Community Paramedicine Program

Community Referrals by Emergency Medical Services

Toronto Paramedic Services’ Community Referrals by Emergency Medical Services (CREMS) program was established in 2006 and enables Paramedics while responding to 911 calls to identify clients that would benefit from additional support managing their healthcare at home. While on scene, Paramedics are uniquely positioned to identify additional medical and/or social needs for their patients. When needs are identified, responding Paramedics submit a referral outlining the barriers experienced by the client, based on information gathered at the time of the 911 call. Depending on the information provided, clients are either referred directly to Ontario Health atHome or Toronto Paramedic Services’ Community Paramedics for follow-up.

The Community Paramedicine program also receives referrals directly from third party sources, including local hospitals, primary care, community agencies, allied emergency services, as well as clients and caregivers. Clients can be referred using the attached Referral Form, as well as by phone, email, or fax.

Community Paramedic Led Clinic

Community Paramedic-Led Clinics (CPLC) are operated biweekly by Community Paramedics to support seniors and other at-risk demographics. These wellness clinics are typically located in Toronto Community Housing, Toronto Seniors Housing, and shelters where Community Paramedics (CPs) provide patient assessments, vital sign checks, health education and referrals to various community programs and services.

The CPLC team performs multiple functions and primarily serves frail, vulnerable, and (in some instances) homebound residents. Clients are supported by one-on-one clinic assessments, health and wellness educational presentations, and home visiting. Clients typically have their vital signs assessed (and monitored for trends), their health-related questions answered, and referrals made for additional services (where appropriate).

At clinic locations potential clients are identified through review of recent 911 calls placed at clinic locations to Paramedic Services. CPs can reach out to the 911 caller/potential client and invite them to the biweekly clinic. Alternatively, the CP may opt to follow up later, with the goal of better supporting the individual at home.

Community Paramedic Home Visit Program

Community Paramedics perform home visits for clients who require additional support in the community. Clients are predominantly identified through three sources:

1. Paramedic referrals from emergency calls (i.e. CREMS referrals),
2. Analysis of frequent requests for Paramedic service via 911, and
3. Direct referrals from program partners, clients, or caregivers.

The home visit program assists vulnerable clients in Toronto through:

• Advanced medical assessment, vital signs evaluation, and diagnostics
• Identifying and addressing gaps in healthcare and social support
• Healthcare system navigation and connecting clients to additional community supports and services
• Working with partner agencies and primary care to support and augment existing services and programs
• Coaching and education on various topics, including chronic disease management
• Support with hospital discharge planning and providing outreach to clients returning home from hospital
• Collaboration of multi-agency support via situation tables (e.g., FOCUS) and patient care conferences
• Vaccinations for homebound individuals
• Follow-up with frequent users of 911 and the emergency departments they attend (where appropriate)

The program provides non-emergent home visits; typically referrals are responded to within one to three business days for booking of an initial home visit. If a more urgent visit is required, partners are encouraged to call 416-397-4322 and select option one to speak to the Community Paramedicine Program directly. For medical emergencies please call 9-1-1.

Targeted Street Outreach

Community Paramedics participate in weekly targeted street outreach with the City of Toronto’s Streets-to-Homes outreach workers to provide medical and social support to clients experiencing homelessness. City outreach workers identify individuals who would benefit from a Community Paramedic assessment, and the joint Community Paramedic-outreach worker team perform targeted visits. City-wide outreach typically occurs at locations such as encampments, shelters, or areas where clients are known to be located. The partnership provides opportunity to build and maintain positive relationships and connections between clients, Paramedics, and the healthcare system.

As an extension of Toronto Public Health’s “The Works” program, Community Paramedics provide free Naloxone (also referred to as Narcan) kits and training to clients at risk of opioid overdose, as well their family and friends. Kits are available for distribution to eligible clients across the city to help address the increasing opioid overdose crisis.

Community Paramedicine Homebound Vaccination Program

Toronto Paramedic Services supports homebound clients and their caregivers with in-home Influenza and COVID-19 vaccinations. Clients are primarily referred by their assigned Care Coordinator at Home and Community Care Support Services (HCCSS). Alternatively, clients who do not receive HCCSS support can be also referred through by their primary care provider or the Toronto Seniors Helpline.

Homebound clients are defined as those experiencing medical, physical, cognitive, or psychosocial needs/conditions that inhibit them from visiting a local clinic, pharmacy, or primary care provider. Additionally, transportation and other strategies to remedy access challenges are either not available or not appropriate given the circumstances.

Toronto Paramedic Services has staffed targeted vaccination clinics for vulnerable individuals since 2002. Targeted clinics occur in several congregate settings, including retirement homes, subsidized housing, shelter locations, encampment sites, as well as hotspots identified by Toronto Public Health. Vaccination clinics have typically provided seasonal influenza vaccination; however, the clinics’ scope was expanded in 2020 to include COVID-19 vaccines during the pandemic.

Please note this program is seasonal and runs from October to March each year.

Community Paramedicine for Long-Term Care

The Community Paramedicine for Long-Term Care (CPLTC) program focuses on supporting clients who are eligible for or awaiting placement within a long-term care home. Community Paramedics perform home visits and remote consultations with clients to identify and investigate gaps in services. The mandate of the program is to create or enhance the clients’ connections and supports while they await long-term care placement. Home visits involve a physical assessment, medical and social history gathering, vital signs acquisition, and other diagnostics required to identify and execute treatment options for clients. In addition to scheduled visits, the program responds to real-time requests for in-home support from clients, their caregivers, and community practitioners.

Complex Care Cases Program

The Complex Care Cases (CCC) program is intended to identify clients (usually children) living in the community who have medically complex care requirements. The program addresses each clients’ treatment needs and hospital destination considerations. Every client is issued a specialized treatment plan (also known as an Emergency Information Sheet) which provides guidance to family members, caregivers, and first responders in the event of a medical emergency requiring a 911 response. The CCC program is a collaborative effort between Community Paramedics, Emergency Medical Dispatchers and Call Takers, Toronto Paramedic Services’ Medical Director, Sunnybrook Regional Base Hospital, Home Community Care Support Services (HCCSS), the Hospital for Sick Children, and the families/caregivers of the complex clients.

Referrals are received directly from either the Hospital for Sick Children Complex Care team or through the HCCSS Care Coordinator. Each referral received is thoroughly reviewed and screened for eligibility.

CCC eligibility criteria includes:

• Lives within the City of Toronto (‘M’ postal code)
• Complex treatment requirements and/or equipment that provides treatment interventions outside of the Paramedic’s standard scope of practice
• A hospital requirement that differs from conventional hospital destination protocols

For more information about this program, or to discuss eligibility and enrollment, please contact cphome@toronto.ca or 416-397-4322 and select option one.