Novel wound care training to support evolving role of community care paramedics

There is paradigm shift towards Paramedic Services providing improved and expansive prehospital care. Training and education for Paramedic’s has been structured to support emergency acute care, however; with this paradigm shift to an expanded role for community care paramedics, the paramedic education model has expended to include inhouse, community care education including wound management. Traditional perceptions of the Paramedic Service are gradually being replaced with the view that it is a mobile health resource, able to provide an increasing range of assessment, treatment and diagnostic services.

Paramedic Services are playing a vital role in Ontario’s healthcare system, not just by providing a rapid response to emergency 911 calls and transferring patients to hospital but by becoming a portable healthcare service within the community. According to the Ontario Paramedic Association, there are over 11,000 Paramedics, 1200 Communications Officers and more than 2000 Support Staff who handle 1.75 million emergency calls every year in Ontario. Paramedics provide a critical service to 14.8 million Ontario residents in 444 communities.

The highly trained Paramedic’s in Ontario, were faced with a shift to work in multiple contexts of health care throughout the COVID-19 pandemic such as :

1. Long Term Care settings (other provinces utilized the Canadian Armed Forces)

2. Community Paramedics (providing hospital-level treatments in private residences)

3. COVID swabbing and COVID vaccine teams

4. Operation Remote Immunity (vaccinating communities in the far north) and

5. Emergency Departments (due to staffing shortages in hospitals)

There is a need for Paramedics to take wound care education in order to develop knowledge, skills and an understanding of modern technology to provide healthcare to individuals inside of the community environ- ment. Paramedics reach a wide range of patient groups including those patients who need an emergency response to individuals who do not have a life-threatening condition but are seeking urgent advice or treatment, and to those whose condition or location prevents them from travelling easily to access healthcare services such as the elderly.

Paramedics are not generally trained or educated in chronic wound management. With the paradigm shift towards Paramedic Services providing improved and expansive pre hospital care, knowledge about the principles of best practice in wound care for the paramedic on the scene to facilitate care delivery within the home environment can reduce the need for acute hospital care which places a heavier demand on the time and costs of all parties involved.

Wound care is an integral part of the role of the Paramedic and is a clinical skill supported by evidence-based knowledge that is acquired during an educational process. The overall aim of managing wounds is to promote healing and to achieve wound closure as quickly as possible. It is well documented that wound care has advanced significantly within recent years and with the development of wound care specialists who are knowledgeable in research, policy and practice and are able to effectively bridge the gap across theory and practice. Other health professionals, such as paramedics, have the opportunity to learn skills and techniques in wound management by sharing best practice and being able to access wound focused educational programs that are specifically tailored to paramedics to develop clinical skills in wound care.

In response to the paramedics evolving role, Nurses Specialized in Wound, Ostomy and Continence Canada (NSWOCC) saw an opportunity to develop and provide a wound management educational program that was designed for Paramedics. The Practice Enrichment Series for Paramedics: Wound Management, is a state-of-the-art educational program, designed to provide community care paramedics with the ability to provide optimal wound care in collaboration with an interprofessional team.

This educational program, which is offered through the NSWOCC Wound, Ostomy and Continence Institute, is a competency-based, selfpaced, online foundational program in wound management facilitated by a team of Nurses Specialized in Wound, Ostomy and Continence (NSWOCs) who are Canadian Nurses Association (CNA) certified ( WOCC (C )). While this educational program is delivered on-line to provide a convenient way of learning, an onsite Paramedic Wound Management education program delivered by NSWOCs is available.

The goal of the program is to provide paramedics with knowledge about timely and appropriate wound intervention to positively impact patient outcomes through minimizing patient transfers to hospital and improving communications with community nurses and primary care providers. There is a strong focus on paramedic – nurse collaborations and pathways to care.

Paramedics now have a way to become educated in wound management in order to provide an essential healthcare service in the community. This will provide Ontarians with a new way to receive wound management in the community and could reduce unnecessary patient transfers to the hospital if the wound can be managed in the home. For more information on the program please visit nswoc.ca or email programmanager@wocinstitute.ca.