More than twenty years later EHS special patients program continues to adapt to Nova Scotians’ unique needs

Mother and daughter, Robyn and Helen McTague (contributed)

The Emergency Health Services (EHS) Special Patient Program (SPP) was created to help Nova Scotians with rare conditions or complex health needs that may not be classified under paramedics’ standard care protocols.

When paramedics are trained, they are trained to follow standard care policies, protocols and guidelines. This includes providing pre-hospital emergency medical care to patients and transporting them to hospitals or other medical facilities for further medical attention if needed.

However, those with complex health care needs may require care that falls outside EHS’s standards of care.

At the age of four and a half months, Robyn McTague took her first seizure which her mother, Helen described as horrific. Helen said she had never seen a seizure before but instantly knew what was happening. Robyn ended up in the intensive care unit (ICU) at the IWK Health and a month later was diagnosed with intractable epilepsy. 

Robyn became a frequent patient of EHS and the IWK Health – requiring a very specific type of care.

The SPP was created when her family and her health care team noticed the gap. A customized care plan was developed in collaboration with Robyn, her family and health care team so that when they called 9-1-1, paramedics knew to activate the care plan attached to the patient.

Through the SPP, the EHS call centre can pull up the care plan specific to the patient and send it digitally to paramedics before they arrive on-scene.

In some cases, care plans allow for patients to be treated in-home and other care plans provide directions to the paramedics and alert the appropriate health team at the hospital to prepare for the patient’s arrival.

“This demonstrates two complex systems – Nova Scotia Health/IWK Health, and EHS – working together to come up with specialized care plans for complex patient needs,” said Dr. Andrew Travers, EHS provincial medical director. “Not only are we able to treat them better, but we may be able to treat and release them without having to transport them to hospital.”

Now, 20 years later Robyn is a Nova Scotia Health patient and still registered with the SPP.

Robyn at Point Pleasant Park – one of her favourite places.

“This program has enabled Robyn to have a life and be able to do things – it has truly been a godsend,” said Robyn’s mother, Helen. She explained that Robyn has a rare condition that results in major seizures that need medical intervention. Due to the nature of her condition, they are never more than 10 minutes away from the hospital.

Beyond the specialized care received by patients, the program also improves the patients’ quality of life, respects patients’ wishes and reduces the stress on patients and their families.

“People feel safe when there’s a defined plan in place,” said Dr. Travers. “This program gives patients the sense that they are plugged into a system that already knows what to do in advance of something bad happening. That gives comfort to families and their next of kin.”

Helen, who is a single parent, explained “I don’t feel like a single parent. I have all the paramedics and they got our backs.” She also noted that she doesn’t have to worry when she has respite care in to look after Robyn because this program speaks for her daughter.

The program began to care for those with very rare and complex conditions, however the model has been adapted to other areas of care.

For example, palliative care patients can register for this program.

Paramedics have been trained to provide palliative care and support for patients in their home. They work with the patients’ health care team and family to provide individual care in the best setting possible.

“Palliative care teams register many, if not most, patients in the EHS Special Patient Program,” said Dr. David Henderson, senior medical director, palliative care at Nova Scotia Health. “This program helps to enhance the circle of care for patients and their families by allowing us to share important information about the person’s condition, goals of care, potential symptom issues that may arise, and treatments that can be provided at home by paramedics. This allows more people to remain at home and receive timely symptom management there, or, prior to and during transport to hospital if that what is wanted or needed.”

When paramedics can provide care within communities it helps reduce the number the emergency department visits.

This model is also being looked at in different areas of the health system as well including cardiology.

The SPP is a homegrown initiative that began with a card system. Patients were required to carry a card with a unique patient number on it. It has now changed to an electronic system providing health care teams easily accessible and coordinated care plans.

“We are unique in terms of a jurisdiction in Canada and even North America – having this type of coordinated care plan,” explained Dr. Travers.

Learn more about the EHS special patient program (.pdf)