The Urgent Need to Modernize Prehospital Care in Ontario.

To the editor: As medicine has progressed over the past decade, prehospital care in Ontario has largely remained stagnant. The failure to implement evidence-based best practices means that Ontarians are not receiving an appropriate level of prehospital care. Paramedics are dependent on the Ministry of Health and Long-Term Care to provide clinical standards through the Basic Life Support (BLS) Patient Care Standards, the primary document governing paramedic clinical practice in Ontario. This crucial document has not been updated since January 2007. (The Advanced Life Support Patient Care Standards are updated more frequently but often deviate from medical evidence in ways that are beyond the scope of this letter.) Despite the known risks of the overuse of supplemental oxygen, the BLS Patient Care Standards force paramedics to administer it to patients when it is likely to be detrimental. Spinal immobilization in patients with penetrating trauma increases mortality, but this is still the required practice in Ontario. The Canadian C-Spine Rule is a clinical decision rule designed and validated in Ontario that can reduce unnecessary, uncomfortable, and potentially harmful spinal immobilization for patients who have suffered blunt trauma. Despite it being our own research, we have seen this implemented internationally, while Ontario paramedics are still are not permitted to use it. The issue of the need to modernize Ontario prehospital care has been raised directly with two successive Health Ministers, most recently in a written question tabled in the Legislature. Their responses suggest that the Ministers believe that our current system is working. The few selected examples above clearly refute that assertion. We call on the Honourable Dr. Eric Hoskins to reconsider the need to modernize prehospital care in Ontario. We also ask emergency physicians to contact their MPPs or the Minister to help convey the importance of this issue. It is only with the support and advocacy of emergency physicians that change and modernization will come to prehospital care in Ontario. Ontarians deserve world-class prehospital care through the implementation of evidence-based best practices. This is not being achieved in our current system. Without updating the clinical standards and creating a transparent and accountable process to keep them current, we will continue to lag far behind the evidence. When this happens it is our patients—Ontarians—who will continue to suffer the consequences.