Paramedicine: Altruism in Emergency Medicine

I am a Primary Care Paramedic in Ontario. How does this fit into the greater framework of Canadian Healthcare? How does my professional identity compare with my own professional values?

A professional identity is defined as “a form of social identity by which members of a profession categorize and differentiate themselves from other professions” (Melrose et. al., 2015). The Ontario Paramedic Association has outlined a set of ethics that are central to paramedicine - inherently, our professional identity. I have outlined these guidelines in the My Professional Identity page of this website. The basic tenets of paramedicine’s professional identity are a commitment to conserving life and reduce suffering free of judgments and bias all while maintaining a professional decorum (Code of Ethics, 1995). 

This professional identity is deep-rooted in the profession, but where our individuality to practice bifurcates is with our professional values. Professional values “provide a foundation for our [professional] behaviour, guiding principles that are acquired through socialization and through a unique learning experience” (Melrose et.al, 2015).  So what are my professional values? 

My work, at its core, is built on the the foundation of providing care and relief of suffering in a non-judgmental manner. Some of the values I recognized prior to my career have become strengthened, like altruism and compassion. Other values are newly developed, like a commitment to communication, caring, and advocacy for those who cannot speak up for themselves.  

In order to fully understand how my professional identity and values fit into Canadian healthcare, it is imperative to have an understanding of the health care system in 2024. Healthcare in Canada is driven by the Canada Health Act (Flood & Thomas, 2016). This act was implemented in response to Tommy Douglas’ drive for universal healthcare for the citizens of Saskatchewan (Flood & Thomas, 2016). This act was intended to provide free and accessible health care to Canadians as long as it was deemed “medically necessary” (Flood & Thomas, 2016). Determining whether something is "medically necessary" is arbitrary and can vary from person to person, just as much as both professional identities and professional values can vary (Flood & Thomas, 2016).  Values, and thus medical direction, can change based on your organization, your experience within the profession, and your current personal values.  

In knowing this, it is important to frequently “check in” with oneself to re-evaluate one’s professional identity and professional values. As mentioned above, my personal values are rooted in altruism, caring, compassion, lack of judgement, and communication.  These values can be implemented in my daily practice with each person I encounter. My patients deserve a professional who exhibits these values, as do my co-workers. All of these values, together, allow me to foster a care environment based on respect.  This inherent respect will ensure productive practice in patient care and mutual respect from allied resources.  

So, how do I fit?  This question is one that is difficult to answer in a system that is overrun by offload delay, nursing shortages, hospitals that are over-capacity, and lack available ambulances.  The image below shows the increase in Code Reds and Code Yellows in my region, when there are zero or less than 3 ambulances available regionwide (respectively). Code reds and yellows are events exacerbated by persistent offload delays

These realities seem to be in direct contradiction with the promise to alleviate suffering, provide care, and calls into question our innate sense of altruism on a daily basis. They also seem to contradict our promise for access to universal healthcare.  

In July 2023, the Ontario government released a document titled Ontario Reducing Wait Times in Emergency Departments which announced they would be investing an additional $4 million in emergency departments (2023). Sylvia Jones, Deputy Premier and Minister of Health, said “When someone experiences a medical emergency, it is vital that they get the urgent attention they need ... ” (Ontario Reducing Wait Times, 2023). In the document Your Health: A Plan for Connected and Convenient Care, the province outlines a plan for action to strengthen all aspects of health care. The province has committed to providing high volume emergency departments an additional $29 million in funding, and $15 million to smaller centres (Government of Ontario, 2023). In addition, paramedic services will be provided $23.1 million dedicated toward offload relief nurses (Government of Ontario, 2023).

At the core of this initiative? Provide faster and more available care in both emergency and non-emergency situations. To allow for more seamless transitions from pre-hospital to emergency rooms with solutions that answer he problems we are plagued with systemically. This is highly valuable for all members of the healthcare sector. It will allow us to reconnect with our professional identity and values and provide the care we truly are capable of delivering. For me, it will allow me to ensure I am consistently delivering compassionate care, free of judgement, and open to communication with patients and allied resources alike. 

https://www.youtube.com/watch?v=_eRWrlItpjw

(Youtube, 2023)

RESOURCES

Ambulance offload delays led to 571% increase in Code Reds in 2022. CambridgeToday.ca. (2023, March 31). https://www.cambridgetoday.ca/local-news/ambulance-offload-delays-led-to-571-increase-in-code-reds-in-2022-6790499#:~:text=Ambulance%20offload%20delays%20led%20to%20571%25%20increase%20in%20code%20reds%20in%202022,-Ambulance%20responses%20grew&text=The%20measure%20of%20how%20tough,delays%20had%20on%20the%20service.

Code of ethics. Ontario Paramedic Association. (1995). https://www.ontarioparamedic.ca/about-us/code-of-ethics/

Flood, C. M., & Thomas, B. (2016). Modernizing the Canada health act. Dalhousie Law Journal, 39(2).

Government of Ontario. (2023). Your Health: A plan for connected and convenient care. NA, Ontario. Retrieved January 25, 2024, from https://files.ontario.ca/moh-your-health-plan-connected-convenient-care-en-2023-02-02-v3.pdf.

Melrose, S., Park, C. & Perry, B. (2015). Creative clinical teaching in health professions. (Chapter 4). Retrieved January 25, 2024 from https://clinicalteaching.pressbooks.com

Ontario Reducing Wait Times in Emergency Departments. Ontario newsroom. (2023, July 20). https://news.ontario.ca/en/release/1003300/ontario-reducing-wait-times-in-emergency-departments

YouTube. (2023, December 22). Region of Waterloo Paramedic Services recruitment. Region of Waterloo Paramedic Services. https://www.youtube.com/watch?v=_eRWrlItpjw