Saturday Community Builers’ Circle: “Collaborative Rural Health”

New concept for emergency health in rural N.S.

By Tammy Scott-Wallace

GeorgetownHealthPoirier GeorgetownHealthTravers

Georgetown, PE.I. – A new model for emergency care taking shape in Nova Scotia’s rural communities is helping solve a problem common throughout Atlantic Canada.

According to the team behind the new concept of collaborate emergency centres in that province, the goal was to create a new way of treating patients to ease the burden on the limited doctor pool.

For those people who have a family physician, the wait times are often long for an appointment, says Paula Poirier, chief operating officer for Emergency Medical Care Inc. in Nova Scotia. The shortage, therefore, often leads to more emergency room visits, and sometimes long drives to find an emergency department that may not be open.

The province of Nova Scotia was up against the growing dilemma, she said, and had to shift gears to consider other ways of meeting the health care needs in rural areas.

Poirier led a builders’ circle as part of the Georgetown Conference that ran Oct. 3-5 in eastern Prince Edward Island.

The conference, named Rural Redefined, was aimed at rediscovering ways rural Atlantic Canadians could strengthen their regions.

Poirier said in order to work within the parameters of Nova Scotia’s health care reality, in 2010 collaborate emergency centres were created by the province.

The centres are located in rural and remote communities “which have been plagued by frequent emergency department closures due to a lack of staffing and resources,” she said.

There are six centres in the province now with a goal to double that number by the end of next year, each staffed during the nighttime hours by a registered nurse and a paramedic. In these communities emergency rooms are now kept closed at night. As well, as mobile emergency centre was put on the road just weeks ago in New Waterford, which allows emergency personnel to hit the road to go where patients need them.

Dr. Andrew Travers, the medical director for emergency health services in Nova Scotia, said the concept has strengthened health care in rural communities in many ways. As part of the centres’ creation, primary care during the day was stabilized to ensure available doctors and nurse practitioners seven days a week, 12 hours a day, with a nurse and emergency medical technician taking over during the night.

He said 85 per cent of the time patients are able to be treated in their communities by the duo, and given an appointment, when needed, to see a doctor within 24 hours. The other, more serious cases determined through the help of a “virtual” doctor, or doctor off-shift, are transported for treatment by ambulance to the nearest regional hospital’s emergency room.

The model has brought consistency to what was becoming an unstable emergency care system in rural areas, the presenters agreed.

“Your journey with health care starts when you dial 911,” Travers said, adding paramedics are extensively trained to start treatment as soon as the call is made and cannot be seen simply as transporters.

“Nurses don’t do what paramedics do. Paramedics don’t do what nurses do. They work together,” he said.

Other provinces are following the model. Saskatchewan recently announced the change after visiting the first centre in Parrsboro, N.S., and Prince Edward Island is also considering it.

Abby Pond, who attended the Oct. 3-5 Georgetown Conference intended to redefine rural regions, thinks New Brunswick should be eyeing the concept, particularly the mobile centres, for its most remote communities where seniors or those without transportation can have care come to them without driving upwards of an hour to a town or city hospital.

Doctor shortages and closed emergency rooms is not new in New Brunswick, the St. Stephen woman stressed, and requires a reasonable solution like she is seeing in Nova Scotia with the collaborative system.

“In some of our communities there are doctors offices open during the day but what do these people do when they are in trouble at night?” she asked. “You hear of many older people who may not be able to drive a far distance themselves and they don’t want to call an ambulance because it costs so much money, so they wait until they are really too sick. This is a problem in the rural areas of our province.”

The collaborative system in Nova Scotia is free, including the mobile emergency unit being tested now.

Pond said at one time in rural areas if was not uncommon for local nurses to offer care and deliver babies when doctors were not as readily available. She feels consideration should be given to using the expertise of medical professionals in small communities again for non-life-threatening emergency care.


Tammy Scott-Wallace is a writer for Brunswick News Inc. She is reporting from the Georgetown Conference as part of Newspapers Atlantic.