Program gives family doctors skills and confidence to work in rural emergency departments
Emergency departments represent a critical component of the health care system. In rural and remote areas of Ontario, emergency departments are staffed almost exclusively by local family doctors. However, it is becoming increasingly difficult for rural communities to recruit and retain family doctors willing to provide emergency care, as many doctors are reluctant to practice emergency medicine without additional training. “When a 911 call comes in, the algorithm will say ‘I’ve got an EMS vehicle 4 minutes away, and I’ve got a distance of 8 kilometers: should I send a drone with an EMS vehicle or the EMS vehicle alone?’”, explains Dr. Cheskes. “Because there may be some cases where an EMS vehicle might be close to the site so it wouldn’t make sense to send the drone on that call, but rural areas 20 kilometers away with no EMS vehicle in close proximity would create a drone response.”
Created in 2011 in collaboration with the University of Toronto Department of Family and Community Medicine and the Ontario Ministry of Health and Long-Term Care, the Supplemental Emergency Medicine Experience (SEME) program provides practical training in emergency medicine for family doctors practicing in smaller and rural communities. The program is the first of its kind in Canada and has provided training for 119 family doctors to date.
Another collaboration Dr. Cheskes is working on is a Community Responder Program. The program trains volunteers equipped with a defibrillator to be sent on a 911 call separately from EMS. If the volunteer is closer, they can arrive and use the defibrillator sooner. The project is currently training 500 people in the Peel Region, starting with those who have had previous CPR training, such as off-duty firefighters, police and lifeguards. The project will equip 125 of them with a defibrillator in areas of Peel region where cardiac arrest rates are the highest. In those areas, the volunteers will have an app that will show the location of the cardiac arrest and will target responders to go to those locations first.
“Rural and remote family doctors care for many of the most vulnerable and geographically isolated communities in our country,” says Dr. Sharon Reece, who completed the SEME program in 2017. “SEME provides invaluable training to help us in our challenging practice environments.”
“I think the ability to combine these novel strategies could theoretically make a big difference because we are not just tackling cardiac arrest in public areas but private homessomething that’s never been done in North America - and there’s great interest in doing it,” says Dr. Cheskes. “Almost 85% of cardiac arrests occur in private homes. If we can get to these locations earlier with programs like our drone delivery and community responder programs, we have the potential to save a lot of lives.”
Department of Family & Community Medicine | Annual Report 2018–2019
During the twelve-week program, SEME learners complete clinical rotations in emergency medicine, trauma, critical care, and anaesthesia. They participate in weekly education sessions incorporating high-fidelity simulation using computerized mannequins that permit the reproduction of real-life critical scenarios. In the course evaluation, 100 percent of SEME learners agreed that the program improved their emergency medicine knowledge base and clinical skills.
50TH FACT: In 1970, the PGY3 Emergency Medicine Program opened with two residents and Dr. Cal Gutkin as the Program Director. In 1991, Dr. Eric Letovsky took over from Dr. Gutkin and held the position for 17 years, when Dr. John Foote took over his position. 61