Ambulance Services Attendance for Mental Health and Overdose Before and During COVID-19 in Canada and the United Kingdom: Interrupted Time Series Study.

BACKGROUND: The COVID-19 pandemic impacted mental health and health care systems worldwide. OBJECTIVE: This study examined the COVID-19 pandemic's impact on ambulance attendances for mental health and overdose, comparing similar regions in the United Kingdom and Canada that implemented different public health measures. METHODS: An interrupted time series study of ambulance attendances was conducted for mental health and overdose in the United Kingdom (East Midlands region) and Canada (Hamilton and Niagara regions). Data were obtained from 182,497 ambulance attendance records for the study period of December 29, 2019, to August 1, 2020. Negative binomial regressions modeled the count of attendances per week per 100,000 population in the weeks leading up to the lockdown, the week the lockdown was initiated, and the weeks following the lockdown. Stratified analyses were conducted by sex and age. RESULTS: Ambulance attendances for mental health and overdose had very small week-over-week increases prior to lockdown (United Kingdom: incidence rate ratio [IRR] 1.002, 95% CI 1.002-1.003 for mental health). However, substantial changes were observed at the time of lockdown; while there was a statistically significant drop in the rate of overdose attendances in the study regions of both countries (United Kingdom: IRR 0.573, 95% CI 0.518-0.635 and Canada: IRR 0.743, 95% CI 0.602-0.917), the rate of mental health attendances increased in the UK region only (United Kingdom: IRR 1.125, 95% CI 1.031-1.227 and Canada: IRR 0.922, 95% CI 0.794-1.071). Different trends were observed based on sex and age categories within and between study regions. CONCLUSIONS: The observed changes in ambulance attendances for mental health and overdose at the time of lockdown differed between the UK and Canada study regions. These results may inform future pandemic planning and further research on the public health measures that may explain observed regional differences.

Development of indicators for avoidable emergency medical service calls by mapping paramedic clinical impression codes to ambulatory care sensitive conditions and mental health conditions in the UK and Canada.

OBJECTIVE: Paramedic assessment data have not been used for research on avoidable calls. Paramedic impression codes are designated by paramedics on responding to a 911/999 medical emergency after an assessment of the presenting condition. Ambulatory care sensitive conditions (ACSCs) are non-acute health conditions not needing hospital admission when properly managed. This study aimed to map the paramedic impression codes to ACSCs and mental health conditions for use in future research on avoidable 911/999 calls. DESIGN: Mapping paramedic impression codes to existing definitions of ACSCs and mental health conditions. SETTING: East Midlands Region, UK and Southern Ontario, Canada. PARTICIPANTS: Expert panel from the UK-Canada Emergency Calls Data analysis and GEospatial mapping (EDGE) Consortium. RESULTS: Mapping was iterative first identifying the common ACSCs shared between the two countries then identifying the respective clinical impression codes for each country that mapped to those shared ACSCs as well as to mental health conditions. Experts from the UK-Canada EDGE Consortium contributed to both phases and were able to independently match the codes and then compare results. Clinical impression codes for paramedics in the UK were more extensive than those in Ontario. The mapping revealed some interesting inconsistencies between paramedic impression codes but also demonstrated that it was possible. CONCLUSION: This is an important first step in determining the number of ASCSs and mental health conditions that paramedics attend to, and in examining the clinical pathways of these individuals across the health system. This work lays the foundation for international comparative health services research on integrated pathways in primary care and emergency medical services.

Paramedics assessing patients with complex comorbidities in community settings: results from the CARPE study.

OBJECTIVES: The aim for this study was to provide information about how community paramedicine home visit programs best "navigate" their role delivering preventative care to frequent 9-1-1 users by describing demographic and clinical characteristics of their patients and comparing them to existing community care populations. METHODS: Our study used secondary data from standardized assessment instruments used in the delivery of home care, community support services, and community paramedicine home visit programs in Ontario. Identical assessment items from each instrument enabled comparisons of demographic, clinical, and social characteristics of community-dwelling older adults using descriptive statistics and z-tests. RESULTS: Data were analyzed for 29,938 home care clients, 13,782 community support services clients, and 136 community paramedicine patients. Differences were observed in proportions of individuals living alone between community paramedicine patients versus home care clients and community support clients (47.8%, 33.8%, and 59.9% respectively). We found higher proportions of community paramedicine patients with multiple chronic disease (87%, compared to 63% and 42%) and mental health-related conditions (43.4%, compared to 26.2% and 18.8% for depression, as an example). CONCLUSION: When using existing community care populations as a reference group, it appears that patients seen in community paramedicine home visit programs are a distinct sub-group of the community-dwelling older adult population with more complex comorbidities, possibly exacerbated by mental illness and social isolation from living alone. Community paramedicine programs may serve as a sentinel support opportunity for patients whose health conditions are not being addressed through timely access to other existing care providers. PROTOCOL REGISTRATION: ISRCTN 58273216.

RéSUMé: OBJECTIFS: L'objectif de cette étude était de fournir des informations sur la façon dont les programmes de visites à domicile des paramédicaux communautaires " naviguent " le mieux possible dans leur rôle de prestation de soins préventifs aux utilisateurs fréquents du 9-1-1 en décrivant les caractéristiques démographiques et cliniques de leurs patients et en les comparant aux populations de soins communautaires existantes. MéTHODES: Notre étude a utilisé des données secondaires provenant d'instruments d'évaluation normalisés utilisés dans la prestation de soins à domicile, de services de soutien communautaire et de programmes de visites à domicile paramédicaux communautaires en Ontario. Des éléments d'évaluation identiques de chaque instrument ont permis de comparer les caractéristiques démographiques, cliniques et sociales des personnes âgées vivant dans la collectivité à l'aide de statistiques descriptives et de tests z. RéSULTATS: Les données ont été analysées pour 29 938 clients des soins à domicile, 13 782 clients des services de soutien communautaire et 136 patients des services paramédicaux communautaires. Des différences ont été observées dans les proportions de personnes vivant seules entre les patients paramédicaux communautaires par rapport aux clients des soins à domicile et aux clients du soutien communautaire (47,8%, 33,8% et 59,9% respectivement). Nous avons trouvé des proportions plus élevées de patients paramédicaux communautaires atteints de maladies chroniques multiples (87%, contre 63% et 42%) et de problèmes de santé mentale (43,4%, contre 26,2% et 18,8% pour la dépression, par exemple). CONCLUSION: En utilisant les populations de soins communautaires existantes comme groupe de référence, il semble que les patients vus dans les programmes de visites à domicile paramédicaux communautaires soient un sous-groupe distinct de la population des personnes âgées vivant dans la collectivité avec des comorbidités plus complexes, peut-être exacerbées par la maladie mentale et l'isolement dû au fait de vivre seul. Les programmes paramédicaux communautaires peuvent servir de soutien sentinelle pour les patients dont l'état de santé n'est pas pris en charge par le biais d'un accès rapide à d'autres prestataires de soins existants.

Pragmatic Strategy Empowering Paramedics to Assess Low-Risk Trauma Patients With the Canadian C-Spine Rule and Selectively Transport Them Without Immobilization: Protocol for a Stepped-Wedge Cluster Randomized Trial.

BACKGROUND: Each year, half a million patients with a potential neck (c-spine) injury are transported to Ontario emergency departments (EDs). Less than 1.0% (1/100) of these patients have a neck bone fracture. Even less (1/200, 0.5%) have a spinal cord injury or nerve damage. Currently, paramedics transport all trauma victims (with or without an injury) by ambulance using a backboard, cervical collar, and head immobilizers. Importantly, prolonged immobilization is often unnecessary; it causes patient discomfort and pain, decreases community access to paramedics, contributes to ED crowding, and is very costly. We therefore developed the Canadian C-Spine Rule (CCR) for alert and stable trauma patients. This decision rule helps ED physicians and triage nurses to safely and selectively remove immobilization, without x-rays and missed injury. We successfully taught Ottawa paramedics to use the CCR in the field in a single-center study. OBJECTIVE: This study aimed to improve patient care and health system efficiency and outcomes by allowing paramedics to assess eligible low-risk trauma patients with the CCR and selectively transport them without immobilization to the ED. METHODS: We propose a pragmatic stepped-wedge cluster randomized design with health economic evaluation, designed collaboratively with knowledge users. Our 36-month study will consist of a 12-month setup and training period (year 1), followed by the stepped-wedge trial (year 2) and a 12-month period for study completion, analyses, and knowledge translation. A total of 12 Ontario paramedic services of various sizes distributed across the province will be randomly allocated to one of three sequences. Paramedic services in each sequence will cross from the control condition (usual care) to the intervention condition (CCR implementation) at intervals of 3 months until all communities have crossed to the intervention. Data will be collected on all eligible patients in each paramedic service for a total duration of 12 months. A major strength of our design is that each community will have implemented the CCR by the end of the study. RESULTS: Interim results are expected in December 2019 and final results in 2020. If this multicenter trial is successful, we expect the Ontario Ministry of Health will recommend that paramedics evaluate all eligible patients with the CCR in the Province of Ontario. CONCLUSIONS: We conservatively estimate that in Ontario, more than 60% of all eligible trauma patients (300,000 annually) could be transported safely and comfortably, without c-spine immobilization devices. This will significantly reduce patient pain and discomfort, paramedic intervention times, and ED length of stay, thereby improving access to paramedics and ED care. This could be achieved rapidly and with lower health care costs compared with current practices (possible cost saving of Can $36 [US $25] per immobilization or Can $10,656,000 [US $7,335,231] per year). TRIAL REGISTRATION: ClinicalTrials.gov NCT02786966; https://clinicaltrials.gov/ct2/show/NCT02786966. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/16966.

Understanding Why Frequent Users of EMS Call 9-1-1: A Grounded Theory Study.

INTRODUCTION: Frequent users of emergency medical services (EMS) have disproportionately high 9-1-1 call frequency. Evidence suggests that this small group burdens the health care system, leading to misallocation of already-limited health resources. AIM: To understand frequent users' perceptions and experiences regarding EMS, as well as the driving factors underlying their frequent use. METHOD: A grounded theory approach guided our qualitative research process. Participants older than 17 years who called EMS five or more times in the past year were consecutively sampled where each participant was contacted in the order they appeared on our list of potential participants for interviews until data saturation was achieved. Transcripts were analyzed to derive common themes among frequent EMS callers. RESULTS: Frequent EMS calls often resulted from chronic medical conditions creating recurrent crisis situations, mental health issues as well as mobility issues, frequent noninjurious falls, and social isolation. Combined with these factors, perceptions of the purpose of EMS and social circumstances also contributed to the creation of complex health issues that influenced frequent EMS use. These findings can advise the development of future paramedicine programs and health promotion interventions.

What do community paramedics assess? An environmental scan and content analysis of patient assessment in community paramedicine.

OBJECTIVES: Patient assessment is a fundamental feature of community paramedicine, but the absence of a recognized standard for assessment practices contributes to uncertainty about what drives care planning and treatment decisions. Our objective was to summarize the content of assessment instruments and describe the state of current practice in community paramedicine home visit programs. METHODS: We performed an environmental scan of all community paramedicine programs in Ontario, Canada, and used content analysis to describe current assessment practices in home visit programs. The International Classification on Functioning, Disability, and Health (ICF) was used to categorize and compare assessments. Each item within each assessment form was classified according to the ICF taxonomy. RESULTS: A total of 43 of 52 paramedic services in Ontario, Canada, participated in the environmental scan with 24 being eligible for further investigation through content analysis of intake assessment forms. Among the 24 services, 16 met inclusion criteria for content analysis. Assessment forms contained between 13 and 252 assessment items (median 116.5, IQR 134.5). Most assessments included some content from each of the domains outlined in the ICF. At the subdomain level, only assessment of impairments of the functions of the cardiovascular, hematological, immunological, and respiratory systems appeared in all assessments. CONCLUSION: Although community paramedicine home visit programs may differ in design and aim, all complete multi-domain assessments as part of patient intake. If community paramedicine home visit programs share similar characteristics but assess patients differently, it is difficult to expect that the resulting referrals, care planning, treatments, or interventions will be similar.

OBJECTIFS: L'évaluation des patients est un élément fondamental de la pratique de la paramédecine communautaire, mais l'absence de norme reconnue en matière d'évaluation contribue à l'incertitude qui plane sur les facteurs pris en considération dans la planification des soins et les prises de décision relatives au traitement. L'étude visait donc à présenter un résumé du contenu des instruments d'évaluation et à décrire l'état de la pratique actuelle dans les programmes de visites à domicile en paramédecine communautaire. MÉTHODE: L'étude consistait en une analyse environnementale de tous les programmes de paramédecine communautaire offerts en Ontario et en une analyse de contenu visant à décrire les pratiques actuelles d'évaluation des patients appliquées dans le cadre des programmes de visites à domicile. Les chercheurs se sont référés à la Classification internationale du fonctionnement, du handicap et de la santé (CIF) pour comparer et classer les évaluations, et chacun des éléments inscrits sur chaque formulaire d'évaluation a été classé selon la taxonomie de la CIF. RÉSULTATS: Au total, 43 services paramédicaux sur 52, en Ontario, ont participé à l'analyse environnementale, dont 24 se prêtaient à une recherche approfondie reposant sur une analyse de contenu des formulaires d'évaluation initiale. Sur les 24 services, 16 répondaient aux critères de sélection en vue d'une analyse de contenu. Le nombre d'éléments évalués variait de 13 à 252 selon les formulaires (médiane : 116,5; écart interquartile : 134,5). La plupart des questionnaires contenaient des éléments tirés de chacun des domaines inscrits dans la CIF. Au niveau des sous-domaines, seule l'évaluation des troubles de fonctionnement des systèmes cardiovasculaire, sanguin, immunitaire et respiratoire figuraient sur tous les formulaires. CONCLUSION: Les programmes de visites à domicile en paramédecine communautaire peuvent certes avoir des différences de conception et de but, mais ils permettent tous une évaluation pluridimensionnelle des nouveaux patients. Si les programmes de visites à domicile en paramédecine communautaire ont des caractéristiques communes mais des formes d'évaluation différentes, il est difficile de s'attendre à des résultats comparables en ce qui concerne les consultations, les plans de soins, les traitements et les interventions.

Social factors in frequent callers: a description of isolation, poverty and quality of life in those calling emergency medical services frequently.

BACKGROUND: Frequent users of emergency medical services (EMS) comprise a disproportionate percentage of emergency department (ED) visits. EDs are becoming increasingly overwhelmed and a portion of use by frequent callers of EMS is potentially avoidable. Social factors contribute to frequent use however few studies have examined their prevalence. This study aims to describe social isolation/loneliness, poverty, and quality of life in a sample of frequent callers of EMS in the Hamilton region, a southern Ontario mid-sized Canadian city. STUDY DESIGN: Cross-sectional quantitative study. METHODS: We surveyed people who called EMS five or more times within 12 months. A mailed self-administered survey with validated tools, and focused on four major measures: demographic information, social isolation, poverty, and quality of life. RESULTS: Sixty-seven frequent EMS callers revealed that 37-49% were lonely, 14% had gone hungry in the preceding month, and 43% had difficulties making ends meet at the end of the month. For quality of life, 78% had mobility problems, 55% had difficulty with self-care, 78% had difficulty with usual activities, 87% experienced pain/discomfort, and 67% had anxiety/depression. Overall quality adjusted life years value was 0.53 on a scale of 0 to 1. The response rate was 41.1%. CONCLUSIONS: Loneliness in our participants was more common than Hamilton and Canadian rates. Frequent EMS callers had higher rates of poverty and food insecurity than average Ontario citizens, which may also act as a barrier to accessing preventative health services. Lower quality of life may indicate chronic illness, and users who cannot access ambulatory care services consistently may call EMS more frequently. Frequent callers of EMS had high rates of social loneliness and poverty, and low quality of life, indicating a need for health service optimization for this vulnerable population.

Rationale and methods of an Evaluation of the Effectiveness of the Community Paramedicine at Home (CP@home) program for frequent users of emergency medical services in multiple Ontario regions: a study protocol for a randomized controlled trial.

BACKGROUND: Frequent users of emergency medical services for issues that could be more appropriately managed through non-urgent care deplete the limited resources of the health-care system. Community paramedicine is an emerging field that extends the role of paramedics beyond the traditional emergency response. The goal of the current study is to evaluate the impact of a community paramedicine home-visit intervention with frequent users on reducing ambulance calls, hospital visits, and admissions. The study will also provide a cross-sectional description of the characteristics of frequent users of emergency medical services. METHODS/DESIGN: An open-label, pragmatic, randomized controlled trial with parallel intervention and control groups will be conducted in four paramedic services in Ontario. The sample size has been calculated as 261 per group for a 25% reduction in ambulance calls. Eligible participants will be frequent callers (three or more calls in 6 months), individuals who call for at least one lift assist, or individuals referred to the program by a paramedic. Individuals will be randomly allocated to receive either the Community Paramedicine at Home (CP@home) program intervention or their usual care (control). Intervention participants will receive up to three visits from a community paramedic, who will conduct health risk assessments, provide health promotion and education, provide referrals to local resources, and fax reports back to the family physician. Data will be collected from administrative databases (e.g., paramedic services), a custom CP@home program database, participant surveys, and key informant interviews. An intention-to-treat analysis will be conducted, including descriptive statistics and multi-level modeling to find factors predictive of primary and secondary outcomes. A thematic analysis will be used to analyze the qualitative outcomes. An economic analysis will consider the cost-effectiveness of the program. DISCUSSION: CP@home has the potential to reduce the health-care system burden significantly by targeting current frequent users of emergency medical services. By targeting this population, CP@home aims to decrease ambulance calls and emergency department visits, reducing health-care costs and improving the quality of life of a vulnerable population. If successful, CP@home will inform the development of community paramedicine policies and the expanding role of paramedics in regions across Canada. TRIAL REGISTRATION: ClinicalTrials.gov, NCT02835989 . Registered on July 14 2016.

Reducing 9-1-1 Emergency Medical Service Calls By Implementing A Community Paramedicine Program For Vulnerable Older Adults In Public Housing In Canada: A Multi-Site Cluster Randomized Controlled Trial.

Objective: Older adults account for 38-48% of emergency medical service (EMS) calls, have more chronic diseases, and those with low income have lower quality of life. Mobile integrated health and community paramedicine may help address these health inequalities and reduce EMS calls. This study examines the effectiveness of the Community Paramedicine at Clinic (CP@clinic) program in decreasing EMS calls and improving health outcomes in low-income older adults. Methods: This was an open-label, pragmatic, cluster-randomized controlled trial conducted within subsidized public housing buildings for older adults in 5 paramedic services across Ontario, Canada. A total of 30 apartment buildings were eligible (>50 units, >60% of units occupied by older adults, unique postal code, available match for pairing). Paired buildings were randomly allocated to intervention (CP@clinic for one year) or control (usual care) via computer-generated randomization. The CP@clinic intervention is a community-based, paramedic-led, health promotion and disease prevention program held weekly in building common rooms. CP@clinic includes risk assessment with validated tools, decision support, health promotion, referrals to resources, and reports back to family doctors. All residents could participate, but only older adults (55 years and older) were included in analyses. The primary outcome was building-level EMS calls from paramedic service databases. Secondary outcomes were individual-level changes in chronic disease risk factors and quality-adjusted-life-years (QALYs). Data were analyzed using Generalized Estimating Equations to account for clustering by sites. Results: Intention-to-treat analysis showed no significant difference in EMS calls (mean difference = -0.37/100 apartment units/month, 95%CI: -0.98 to 0.24). Sensitivity analysis excluding data from 2 building pairs with eligibility changes after intervention initiation revealed a significant difference in EMS calls in favor of the intervention buildings (mean difference = -0.90/100 apartment units/month, 95%CI: -1.54 to -0.26). At the individual level, there was a significant QALY increase (mean difference = 0.06, 95%CI: 0.02 to 0.10) and blood pressure decrease (systolic mean change = 3.65 mmHg, 95%CI: 2.37 to 4.94; diastolic mean change = 2.03 mmHg, 95%CI: 1.00 to 3.06). Conclusions: CP@clinic showed a significant decrease in EMS calls, decrease in BP, and improvement in QALYs among older adults in subsidizing public housing, suggesting this simple program should be replicated in other communities with public housing. Trial Registration: Clinicaltrials.gov, Registration no. NCT02152891.

Evaluation of a community paramedicine health promotion and lifestyle risk assessment program for older adults who live in social housing: a cluster randomized trial.

BACKGROUND: Low-income older adults who live in subsidized housing have higher mortality and morbidity. We aimed to determine if a community paramedicine program - in which paramedics provide health care services outside of the traditional emergency response - reduced the number of ambulance calls to subsidized housing for older adults. METHODS: We conducted an open-label pragmatic cluster-randomized controlled trial (RCT) with parallel intervention and control groups in subsidized apartment buildings for older adults. We selected 6 buildings using predefined criteria, which we then randomly assigned to intervention (Community Paramedicine at Clinic [CP@clinic] for 1 yr) or control (usual health care) using computer-generated paired randomization. CP@clinic is a paramedic-led, community-based health promotion program to prevent diabetes, cardiovascular disease and falls for residents 55 years of age and older. The primary outcome was building-level mean monthly ambulance calls. Secondary outcomes were individual-level changes in blood pressure, health behaviours and risk of diabetes assessed using the Canadian Diabetes Risk Questionnaire. We analyzed the data using generalized estimating equations and hierarchical linear modelling. RESULTS: The 3 intervention and 3 control buildings had 455 and 637 residents, respectively. Mean monthly ambulance calls in the intervention buildings (3.11 [standard deviation (SD) 1.30] calls per 100 units/mo) was significantly lower (-0.88, 95% confidence interval [CI] -0.45 to -1.30) than in control buildings (3.99 [SD 1.17] calls per 100 units/mo), when adjusted for baseline calls and building pairs. Survey participation was 28.4% (n = 129) and 20.3% (n = 129) in the intervention and control buildings, respectively. Residents living in the intervention buildings showed significant improvement compared with those living in control buildings in quality-adjusted life years (QALYs) (mean difference 0.09, 95% CI 0.01 to 0.17) and ability to perform usual activities (odds ratio 2.6, 95% CI 1.2 to 5.8). Those who received the intervention had a significant decrease in systolic (mean change 5.0, 95% CI 1.0 to 9.0) and diastolic (mean change 4.8, 95% CI 1.9 to 7.6) blood pressure. INTERPRETATION: A paramedic-led, community-based health promotion program (CP@clinic) significantly lowered the number of ambulance calls, improved QALYs and ability to perform usual activities, and lowered systolic blood pressure among older adults living in subsidized housing. Trial registration: Clinicaltrials.gov, no. NCT02152891.

Implementing powered stretcher and load systems was a cost effective intervention to reduce the incidence rates of stretcher related injuries in a paramedic service.

Paramedic services are considering moving towards the use of powered stretcher and load systems to reduce stretcher related injuries, but cost is perceived as a barrier. This study compared injury incidence rates, days lost, and compensation costs between Niagara Emergency Medical Service (NEMS) and Hamilton Paramedic Service (HPS) pre- (four years) and post- (one year) implementation of powered stretcher and load systems in NEMS. Prior to the intervention stretcher related musculoskeletal disorder (MSD) incidence rates averaged 20.0 (±6.8) and 17.9 (±6.4) per 100 full time equivalent (FTE), in NEMS and HPS respectively. One-year post intervention rates decreased to 4.3 per 100 FTE in NEMS, a 78% reduction. Rates modestly increased to 24.6 per 100 FTE in HPS in same period. Cost-benefit analysis estimated that the added cost to purchase powered stretcher and load systems would be recovered within their expected 7-year service life due to the reduction in compensation costs.

Rationale and methods of a multicentre randomised controlled trial of the effectiveness of a Community Health Assessment Programme with Emergency Medical Services (CHAP-EMS) implemented on residents aged 55†years and older in subsidised seniors' housing buildings in Ontario, Canada.

INTRODUCTION: Chronic diseases and falls substantially contribute to morbidity/mortality among seniors, causing this population to frequently seek emergency medical care. Research suggests the paramedic role can be successfully expanded to include community-based health promotion and prevention. This study implements a community paramedicine programme targeting seniors in subsidised housing, a high-risk population and frequent users of emergency medical services (EMS). The aims are to reduce EMS calls, improve health outcomes and healthcare utilisation. METHODS/ANALYSIS: This is a pragmatic clustered randomised control trial in four communities across Ontario, Canada. Within each, four to eight seniors' apartment buildings will be paired and within each pair one building will be randomly assigned to receive the Community Health Assessment Programme through EMS (CHAP-EMS) intervention, while the other building receives no intervention. During the 1-year intervention, paramedics will run weekly sessions in a common area of the building, assessing risk factors for cardiovascular disease, diabetes and falls; providing health education and referrals to community programmes; and communicating results to the participant's primary physician. The primary outcomes are rate of emergency calls per 100 residents, change in blood pressure and change in Canadian Diabetes Risk (CANRISK) score, as collected by the local EMS and study databases. The secondary outcomes are change in health behaviours, measured using a preintervention and postintervention survey and healthcare utilisation, available through administrative databases. Analysis will mainly consist of descriptive statistics and generalised estimating equations, including subgroup cluster analysis. ETHICS/DISSEMINATION: This study is approved by the Hamilton Integrated Research Ethics Board and will follow the Tri-Council Policy Statement. Findings will be disseminated through reports to local stakeholders, publication in peer-reviewed journals and conference presentations. TRIAL REGISTRATION NUMBER: NCT02152891.

Development of a community health and wellness pilot in a subsidised seniors' apartment building in Hamilton, Ontario: Community Health Awareness Program delivered by Emergency Medical Services (CHAP-EMS).

BACKGROUND: Older adults have higher risk of developing cardiovascular disease, diabetes and falls, leading to costly emergency medical service (EMS) calls and emergency room visits. We developed the Community Health Assessment Program through EMS (CHAP-EMS) that focuses on health promotion/prevention of hypertension and diabetes, links with primary care practitioners, targets seniors living in subsidized housing, and aims to reduce morbidity from these conditions, thereby reducing EMS calls. In this pilot study, we evaluated the feasibility of implementing the CHAP-EMS, attendance rates, prevalence of high blood pressure and cardiovascular risk factors. METHODS: In this pilot study the CHAP-EMS was implemented in the intervention site over a 12 month period. BP, lifestyle, cardiovascular risk and EMS call rates were collected and descriptive analyses performed. Participants were residents (low income seniors) of a subsidized housing complex in Hamilton, Ontario. Two paramedics provided once-weekly sessions, measuring BP, assessing diabetes/lifestyle risk (CANRISK questionnaire) and discussed prevention/local wellness activities in the intervention site. Follow up was invited. RESULTS: A total of 1365 visits with 79 unique participants occurred; 48 (25.2%) visited at least twice; mean age was 72.2; 87.2% were 65 years of age and older and 68.1% were female; 90.3% had a family doctor. Overall, 45.2% had elevated BP initially from the total; 50.0% of participants previously diagnosed with hypertension had elevated BP while 33.3% not previously diagnosed had elevated BP. Almost 1 in 5 (19.4%) had diabetes; 66.7% had moderate to high risk of developing diabetes. CONCLUSION: This pilot study indicates that CHAP-EMS is a feasible program that could have impact on BP, lifestyle factors, diabetes risk and EMS calls in the buildings in which it was implemented.

Developing injury prevention policy through a multi-agency partnership approach: a case study of a state-wide sports safety policy in New South Wales, Australia.

Sports injuries are an important public health issue. A multi-agency key stakeholder partnership was formed to develop a state-wide response to sports injury prevention in New South Wales, Australia. This study evaluated the partnership approach to injury prevention policy development. The partnership approach to policy development was evaluated pre- and post-partnership using semi-structured telephone interviews and questionnaire data gathered from participants. Participants were satisfied with the partnership operation and outcomes. Challenges included: maintaining focus and efficiency; time constraints; sector diversity limiting the likelihood of addressing needs and reaching consensus; and ensuring commitment from all relevant organisations. Potential benefits included: a sense of policy ownership; a broad-based approach across the sector and savings from resource sharing. Policy resulted from a shared understanding of the injury problem, and of an appropriate response. A credible industry leader, investment in partnership management and a consultative approach facilitated the success of the partnership.