Making a life-saving difference
- August 2007
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Niagara Base Hospital Leaders Lorie Luinstra-Toohey and Dr. Doug Munkley were co-investigators for the study on pre-hospital care which shows that patient outcomes improve when Advanced Care Paramedics provide life-saving treatments in ambulances.
For health care professionals involved in research, having study results published in the New England Journal of Medicine is just about as good as it gets. Niagara Base Hospital staff Dr. Doug Munkley and Lorie Luinstra-Toohey have had the honour of being published twice in the prestigious medical journal.
The duo is part of a team that involves Base Hospital, Niagara Health System, Niagara Emergency Medical Services (EMS) and Regional Niagara, who are studying the treatment Advanced Care Paramedics give to emergency patients before they are brought to hospital emergency departments. The results of the most recent study were published in the New England Journal's May/07 issue.
The involvement of Niagara health care agencies in this research goes back to 1991 when an Ontario Ministry of Health and Long Term Care steering committee was formed to place Advanced Care Paramedics in the field. "In order for Niagara to receive funding to train and employ Paramedics on ambulances, the Ministry stipulated there would have to be a research component," Dr. Munkley, Medical Director for Niagara Base Hospital, recalls. Dr. Munkley and Lorie Luinstra-Toohey, Base Hospital Manager, are members of the provincial steering committee and were co-investigators for the studies.
Base Hospital's day-to-day role in ambulance or pre-hospital care involves the delegation of controlled acts to Primary Care and Advanced Care Paramedics, ensuring paramedics have access to medical advice 24 hours per day/seven days per week through the Emergency Department physician at Greater Niagara General Site, providing quality assurance and continuing medical education relating to pre-hospital patient care and controlled acts, and liaison with Emergency Departments (ED) in Niagara (including Niagara Health System's five ED's) and Niagara Emergency Medical Services. In addition, the Base Hospital is involved with the certification of new paramedics, including those completing the Niagara College – NHS Advanced Care Paramedic Program. An extra year of study is required before a Primary Care Paramedic can become an Advanced Care Paramedic.
Respiratory Distress Patients part of Study Group
For the research study into pre-hospital care, Base Hospital co-ordinated the data that was collected from ambulance call reports, dispatch reports, other first responders such as fire departments, hospital records and a host of other agencies for about 1,000 Niagara patients who made a 911 call for their medical condition. "The purpose of the study was to measure the impact that Advanced Care Paramedics had on patients who are critically ill and suffering from acute respiratory distress," explains Lorie. "The most common causes of respiratory distress in this setting are congestive heart failure, pneumonia, chronic obstructive pulmonary disease and asthma."
The study, compiling patient data from 1995 to 2000, looked at respiratory distress patients receiving pre-hospital care from Primary Care Paramedics compared to those who received pre-hospital care from Advanced Care Paramedics. The difference in care provided by Advanced Care Paramedics is significant, says Dr. Munkley. "Advanced life support includes endotracheal intubation and intravenous (IV) drug therapy and having those treatments started before the patient comes to the hospital ED can literally mean the difference between life and death."
In fact, the study shows that patients who received advanced life support treatment in the ambulance have a greater survival rate. "We saw a 15% improvement in survival rates for these critically-ill patients," Dr. Munkley says. "For the patients with congestive heart failure, the survival rate improvement was even higher, at 20%."
The study demonstrates overwhelmingly the value in having Advanced Care Paramedics responding to emergency calls, Dr. Munkley says. "We are talking about the sickest patients in our whole system of care and until our study there really wasn't much information available on the difference the Advanced Care Paramedics make to these patients."
Summary
Niagara enjoys a higher-than-average number of Advanced Care Paramedics in the field. "This is due to Regional Niagara's commitment to place one Advanced Care Paramedic on every ambulance on duty in Niagara," says Dr. Munkley. There are currently about 100 Advanced Care Paramedics working in Niagara, almost double the original 54 positions funded by the province.
The work of the steering committee was first published in the New England Journal of Medicine a few years ago with a focus on survival of cardiac arrest patients whose pre-hospital care was given by Advanced Care Paramedics. The most recent results are a sub-study from that original effort.
Next, the group is going to review the statistics and outcomes for patients calling 911 for chest pain. "ED nurses and physicians like myself can now attest that these patients are coming in to our ED's by ambulance with all kinds of advanced procedures already performed," Dr. Munkley says. "Having life-saving interventions earlier affects mortality rates in a very positive way and it also changes hospital practices. That's why the partnerships we have in Niagara are vital – our focus is saving lives and the research bears out that this team effort has made a difference to a lot of people and families."
Click HERE to view the article in the New England Journal of Medicine.