Nurses on 911 team free up paramedics to handle more urgent calls

Jessica Chisholm says it comes as a bit of a shock to many people at the other end of the 911 line to hear they're being helped by a registered nurse.

 "Most people are surprised to hear that we are calling them back," says Chisholm, an experienced emergency department nurse. "But again, it's a very new program."

That program started last November when Emergency Health Services added four registered nurses to the team of clinical support paramedics and doctors to help 911 callers, and paramedics in the field, deal with medical problems. Nova Scotia is the first province in Canada to have this mix of expertise in its 911 communications centre, which handled about 190,000 calls last year.

Chisholm and the other nurses working from 7 a.m. to 11 p.m. each day handle cases that are not life-threatening and do not require urgent care or treatment. Instead, the nurses assess the situation, take a history and suggest possible alternatives to going to hospital in an ambulance. 

"We're reviewing their medications, a little bit more, and their health history, a little bit more, to paint this big picture and understand everything that's going on," says Chisholm. "That includes home dynamics, if a patient's home alone, then we identify that they would probably need a resource because they're alone, they're not able to transport themselves to hospital and that kind of stuff.

"Those questions don't typically get asked."

Reduces strain on emergency department

Chisholm says even if an ambulance needs to be dispatched, someone with a less serious health problem may have to wait for more urgent cases to be dealt with first. She says getting some reassurance from a nurse helps.

"Just to hear another voice and give them some interim advice if they are waiting for an ambulance or to assist them navigating the system and how they can reach out to different resources that are available to them," says Chisholm.  "It's a privilege to be in this position."

Andrew Travers, provincial medical director for Emergency Health Services, says nurses are providing patients with "better care."

"It's brought that nursing perspective into a 911 call and it's allowed the nurses to focus on some of the low-acuity calls," he says. "Before when people called 911, it was an ambulance transport to the emergency department and it was all built on a two-minute conversation.

"But there's a lot more that can unfold by asking patients more questions, by having a conversation with them to figure out [their] health-care needs," Travers says. "Whether it's a nurse, medic or a doc. It's get the right resource, to the right patient, at the right time, for the right reason.

"Not everything needs to go to an overwhelmed [emergency department] right now."

So far, the nurses have fielded about 500 calls. That's too few, according to Travers, to know yet how many ambulance transports have been avoided by adding registered nurses.

The union that represents paramedics in Nova Scotia, Local 727 International Union of Operating Engineers, supports the program.

"I believe it's going to be helpful down the road," says Kevin MacMullin, business manager for the union. "It'll be able to triage the calls much more effectively.

"We are short staffed, and like everything in health care, we're in the middle of a crisis," says MacMullin. "Anything that will alleviate some of the low-acuity calls that we don't need to get to right away will make it easier for paramedics to concentrate on the more important calls."

Chisholm says the experience she is gaining in the communications centre helps her when she is at her other job looking after patients in the emergency department at the Halifax Infirmary. 

"I would say my assessment skills are honed in a lot more, just even the way that I speak to people, ensuring that I'm covering all of the bases with them like [I do] over the phone," she says. "Mobility issues, that's not typically something I ask frequently in the emergency department until I need to assist the patient to get into bed. But over the phone I'm asking them, do they use a walker?

"Now I've just integrated that into my general conversation."