To Whom It May Concern:

The McNally Project for Paramedicine Research was established in 2014 to foster the growth and development of research capacity within and related to paramedicine by those close to practice.  We do this through collaboration, education, engagement, and advocacy. The McNally Project now consists of over 60 members, fellows, senior fellows, and scientists mainly from Ontario but also across Canada.  We bring together a diverse set of research interests and expertise, connected by the common theme of studying and advancing paramedicine through scholarship. It is our aim to contribute knowledge to the academic (scientific) literature on paramedicine and topics related to paramedicine that has and/or contributes to practical solutions and policy. This is our motivation for providing comments on the proposed “Patient Care Models Standards v1.0a”.

We recognize the proposed changes as an appropriate patient/public centered effort to provide opportunities to broaden paramedic services available to the community. It promotes the leveraging of the collective experience and wisdom of the system to seek meaningful local and health care system level contributions and solutions. We ask that the following be considered as mechanisms to contribute further to the rigour of the proposed standard. Our suggestions are grounded in an interest to promote long term advancement of the system and to support our Ambulance Service Operators (ASO) in contributing to that effort. These include:

  1. That guidance and resources be made available or at least known to communities to support the contribution of “strong supporting evidence” or the evidence necessary for model selection. This is particularly needed for ASOs that lack inherent infrastructure or expertise. Efforts related to knowledge dissemination – the communicating of new knowledge to target groups that may lead to improve accessibility of desired knowledge – serves to advance the system overall. We suggest that the McNally Project, with its diverse areas of expertise, be considered as a resource. Also, that a consortium of scholars and operators be organized to support these activities.
  2. That a public reporting framework and/or knowledge dissemination plan be included in or made mandatory. We recognize that the standard does include reference to an evaluation plan, and that ASOs are obligated to measure, collect, share and report on the program, including a history of quality and performance improvement. However, our suggestion is that the standard obligate that this be publicly reported using conventions of science, program evaluation or quality improvement frameworks and/or through formal reporting guidelines.
  3. That the standard obligate a description on how they intend to link their data to provincial or national databases and/or provide access (in an appropriate form) to scholarly/research centres. To meet this aim, data must be compliant with existing data management, analytical and reporting guidelines. Innovative programs have historically had their data unavailable to individuals or groups outside of their local context making it difficult to leverage the significant resources (e.g., others scientists and developers) and opportunities that may collectively advance the system. The current fragmented approach to data generation and sharing, greatly and unnecessarily diminishes opportunities for growth.
  4. That an extension be provided until the “Patient Care Model Evaluation Framework” is made publicly available for review. We agree with and support the inclusion of an evaluation framework, but are unable to examine the extent to which it supports the goals of improvement but also public knowledge dissemination as described above. We suggest that any evaluation framework should consider both processes and patient-focused outcomes, be flexible to support the varying contexts in which it may be implemented, and be informed by scholarship and national/international best-practices.

Some of the challenges our system faces today in considering various models of care is a lack of evidence to support them, despite multiple models existing in the province.  This limits what care models may be considered appropriate, or how to leverage new knowledge for improved models / proposals. As such, the suggestions above are intended to support the role of scholarship, promote public consumption such that knowledge related to model shifts grows and to promote a collective advancement of the system.

There is now an increased and growing capacity for paramedics to lead and contribute to knowledge production, translation, use, and evaluation targeted toward the evolution of paramedicine. As paramedicine evolves, it will be increasingly important to enable our system and paramedics, who are close to practice, to conduct scientific inquiries in support of advances. The human resources and will necessary to conduct this work now exist. We therefore encourage the Ministry of Health to provide language that supports long term knowledge development related to any new models of care. The McNally Project is at the service of the Ministry to aid in the development of any such language or strategy.

On behalf of The McNally Project,

Walter Tavares, ACP, PhD
McNally Project Scientist

Polly Ford Jones, PCP, PhD
McNally Project Scientist

Alan Batt, CCP, MSc, PGCME, PhD(c)
McNally Project Senior Fellow

Justin Mausz, ACP, PhD (c)
McNally Project Senior Fellow

Matthew Leyenaar, PCP, BSc, MA, PhD(c)
McNally Project Senior Fellow

Public comment re: Patient Care Model Standards v1.0a