redirect the patient to hospitals in either Charlottetown or Summerside?

- Major car accident;

- amputation;

- gunshot or knife wound;

- skull fracture;

- burns;

- low blood pressure that cannot be stabilized or any other time-sensitive life-threatening emergency.

Organizations: Queen Elizabeth Hospital, The Guardian, Prince County Hospital Western Hospital Alberton and Kings County Memorial Hospital Hospital in Alberton

Geographic location: Prince Edward Island, Charlottetown, Summerside Montague

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Comments

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Recent comments

  • Thaddeus Sholto
    November 04, 2011 - 18:19

    It would appear Olive Crane and her party are more interested in some rural votes than they are for the welfare of rural Islanders. If it erodes the services at some country hospitals then so be it. If it is better and faster to take emergency patients to Summerside or Charlottetown than that is good. A patient needing emergency care who is taken to a smaller rural hospital is often sent to Summerside or Charlottetown anyway so time will be saved if automatically they are taken to the larger centres. The Tories are more concerned about scoring political points and using the federal Tories tactic of divisive politics - rural pitted against urban voters. The Island Tories are a far cry from the parties of Jim Lee and Angus MacLean. The Crane Tories have learned well from their brethren in Ottawa.

  • Another Island Medic
    November 04, 2011 - 13:42

    In emergency medicine when it comes to trauma, Paramedics follow the notion of "the golden hour". This means that on average the victem of serious trauma has one hour to get to definitive care. Now this hour does not start when the Paramedics arrive, it begins when the traumatic event occurs. If you live in rural PEI you already loose a large chunk of that hour waiting for the ambulance to arrive. So the last thing you need is to be taken to a rural er that cannot do what you need. In severe trauma pt's require what we call "bright lights cold steel" in other words surgical services and that is only available at two Island hospitals. I would would like to ask Mrs. Crane to stop playing politics and leave these decisions to the medics, doctors and and other health professionals who are trained to make these decisions, and stop playing politics on a topic she obviously has no idea about.

  • First responder Montague
    November 04, 2011 - 11:33

    Put a real Hospital at Pooles corner and ditch Souris Montague. Even Better yet , dump the municipalities as current and form three Kings, Queens and prince. Nah that wouldn't work someone would lose a vote! Oh well move to Alberta get a job and a Doctor!

  • It's about time
    November 04, 2011 - 09:53

    Well I am very happy to hear that the patient will be put first instead of what hospital is the closest. Over the past two years I've come across several accidents in which I've been asked to help with as i have my first aid training and CPR. I've seen some people who were hurt badly and instead of being taken to QEH they were transported to KCMH. Not saying its not a fine hospital It is, but is limited in what they can do. Our paramedics are excellently trained , so why not let them do their job.

  • To Get The Staff
    November 04, 2011 - 09:46

    If someone has a life threatening situation and arrives at an Island Hosp. via transportation by Paramedics they will be considered an Emergency situation and given attention stat!

  • SG
    November 04, 2011 - 09:37

    With All Due Respect to our Opposition Leader I Disagree! If I was living in Rural PEI or Ch'town and had Emergency Issues ie: a Stroke or a Heart Attack I would want Paramedics to get me to a Hospital STAT not a Clinic or Emerg. in Rural PEI that isn't equipped to handle such situations. The Paramedics are also in contact with Doctors, Professionals EN ROUTE to hosp. if they have a Patient with a Stroke or Heart Attack or a possible life threatening situation. I also Disagree that we need Hospitals or even Semi Hospitals in Rural PEI. Those monies IMO would be better spent on more Specialists, Surgeons, Doctors, Equipment etc that would BENEFIT and SERVE all Islanders. This is not about Rural or Urban PEI. This is about providing the Best Health Care for Isladers in an Emerg. Situation! The Urban Rural Spitting Contest needs to End and the sooner the better! I dont' know of any other Provinces that have a Hospital setting in Rural areas. IMO Such set ups only serve to take away critical Services and Professional Care for all. I'm more than disappointed regarding Ms. Crane's statement. ("We just came through an election where the premier said he was going to maintain emergency services in rural hospitals, obviously he's not," said Crane.) We're not living in Ottawa, Toronto or Montreal and I seriously doubt such services are provided there for outlying areas!

  • Get the staff
    November 04, 2011 - 08:40

    Fine, if the emergency departments can handle the extra patients. Are the 7-8 hour waits now at QEH going to be increased?

    • No
      November 04, 2011 - 09:57

      They end up there in the end anyway so why would it increase the wait times?

  • John B Smith
    November 04, 2011 - 08:14

    Just another false promise that the Giz made to all Islanders to give the rural Islander hope to have more services in their local Hospital. What is the possibility that this report had already been read and sitting on his deck, before the election,? So he would have been very well aware of it's findings. Just another case of misleading the public...

    • To John B Smith
      November 04, 2011 - 11:07

      Thank Goodness that you feel this is a broken promise!!!If islanders are coming first especially for emergency care, then I am glad he broke it. (Although I don't recall those exact words)

  • PEI Paramedic
    November 04, 2011 - 07:43

    I think it is time the province and Island Ems put some time and effort into showing the people of PEI what a Paramedic can do and what skills and services they can administer as well as what medications we as Paramedics can give !! The general public has no clue to what a Paramedic can do for them!! Basically, anything done in a Rural ER can and will be done by Paramedics in an ambulance !! It's a shame people don't understand this !!!

  • mra
    mra
    November 04, 2011 - 07:29

    the paramedic's are trained to make these decisions , not an MLA..olive do your job let the paramedics do theirs.

  • gary
    November 04, 2011 - 07:07

    There should be only 1 tertiary care hospital in PEI. Have 3 or 4 collaborative health centres in the rest of the province similar to what Nova Scotia is putting in (Parrsboro, Tatamagouche, Shelburne, etc.)

  • I thought so...
    November 04, 2011 - 06:34

    Ms. Crane. With "all due respect" Your comment "this decision will further erode services at rural hospitals" proves to me exactly what I've been telling people for ever. You don't care about what's best for Islanders. You care about what you think is going to make you look better to a certain demographic at a given time. This time, it's rural Islanders and I am neither Liberal or Conservative so this is not just a Ghiz follower reacting negatively to whatever you say. I grew up in West Prince and whenever needed, received excellent care at the West Prince Hospital as did most of my friends and family however, if I or a loved one is in urgent need of care and the best place for them to be is Summerside or Charlottetown, then I want that to happen. I don't think an extra 20 minute stop at the closest ER just to have them say "He needs to be in Summerside or Charlottetown" is necessary...do you? Please, for once in your political career, at least fake the impression that you really care about Islanders. Oh wait...you've been faking it all along havent' you?!

  • first responder
    November 04, 2011 - 05:45

    i sure hope olive took the time last night to rethink her opposition to this issue and dosent wast time with it on the floor of the house.It is really good move and a step in the right direction as long as the emergency room hours are not cut any more at the rural level.

  • island grammie
    November 03, 2011 - 22:42

    2 years ago we had an accident in Cape Breton and were directed to three hospitals, Baddeck, North Sydney and Sydney. I don't know that the outcome would be different but 1 hour vs. 6 wwould have been nice, plus on and off ambulances for the 4 of us was not easy. Plus we had to be examined and our cases discussed at each Hospital.The most difference would have been to my daughter who was denied pain meds until the final tests were done at Sydney. All the paramedics felt (we had 5 ambulances in total) that we should have been sent staight to Sydney given the severity of our accident. The direct way is the way to go.

  • To Olive Crane
    November 03, 2011 - 22:17

    Perhaps you miss the point of this???It is putting the patient first. Instead of them being seen at the rural ER departments and then transferred to Summerside or Charlottetown where the specialist and xrays are, they will go straight to the hospital that will provide the best care. This is putting islanders first!!!Should have known your reaction to the story would be negative and I am sure a lot of your followers will rant at me too........................

  • Proper thing
    November 03, 2011 - 22:04

    Olive Crane said this decision will further erode services at rural hospitals? I thought it was about providing excellent patient care to the residents of PEI. Sending trauma and stroke patients directly to the appropriate facility saves TIME, the most important thing to these patients. Sending them to a rural hospital just to turn around and send them to the proper facility is simply the wrong thing to do.