Diverting 911 calls to nurses helped reduce unnecessary ambulance responses in Ontario area. globalnews.ca

An initiative that combines the expertise of nurses to handle non-critical 911 calls in the Niagara region, reducing the number of ambulances arriving on scene.

Niagara EMS says adding an emergency communications nurse (ECN) to its system five years ago has been a key part of what has contributed to a 20 per cent reduction in paramedics calls since 2019.

The effort aims to eliminate unnecessary ambulance calls and provide an effective alternative care method to avoid visits to a crowded emergency room.

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The commander of Niagara’s Mobile Integrated Health Care Unit says the program recently surpassed its 16,000th “low acuity” call implemented on ECN, relieving pressure on a network that handles about 70,000 911 calls per year. Handles the call.

Marty Mako of Niagara EMS says about 20 percent of screenings through ECN are delayed which prevents EMS resources from being deployed.

Low back pain, a bloody nose, or a child having a fever are some examples of low-priority incidents that the structure might divert to another agency.

“So that means we’re able to find people in the community who need the care they need without having to send an ambulance and two paramedics when they really didn’t need it,” Mako said.

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“And we call back 24 hours a day to make sure people are satisfied.”

An undated photo of emergency caption communications nurses of Niagara EMS

An undated photo of Niagara EMS emergency caption communications nurses.


The program came about after a study conducted between 2011 and 2016 exploring the efficacy of implementing ECNs to conduct secondary level responses to “non-emergent” 911 calls.

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This was followed by another analysis that showed that Niagara had the largest increase in EMS calls across Ontario, nearly 55 per cent, which was almost double the average provincial increase of 30 per cent between 2007 and 2016.

At that time, 44 percent of Niagara 911 calls required an ambulance with lights and sirens.

The initial proposal called for a concept that would use algorithms to identify callers whose health needs should be referred to a walk-in clinic, urgent care center or even a medication-related issue. Can be redirected to pharmacist.

Mako says the “evidence-based” software, called “Locode,” runs secondary testing on some calls and uses “signs and symptoms” to determine a patient’s health need.

“This way, using the patient’s signs and symptoms, they can ask a series of questions in an extra 10 or 15 minutes over the phone to learn about the recommended care level,” Mako explained.

Niagara’s ECN blueprint was the first in Canada, but not the only one, with Nova Scotia and Quebec also having similar plans that added nurses to emergency calls.

Nova Scotia’s Emergency Health Services (EHS) Medical Communications Center launched a version in November 2022, taking it a step further by including not only a nurse, but also a physician and clinical support paramedic.

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EHS said its call center received about 185,000 calls in 2021, about a third of which did not require patient transport.

Within the first six months of launch, EHS reported that nurses fielded approximately 500 calls for issues that were not life-threatening.

“The saying was that you call, we will carry. We are trying to move away from that and have a clinical understanding of providing the right resources to the right patient,” said Ahmed Jamshidi, manager of patient flow and performance for EHS.

“Even if we get five percent or 10 percent to not go to the hospital, that also reduces the burden on emergency departments and the overall system.”

Meanwhile, Quebec launched its own one-year pilot for Montreal and Laval in 2018, transferring about 23,000 non-urgent calls to the 811 Info-Santé health advice service.

In about 20 percent of calls during the pilot, a nurse determined there was no need for an ambulance.

Mako says recent inquiries from across Canada about the Niagara program suggest the idea could expand even further.

But he says it’s not for every community because it not only requires accreditation through the International Academy of Emergency Dispatch and other agencies, but the software must be paired with fairly modern paramedic dispatch systems.

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“It’s important to understand that there may be other EMS services out there that may want to model after us, but structurally they can’t because they don’t have the same systems in place as their predecessors,” Mako said.

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