01 Apr Reflections on a career in paramedicine by Retired Paramedic Chief, Keith Kirkpatrick
It is hard to believe that I have had a career in Paramedicine that has spanned almost four decades! Thirty-eight years have passed since the first day I walked into the Lindsay Ambulance station to find out how to become an ambulance attendant. My dad had suggested the idea and I took his advice and went to the station to ask some questions. That day, I met Len Vanpelt and Clare Gordon who showed me around the station, the ambulance and gave me information about the Ambulance and Emergency Care program at Humber College in Toronto. I was totally inspired and wanted to know more. I started to hang around the ambulance base until Clare, who was the Ambulance Supervisor, finally told me to get some grey pants and a blue shirt so I could ride third. From September to March, I rode out almost one shift a week. In March of 1981, with a Class F driver’s license and First Aid/CPR card, I started working part time for Lindsay and District Ambulance Service. I quickly learned that if we wanted to keep Clare happy, the station and vehicles needed to be immaculate. I was raised by a Dutch mother but Clare Gordon’s version of clean was a level above even my Mom! I learned a lot during that summer about professionalism and serving the public in an exemplary fashion.
In the fall of ’81, I attended Humber College in the Ambulance and Emergency Care Program. At that time, the program was 10 months long and for the first time in my life I excelled academically. EMCA certification was the standard of the day as advanced life support, outside of the air ambulance program or Oshawa ambulance service was still not happening. Almost immediately after graduating, I was hired full time with Lindsay and District Ambulance Service. It was great to be working in my home town and serving that community. Being located in cottage country, trauma calls were not uncommon during the summer months. When I think back to those days, we were really only delivering advanced first aid. We use to refer to our calls as “BOB calls” which stood for Bed, Oxygen and Blanket. I loved my job and role but I wanted to be a paramedic and that meant going to Oshawa, Hamilton, Toronto or the Air Ambulance program.
In 1987, I was hired by Oshawa Ambulance and by 1989, I was a paramedic (today we would call this Advanced Care Paramedic). The program was taught by our base hospital. There were only five of us in the class and, as a result, we became very close. I remember the program was extremely challenging and although we were competitive, we also wanted to make sure that we all succeeded.
Being able to deliver Advanced Life Support was an amazing feeling for me personally. When I look back at that time, there were only approximately 80 Advance Care Paramedics in the entire province and I realize now how pioneering that was. Those were truly the best days I had working on an ambulance. I was partnered with Andy Benson, who is now Manager of the Central East Pre-Hospital Care Program (Lakeridge Health Base Hospital) for about 6 years (1990-1996). We were in our early thirties and the more calls we went on the better. The two of us together seemed to be invincible.
During the early 1990’s, defibrillators started to go on all ambulances and became part of EMCA care. Then symptom relief became the Basic Care and the Primary Care Paramedic level was conceived. When I look back provincially, the 1980s were about building a solid basic life support system and the 1990s was establishing the Primary Care Paramedic level. ACP Care was still very limited in the province by the year 2000. Truly, what changed that was the downloading of Land Ambulance Service responsibility to the municipalities. When that occurred, so did ACP expansion. It started in the late 1990s with the Mitchener Institute program and the Ontario Paramedic ALS Study. The OPALS study, in my mind, had a narrow focus but it did help springboard ACP care in Ontario.
After the download, I began to work for Durham EMS but I will admit that I was now in my forties and my youthful vigor for doing lots of calls and working nights was starting to decrease. I had been teaching part time for Durham Region Base Hospital (now Central East Prehospital Care Program) since the mid 1990s doing PCP and Fire AED education. When an opportunity arose to work for them full time as a clinical coordinator, I was ready for the change. My responsibilities included Paramedic and Fire education as well as a new concept of placing Automated External Defibrillators (AEDS) in public spaces. Within the program, that is now known as Public Access Defibrillation, I had the opportunity to work with a lot of great EMS people such as Garrie Wright (Toronto) and Greg Sage (Halton) and I like to think that our group helped establish a template that is now found throughout this province and country.
I moved from the base hospital in 2004 to Northumberland County where I took on the role of Deputy Chief of Quality Assurance and Education. In 2007, there was a posting for an Operations Supervisor with Kawartha Lakes EMS and I jumped at the chance to end my days as a commuter and to return home to work with the people where I had started my career. Within a year, I became the Land Ambulance Manager of Kawartha Lakes EMS (in 2011 that title changed to Paramedic Chief). During the ten years that I led the Kawartha Lakes Paramedic department, we achieved:
- Independent stand-alone department
- Response time reliability (mobile and dynamic deployment strategies)
- Non-Urgent Patient Transfer Strategy with Ross Memorial Hospital and Community Care Non Urgent Transfer Service (removed 3,000 non urgent calls from Paramedic Service)
- Improve 911 call capture from 88% – 95% (2011-2018)
- ACP expansion (20% full time in 2008 – 55% full time in 2018)
- ACP Capture 75% for code 4 response in 2018
- Public Access Defibrillation Program (200 sites for a community population of 73,000
- Community Outreach i.e. Police / Fire AED program, loaner AEDs for community events, Citizen CPR campaigns, School Programs, CREMS and information sessions at fall fairs and festivals.
- Sudden Cardiac Arrest Return of Spontaneous Circulation (ROSC) at hospital 5% in 2008 and 20% from 2015-2017
- EMS Master Report endorsed by Council in 2016
- 4 successful MOH Peer Accreditations
As Chief, I was successful due to my team. Truly, they were the best. I really have to thank our paramedics, support, administration and management staff for their dedication to serve. I also have to thank the various CAOs, Mayors and Councillors for supporting our department. I know that we put Kawartha Lakes on the map as a great paramedic service.
As I reflect on my time, I want to bring full circle a few thoughts. Ambulance/Paramedic Competitions use to be something in which every service would participate. When I was in Lindsay, we use to compete provincially two to three times per year. During my time in Oshawa, we did the same but also spread our wings and competed internationally as well. If I can brag a bit, we had very successful teams, not just from Lindsay or Oshawa, but Ontario would always be well represented. I remember a few times seeing Ontario teams finish first, second and third internationally. That competitive spirit needs to be rekindled again. I know the National Paramedic competition is usually held in the spring at Durham College and Windsor Essex Paramedic Service has represented Ontario internationally but that movement to compete needs to grow. Truly, that generates not only competitiveness but pride and passion as well. It takes several people to have a successful team. Along with the competing paramedics, coaches, pretend patients and a supportive service are all necessary elements of a team. Those competitions breed fellowship, camaraderie and a sharing of ideas and knowledge from other paramedic systems (provincially, nationally and internationally) and ultimately, advance our profession.
Ontario Paramedicine is in the midst of change and now, more than ever, we need the youth of our departments to network, collaborate and move forward together. Today, Community Paramedicine is moving us into treat and outreach/treat and release programs. Paramedicine needs to, and will, move into this realm of care and improved remote monitoring of patients within this decade. We are in a good place and we presently have great leadership in the OAPC with President Neal Roberts and V.P. Peter Dundas. As a board member, I had the privilege of working with some great paramedic minds and I know that today we are well represented. Our challenge is to start now in developing tomorrow’s leaders and making sure they are ready for the changes that are on the horizon. We have many bright and energetic young paramedics throughout this province and I encourage our present chiefs to support our paramedic leaders of tomorrow through opportunities for networking, learning and working on tomorrow’s challenges today.
In closing, I want to thank everyone I worked with over my thirty- eight years for the support, opportunities and friendship. Truly this never felt like work and I will miss being part of Ontario Paramedicine. As a private citizen, I have a son who is an Ontario paramedic and I will always be an advocate for him and all of you who serve the citizens of Ontario every minute of every day.