09 Apr Target Engagement & Diversion (TED)
The Ottawa Paramedic Service has experienced a 14% increase in call volume over the past 4 years and continually looks for opportunities to improve the delivery of paramedic resources and services to our community.
A particularly challenging population has been the shelter community. Suffering from substance abuse/addiction, mental health complications and overall poor medical health, the shelter community interacts daily with our paramedics. They have unique health care needs and may not fit in the regular mold of health care, which has simply not adapted to deal with members of the shelter community.
INNER CITY HEALTH
Based on the needs of the shelter community, an alternate care pathway had to be established. The Ottawa Paramedic Service then looked into alternatives. Before paramedic involvement, Inner City Health (ICH) ran the TED (Target Engagement and Diversion) Program that was set up to treat members of the shelter community inflicted with addiction issues.
According to their website, ICH “aims to improve the health and access to health care for people who are chronically homeless. [Their] main function is to coordinate and integrate health care services so that homeless individuals can receive the same quality of health care as other Canadians”.
Inner City Health operates within the Shepherds of Good Hope, a homeless shelter in downtown Ottawa. At their Clinic, medical staff offer unique patient care plans to members of the shelter community. The staff know what is required to deescalate a patient in crisis and how to mitigate and support their patients who are suffering from various non-urgent medical conditions as well as from their chronic addiction issues.
This clinic contains heart monitors, resuscitation equipment as well as the life saving capacity of administrating naloxone. Physicians, Registered Nurses and Registered Practical Nurses work together to offer 24-hour medical coverage of the clinic. They are also supported by social workers, street workers as well as counselors.
At the time, this clinic was the perfect alternative destination that would be suitable for the shelter community. However, the current state of the legislation in Ontario prevented any paramedic service to transport to any location other than a hospital.
The first solution was to use alternate means of transport to ICH. The Ottawa Police Service were then brought into the project and TED 1.0 came into effect. Based on their assessment, paramedics were able to request police officers to transport a patient to TED. This was obviously not the ideal solution, but it was an important stop gap until a more sustainable alternative could be determined.
Through discussions with the Ministry of Health and Long-Term Care of Ontario, an agreement was obtained for a pilot project allowing for paramedics to transport members of the shelter community directly to ICH. The Ottawa Hospital played a major role in allowing ICH to operate as one of their satellite locations, remaining within the parameters of the Ambulance Act.
Prior to transport by paramedics, each TED patient receives a thorough paramedic physical assessment. Depending on the outcome of the patient assessment, a transport decision is made by the Paramedics based on an established algorithm. As stakeholders became comfortable with the program, this algorithm evolved based on their feedback.
An example was the membership in the program. At first, a TED card or affiliation confirmation through dispatch was required to be transported to the ICH. Since cards were often lost and the membership list outdated, a more efficient system was designed. The paramedics would then directly confirm the admissibility of a patient through ICH via cellphone.
The clinical inclusion criteria also evolved to include more and more chief complaints. Substance abuse is no longer the unique problem transported to ICH. Mental health complications, wound care and other minor complaints can now all be treated at Inner City Health.