Adding a nurse at 911 takes pressure off ambulances, emergency departments

A nurse is now part of the clinical team that prioritizes 911 calls for an ambulance in Nova Scotia. 

The Emergency Health Services (EHS) Medical Communications Centre is the first in the country to include a nurse, a physician, and a clinical support paramedic.   

“We have an entire clinical team in place that can provide some sort of contact with the patient, some kind of support, in their time of need, “said Ahmed Jamshidi, manager of Patient Flow and Performance for the Medical Communications Centre at EHS.

The addition of a nurse supports Nova Scotia’s Action for Health plan by giving Nova Scotians access to appropriate health care while ensuring paramedics and ambulances are available for the most urgent calls.

Ambulances and paramedics respond to the most urgent calls first.  The less urgent calls go to the nurse.  “We start performing these secondary triages of our patients to determine who needs the next ambulance, “said Jamshidi.  “The adage was you call, we haul.  We’re trying to move away from that and have a clinical understanding of providing the right resource to the right patient.”

Medical Communications Centre nurse Jessica Chisholm says most calls that come her way are blood pressure concerns, falls, back pain, and abdominal pain.  “A person could have a fall and are unable to get up but do not have any injuries.  The patient is evaluated by us, but I refer to the experience of the clinical support paramedic and the physician on the level of response required,” said Chisholm.

For most 911 callers, having a nurse handle their call is a new experience.  “This is still a very new program,” said Chisholm. “I believe that when most people call 911 they are surprised to speak with a nurse.  I think the most important thing for our population to know is that everyone at the Medical Communications Centre is keeping a close eye on every call that we receive to ensure the person is having their emergency met with the most appropriate resource for pre-hospital care.”

At any point during the call with the patient, the nurse can push an emergency button letting the communications centre know an ambulance is needed right away.  If that’s not necessary, the nurse will offer alternatives to the hospital, such as a walk-in clinic or a visit to a mobile primary health clinic. But if the patient insists on going to the hospital by ambulance, that’s what will happen. “Ultimately if the patient says no we send an ambulance when the system allows,” said Jamshidi. 

Jamshidi describes a recent 911 call from a 74-year-old who wanted their blood pressure checked.  While assessing the patient, the nurse decided to send an ambulance. “In this situation the patient obviously had more on their plate than a simple blood pressure check because they ended up being transported.”

Strengthening the team at the medical communications centre is not the only initiative to make sure ambulances are available quickly for the most urgent cases. EHS has also launched a program known as SPEAR, where a single paramedic in an SUV responds to the least urgent calls. “We are trying to be very proactive,” said Jamshidi.  “These projects provide that extra support that takes pressure off emergency departments and our paramedics in the field.”

Triaging 911 calls with the help of a nurse, clinical support paramedic and physician helps improve access to health care for all Nova Scotians.  “Even if we get five per cent or 10 per cent to not go to the hospital it takes that load off the emergency departments and the overall system as well,” said Jamshidi.