Overview

Patient care models (PCMs) have launched for select patient groups to divert patients away from emergency departments (ED) and reduce repeat hospital visits to help reduce patient wait times and ensure hospital beds are available for those that need them most.

Initial PCMs, approved since 2020, focused on palliative care patients and those experiencing mental health and addictions (MH&A) challenges. In 2023, PCMs expanded to provide paramedics with more flexibility to offer safe and appropriate care options for broader patients while helping to protect hospital and ambulance capacity.

Under the Treat and Refer model, an eligible patient may be treated by paramedics on scene as needed and referred for appropriate follow-up care by a healthcare provider (for example, community paramedicine).

Under the Alternate Destination model, an eligible patient may choose to go to an alternate healthcare provider in the community for treatment/care that is not an ED or a hospital-based facility (for example, a mental health crisis centre, hospice, non-hospital affiliated urgent care centres/clinics, family practice offices, or community-based family health teams).

Under the Treat and Discharge model as part of expanded PCMs in 2023, an eligible patient may be treated on-scene by paramedics as needed and discharged with recommendations for follow-up care if needed (for example, by a primary care physician or home and community care provider).

Approved patient care models

The following information outlines the eligible PCMs as of July 24, 2023.

Treat and Refer

Palliative care

Eligible palliative care patients calling 9-1-1 will have the option to be treated by paramedics on-scene for symptom management including for pain or dyspnea, hallucinations or agitation, terminal congested breathing, and nausea or vomiting, and then receive follow up care from their palliative care team or be referred by paramedics on scene to an appropriate care provider for follow-up care (if the patient does not have one).

Approved paramedic services:

  • Algoma District Paramedic Services
  • Brant & Brantford Paramedic Service
  • Bruce County Paramedic Services
  • City of Greater Sudbury Emergency Services
  • Cochrane District Social Services Administration Board
  • Cornwall SDG Paramedic Services
  • District of Timiskaming Emergency Medical Services
  • Dufferin County Paramedic Services
  • Frontenac Paramedic Services
  • Grey County Paramedic Services
  • Guelph-Wellington Paramedic Service
  • Haldimand County Paramedic Service
  • Haliburton County Paramedic Service
  • Halton Region Paramedic Services
  • Hamilton Paramedic Service
  • Hastings-Quinte Paramedic Services
  • Huron County Paramedic Services
  • Kawartha Lakes Paramedic Service
  • Lanark County Paramedic Service
  • Leeds Grenville Paramedic Service
  • Lennox and Addington Paramedic Service
  • Manitoulin-Sudbury District Services Board
  • Medavie Emergency Health Services (Elgin)
  • Niagara Emergency Medical Services
  • Nipissing, Temagami, and Mattawa Emergency Medical Service
  • Norfolk County Paramedic Service
  • Northumberland Paramedics
  • Ottawa Paramedic Services
  • Oxford County Paramedic Services
  • Parry Sound District Emergency Medical Service
  • Perth County Paramedic Services
  • Peterborough County/City Paramedics
  • Prescott and Russell Paramedic Services
  • Region of Durham Paramedic Services
  • Region of Waterloo Paramedic Services
  • Renfrew County Paramedic Service
  • Sault Ste. Marie Paramedic Services
  • Six Nations Paramedic Service
  • Weeneebayko Area Health Authority
  • York Region Paramedic Service

Mental health and addictions (MH&A)

Eligible patients calling 9-1-1 experiencing of MH&A challenges will have the option to be treated by paramedics on scene as needed, and then be referred by paramedics to an appropriate care provider for follow up care, such as a mobile response team for MH&A patients.

Approved paramedic services:

Non-emergent

The Treat and Refer model for non-emergent patients is part of the expanded PCMs. Eligible, non-emergent patients calling 9-1-1 will have the option to be treated by paramedics on scene as needed, and then be referred by paramedics to the Community Paramedicine program for follow up care.

Approved paramedic services:

  • Essex-Windsor Emergency Medical Services
  • Middlesex-London Paramedic Service
  • York Region Paramedic Services

Alternate Destination

Palliative care

Eligible palliative care patients calling 9-1-1 will have the option to be treated by paramedics on-scene as needed, and then to be coordinated and transported by paramedics to a local hospice for wrap-around care.

Approved paramedic services:

  • Bruce County Paramedic Services
  • Dufferin County Paramedic Service
  • Grey County Paramedic Services
  • Guelph Wellington Paramedic Service
  • Huron County Paramedic Services
  • Medavie Emergency Health Services (Elgin)
  • Oxford County Paramedic Services
  • Perth County Paramedic Services
  • Peterborough County/City Paramedics
  • Simcoe County Paramedic Services
  • Region of Waterloo Paramedic Services

Mental health and addictions (MH&A)

Patients calling 9-1-1 experiencing symptoms of MH&A challenges, will have the option to be treated on scene as required, and then be directly transported to a crisis center, or a community-based care setting for further care.

Approved paramedic services:

Non-emergent

The Alternate Destination model for non-emergent patients is part of the expanded PCMs. Eligible, non-emergent patients calling 911 will have the option to be treated on scene as required, and then be directly transported an appropriate community-based care setting for further care.

Approved Paramedic Services: 

  • York Region Paramedic Services 

Treat and Discharge

Hypoglycemia, seizures, and tachydysrhythmia

Eligible patients who experience symptoms of hypoglycemia, seizure and/or tachydysrhythmia will have the option to be treated by paramedic on scene as needed, and then be discharged on scene with recommendations for seeking follow up care as required.

Approved paramedic services:

  • Algoma District Paramedic Service
  • Beausoleil First Nations Paramedic Service
  • Brant County Paramedic Service
  • Chatham-Kent Paramedic Service (currently for hypoglycemia and seizure only)
  • Cochrane District Paramedic Service
  • Cornwall SDG Paramedic Service
  • County Of Renfrew Paramedic Service
  • Dufferin County Paramedic Service
  • Durham Paramedic Service
  • Essex-Windsor Paramedic Service
  • Frontenac Paramedic Service
  • Greater Sudbury Paramedics
  • Grey County Paramedic Service
  • Guelph-Wellington Paramedic Service
  • Haldimand County Paramedic Service
  • Haliburton County Paramedic Service
  • Halton Region Paramedic Service
  • Hamilton Paramedic Service
  • Hasting-Quinte Paramedic Service
  • Hastings-Quite Prince Edward County Paramedic Service
  • Huron County Paramedic Service
  • Kawartha Lakes Paramedic Service
  • Lambton County Paramedic Service
  • Lanark County Paramedic Service
  • Leeds & Grenville Paramedic Service
  • Lennox & Addington Paramedic Service
  • Manitoulin-Sudbury DSD Paramedic Service
  • Medavie EMS Elgin
  • Muskoka Paramedic Service
  • Naotkamegwanning First Nation Paramedic Service
  • Niagara Region Paramedic Service
  • Nipissing Paramedic Service
  • Norfolk County Paramedic Service
  • North West Paramedic Service
  • Northumberland Paramedic Service
  • Ottawa Paramedic Service
  • Oxford County Paramedic Service
  • Parry Sound District EMS
  • Peel Region Paramedic Service
  • Perth County Paramedic Service
  • Peterborough County Paramedic Service
  • Prescott-Russell Paramedic Service
  • Rainy River District Paramedic Service
  • Rama Paramedic Service
  • Region Of Durham Paramedic Service
  • Region Of Waterloo Paramedic Service
  • Sault Ste. Marie Paramedic Service
  • Simcoe County Paramedic Service
  • Six Nations Paramedic Service
  • Superior North Paramedic Service
  • Temiskaming EMS
  • Toronto Paramedic Service
  • Weeneebayko Area Health Authority Paramedic Service
  • Weeneebayko Area Health Authority Constance Lake First Nation Paramedic Service
  • York Region Paramedic Service

Please contact your local municipality for further details regarding program rollout and availability in your region. Find a complete listing of Ontario municipalities, including contact information.

Patient success stories

Middlesex-London

Implementing municipality: London

Project partners: the Canadian Mental Health Association (CMHA) Middlesex, Middlesex-London Paramedic Service and London Health Sciences Centre

Eligible patients: select 9-1-1 patients with care needs related to MH&A

Patient care model: instead of visiting an ED, eligible patients would have the option of going to a 24/7 Walk-in Crisis Centre operated by CMHA Middlesex or be referred to receive care on scene provided by a mobile Crisis Response Team. The Crisis Centre was launched in 2015 to provide crisis support and services within a non-institutional and welcoming environment.

Having the option to come to the Crisis Centre was a huge relief - did not want to go to the ED.

He [the patient] was pleased at Crisis Centre. He was disappointed with the hospital system and felt the Crisis Centre-Paramedic route was "much more helpful" to him. He said he attended at hospital previously and was wanting a "psych evaluation" and said he had waited eight hours and did not receive a psych evaluation and received information to access a family doctor.

Paramedics explained it well. I didn't know going to Crisis Centre was an option before and was happy for it. It was ‘calmer"’ than going to the emergency department. I have referred Crisis Centre and Reach Out to other friends. It's awesome that you don't have to wait six hours! The person I talked to (at Crisis Centre) changed my entire mood!

Honestly, the service was so much help. Yes, I'm reading through the modules and self-reflection about emotions on a phone app. The staff helped and were open. I'm glad for this call too. Keep the program going!

Paramedics were very nice and helpful. Very nice people and very supportive, environment good (at Crisis Centre).

York Region

Implementing municipality: York Region

Project partners: York Region Paramedic Services

Eligible patients: select 9-1-1 patients with care needs related to palliative care

Patient care model: instead of visiting an ED, eligible patients would have the option of receiving symptom management services on scene related to pain and dyspnea, hallucinations or agitation, nausea or vomiting and terminal congested. This model of care allows for comfort-oriented care through relieving symptoms, reassuring families and honouring the wishes of patient or family in transport options (stay home or transport to hospital).

Patient impact / experiences:

The Treat and Refer model for palliative care intends to provide comfort-oriented care at home where patients prefer to be. The project in York has demonstrated that patients and families prefer this model of care than going to an ED. For example, since implementation, there have been cases where paramedics were called multiple times to provide symptom management services at a patient’s home. Some family expressed their appreciation to the services that we are so grateful for the wonderful care all of these paramedics offered. They truly made the process more bearable for all of us.

I am on call this week and on Monday night 10 p.m. I get a call from a family with a palliative patient where paramedics had been on scene for 2-3hrs. This patient declined quickly over a matter of days and the Symptom Relief Kit (SRK) had not yet been in place. The paramedics were able to give several different medications to comfortably settle the patient. I had ordered for urgent delivery of SRK but knew it wouldn't arrive until sometime the next morning. The paramedics had to go back at 7 a.m. the next morning to administer more meds. The patient died that next morning (before an SRK had even arrived). I feel like this patient would have likely ended up in the ER and died there if it had not been for the paramedics! I just wanted to thank the paramedics for their compassionate care and congratulate the team for making an impact on our patients and their families!

Palliative Care Physician (York Region)

Guelph-Wellington

Implementing municipality: Guelph-Wellington

Project partners: Guelph-Wellington Paramedic Service (GWPS) and Hospice Wellington (HW)

Eligible patients: select 9-1-1 patients with care needs related to palliative care and have registered for a hospice

Patient care model: instead of visiting an ED, eligible patients would have the option of being transported to a hospice.

Patient impact / experiences:

I am happy to report the communication between our two organizations was excellent and this provided seamless transitions for those who accessed our services. When the GWPS is called to serve a patient in the community who is at end of life and a referral is in place, with a bed available at Hospice Wellington, (and both parties agree upon the alternate delivery) the emergency department at the hospital is averted. At HW we have 24 hour access to a palliative care physician whenever needed. When patients and families are introduced to our end-of-life care they are also given free access and immediate follow up to our bereavement programs at Hospice Wellington. The participation in these programs has proven to be a huge benefit to patients and families and their appreciation is noted regularly. The improved experience supports the continuum of integrated care. The impact of what could be a traumatic end of life event is changed many times by the implementation of this pilot project for Alternate Destination model for Palliative Care Patients. I would ask your consideration in continuing this important work and assisting us in preventing patients from dying in emergency rooms. As mentioned, we have received positive feedback from family members in regard to the end-of-life experience of their loved one while at Hospice Wellington. We cannot change the outcome of death, but we can change the patient and family experience.

Letter from Hospice Wellington to the ministry

We admitted the above resident overnight via direct 9-1-1 transfer route to Hospice Wellington and it worked out really well. Thank you to our on-call nurse for working with the night staff to guide a plan. The family called asking for admission, but we could not get transportation from non-emergency providers. Staff worked together to determine a call to 9-1-1 by the family and then a direct admit to us here. All the members of the team have been amazing. We are so appreciative of the efforts that were made to ensure his safe transfer and he is very much needing our care here. If we did not have this process in place this patient would have ended up in ER that is already swamped and not an appropriate setting for this client.

Letter from HW to GWPS

To learn more about the impact introducing this model of care had on patients, visit the Guelph Today website.

Ottawa

Implementing municipality: Ottawa

Project partners: Ottawa Paramedic Service and Mental Wellbeing Response Team (MWRT)

Eligible patients: select 9-1-1 patients with care needs related to MH&A

Patient care model: instead of visiting an ED, eligible patients would have the option to be referred for follow up care provided by the MWRT.

Health care system impact: In its first year of operation, the MWRT achieved about 65% diversion rate from ED for the patients responded, which is estimated to have increased ambulance availability by 573 hours and ED stretcher availability by 2,701 hours.

Under this model, patients have received the care need much quicker: individuals cared for through the MWRT can now be assessed, cared for, and referred into resources as needed in just over one hour, compared to over 36 hours after being transported to hospital.

Provider survey results:

Big supporter of the program. I've had 100% success in dealing with MWRT and patients that I've offered this option are not opposed and generally welcoming to the idea instead of a ride to ER and PES. My reports I have offered to MWRT on scenes are listened to and appreciated and feels like a team-based approach. MWRT as an option is long overdue targeting this call volume and dealing with patients that meet the criteria for the MWRT response. The end response is that it has become easier to manage to transport the patient or being left in a higher level of care with MWRT and gives me a new tool to deal with some of the complex patients.

I find the MWRT to be an invaluable resource for certain types of calls and patients we encounter in the community. They are able to address the needs of the community in ways that traditional first responders cannot. I personally feel ill equipped to manage most mental health related emergencies and do not believe the ED is much better at providing care. I am relieved when the MWRT attends these calls with me because I know my patients are being cared for in a more appropriate and effective manner.

This resource is well over-due in the pre-hospital setting and will hopefully only grow in momentum. Even when a diversion from hospital is not achievable the team adds major insight that our frontline crews seem to really appreciate in addition to our hospitals upon transfer of care ensuring the patient's get the most appropriate / direct care. Patient's overwhelmingly state that they feel we are the right people responding to them at time of crisis.

Patient impact / experiences:

The MWRT was requested by paramedics to assist an individual experiencing a situational crisis at home. MWRT arrived and was able to relieve the regular operations crew from the scene, providing a thorough medical and mental health assessment, risk assessment, safety planning and referral into next day resources, providing her with the most appropriate care in the right place at the right time. The regular operations paramedics upon returning to their ambulance were requested on a high priority right around the corner for a sudden cardiac arrest. Upon arrival to the second call the individual was identified to still be in fibrillation and was subsequently defibrillated with a Return of Spontaneous Circulation. This individual was then transported to a local hospital. This case was a great example of 2 patients receiving the most appropriate care required as a direct result of a new patient care model.

The MWRT co-responded for a middle-aged gentleman who recently immigrated to Canada, leaving his family and all social support behind while he established a home for his family to soon join him. Amidst the challenges of immigrating alone to a new country, food and housing insecurities, this individual’s isolation was exacerbated by a COVID lockdown, further impacting his mental health and wellbeing, restricting his ability to access financial, social, and health support. Upon MWRT’s arrival the individual was experiencing a situational crisis due to severe psychosocial stressors, with acute secondary anxiety and depression. Through the scope of the Mental Wellbeing Response Team, the individual was medically assessed, reassured, and empowered with the option of receiving mental health and social support care in the setting of his own home. The individual was referred for culturally and religiously appropriate follow up care that supported his faith, beliefs, and worldviews. This individual received continued support and connection through these referrals, with his religious referral assisting him with food and housing support, connecting him with his family overseas, and providing him a social support.

In the end, the patient was left at home, extremely grateful and satisfied with the resources and a care plan. The service providers left with an overwhelming sense of fulfillment and pride.