Dr. Andrew Travers - How One Canadian Province Is Helping Redefine Health Care

We sit down at Garrison Brewing with Dr. Andrew Travers, Nova Scotia’s EHS medical director, to unpack how a care-first 911 system can calm panic, deliver treatment faster, and often avoid an unnecessary ambulance ride. From text-to-video assessments that let clinicians see a wound in real time to nurse and physician callbacks that build a safe plan without leaving home, Andrew shows how “time to care” now trumps “time to arrival.”

We explore Integrated Health Programs and the paramedic “Jedi” who operate single-response units, treat on scene, and coordinate with doctors to keep patients safe and out of crowded waiting rooms. The numbers are striking: roughly a third of 911 calls end without transport, and specialized units non-transport most cases while maintaining safety. Andrew explains the public utility model that powers EHS, why Nova Scotians own the system, and how moving lifesaving treatments upstream—like thrombolytics for heart attacks or early antibiotics for sepsis—saves lives and dollars.

The conversation widens to prevention and community health. Using real-time surveillance to spot opioid hot spots, connecting callers to 211 for social supports, referring seniors directly to falls clinics, and enrolling frequent callers in special patient plans—this is EMS as a network, not just a ride. We also tackle burnout with practical tools like debriefs and “green/yellow/orange/red” mental readiness checks, and we look at AI that hears distress in a caller’s voice or reads a pulse through a phone camera without replacing the human connection that makes care humane.

Subscribe for more conversations that challenge old assumptions about emergencies, healthcare access, and what “good care” looks like in 2025. If this episode gave you a new way to think about 911, share it with a friend and leave a review so others can find it.

Chapters

• 0:00 Card Trick Cold Open
• 1:24 Meet Dr. Andrew Travers
• 3:14 From Brewing Dreams To ER Medicine
• 6:34 What Happens When You Call 911 Now
• 11:09 Video Triage And Text-To-Video Care
• 14:54 Rethinking Response Times And Care First
• 18:44 Integrated Health Programs Explained
• 23:54 Paramedic “Jedi” And Non-Transport Care
• 29:23 Public Utility Model: How EHS Works
• 34:08 Costs, Ambulance Fees, And Misconceptions
• 38:13 Quintuple Aim And Prevention Lens
• 44:03 Seniors, Falls, And Community Health
• 48:23 Burnout, Debriefing, And Staying “Green”
• 52:13 Doing More Upstream: Drugs In Ambulances
• 56:43 AI, Signal In Noise, And Remote Vitals
• 1:01:23 Ten Questions Lightning Round
• 1:09:43 Last Call: Stay Connected With Family

Transcript

SPEAKER_02: 0:14

Cheers. Cheers. Cheers. Welcome to the afternoon boy, Dog White Tobin.

SPEAKER_04: 0:20

I am Matt Conrad.

SPEAKER_02: 0:21

And who do you have with us today?

SPEAKER_03: 0:23

My name is Andrew Travers. Andrew Travers. Dr.

SPEAKER_04: 0:25

Andrew Travers. Welcome to the show. Do you have a deck of cards with you?

SPEAKER_00: 0:30

Mass. It's one of the things which uh it's a tradition. Uh in terms of meeting patients or new friends and that kind of stuff. We always start off with a card trick and stuff like that. And it's a one. If I if I can bear with you for a minute. A card trick. A card trick.

SPEAKER_04: 0:43

And so the first card trick on our show ever. I don't like magic.

SPEAKER_00: 0:47

If I can just move your phone for a second. Again, you're going to be checking wallets after this.

SPEAKER_05: 0:52

Okay.

SPEAKER_00: 0:53

So there's three calls into 911 for emergency and stuff. Okay.

SPEAKER_02: 0:59

So three cards for our listeners. Three cards are now placed face down in front of us. All right.

SPEAKER_00: 1:04

So there's the first call at uh see, the second call, and the third call. All right. So there's three patients a four-year-old, a nine-year-old, and an eight-year-old.

SPEAKER_02: 1:14

Okay.

SPEAKER_00: 1:15

They're all okay, but the four-year-old, nine-year-old, eight-year-old.

SPEAKER_02: 1:17

Four four is of diamonds and the nine and eight cart variety. I just want to make sure our listeners know in case they're getting two tears. Okay.

SPEAKER_00: 1:26

So watch my hands really closely. There I just did the trick. This one here. What card is that one? Oh, is it four? And the middle one here? Nine. And the list one here?

SPEAKER_01: 1:34

Eight.

SPEAKER_00: 1:35

So four nine eight, eight, nine, four. We send out the ambulances to pick them up. The ambulance went out to the first case, picked up these two patients. Which patients are in my hand?

SPEAKER_02: 1:43

The eight and probably the four?

SPEAKER_00: 1:45

Exactly. So what's this one here? It should be the nine. Take a look.

SPEAKER_02: 1:48

See, this is the best part. Oh, there's a queen of spades there. That's not a good one.

SPEAKER_00: 1:53

But see, the deal is that 24 hours from now, anytime we cross paths, if you bring a joker from a card deck, I keep the joker, and then you keep the card track, and you can show it to anybody you want. But you have to keep that tradition going forwards.

SPEAKER_04: 2:06

Okay.

SPEAKER_00: 2:14

So literally over the course of the past 15 years, we've had thousands of patients, residents, medical students, paramedics, nurses in the comm center, nurses at telehealth swinging by saying, Oh, dear sweet Jesus, you ran into Andrew. Did he torment you with a card trick?

SPEAKER_03: 2:31

All right.

SPEAKER_02: 2:34

I don't understand card tricks. I'm not a I don't spend much time looking into card tricks and stuff. Do you, Matt? I know very little. I mean, I I don't know really any.

SPEAKER_00: 2:44

Just for your listeners that aren't there, they both of them were just checking their wallets as they were just talking to you, making sure that their wallets were in there.

SPEAKER_02: 2:50

I am missing a tic-tac. Just one tic tac. Just one. So uh Andrew, you um you're a medical doctor, uh Nova Scotian native. Uh you completed your undergraduate and uh at uh Delhouse University, pursued a postgraduate in epidemiology at the University of Alberta. Um Fellowship of Training in Emergency Medicine with the Royal College of Physicians and Surgeons in Canada in 1999. Currently you are the professor uh attending medical staff in the Delhousie Department, and my gosh, there's like a hundred other things here.

SPEAKER_03: 3:28

I've been lucky. You've been lucky. I'm blessed.

SPEAKER_04: 3:31

Well, that's lucky. I think that's a whole lot of hard work. You've been busy.

SPEAKER_00: 3:34

Uh the thing I'm most proud of is that I'm a um I'm the fat uh the son of six, a husband of one, and a father of two. Oh wow. And uh but most uh one of the things I'm also very proud about is that uh I have the best job on the planet. I get to work with an incredible team of uh paramedics, nurses, and docs as the medical director for EEHS. And that's my full-time gig.

SPEAKER_02: 3:56

Wow. So I've got to tell you how we made our connection. So my friend Rob, he was a paramedic. Uh I met Rob probably in our teens. When he was in his 20s, early 20s, I read a book by Joe Connolly. It was called Bringing Out the Dead, and it was about a guy as a paramedic in Hell's Kitchen. Okay. Long story short, the book was amazing, read, but mortifying. It wasn't totally based on reality, but it was based this guy was an ambulance driver before he wrote the book, and it had a lot of spiritual stuff incorporated into it. It was a really interesting read. And then when the movie came out, Rob, my buddy, you know, I was showing him the movie. I was mortified, and he was like, Wow, that's awesome.

SPEAKER_05: 4:34

Yeah.

SPEAKER_02: 4:35

And he decided to be a paramedic, and I thought it was the scariest thing in the world. Was it because of the movie? No, it wasn't because of the movie. He was already on his way. But if I watched the movie, he was like highly endorsing of it, like, oh my gosh, this is really great. And I was just like completely like, oh my gosh, like horrified.

SPEAKER_00: 4:50

I see Rob Groom, I see Nicolas Cage. One and the same in many ways.

SPEAKER_04: 4:54

Nice hundred percent. Yes, I can't disagree with that. Uh listen, I I I heard I read this in uh, you know, bringing out your dead, and I immediately went to Monty Python, the Holy Grail, and was like, Bring out Jesus.

SPEAKER_02: 5:06

Well, I guess my question is stemming from that though. It's like, so I mean, there's some people that pursue a medical career, and there's some people that don't. My partner, again, likes the the biology of things of us, and I'm mortified by it, right? So, what made you want to uh pursue a career in medicine?

SPEAKER_00: 5:27

I'm the youngest of six. I come from a family of engineers uh on the on the boys side. Bunch of slackers in your family, and uh nurses on the other and stuff, and so again, being the youngest of six, my middle name is oops, and uh so I wasn't quite sure which path I was gonna go on. But of all things, I was gonna be a brewmaster. Oh, really? Oh wow, my undergrad was uh in microbial biochemistry, and I was gonna work at the what used to be the distillery uh on uh Woodmill Road. That's now an office interiors location. That used to be a brewery, and it was just a fascinating thing of saying I'm gonna be a brewmaster. As I got towards my fourth year in the undergrad, I had a kind of a light that went off and said, I think I'm gonna go into medicine. And when I went to medical school, uh fell in love with emergency medicine, but then I switched gears, orthopedics in second year, urology and third year.

SPEAKER_02: 6:19

Wow.

SPEAKER_00: 6:20

Uh it was my focus. But in my final year of school, and you had to choose what you were gonna do postgraduation, the happiest people that I saw were people that were in emergency medicine. And it's thanks to paramedics at the old VG Emerge. When I was walking through in my first year, and over my years, um, it was paramedics that welcomed me into a family, and that had a big impact on me. And so emergency medicine is what I chose. And I still am learning from my paramedic peers uh since uh 1994.

SPEAKER_03: 6:50

Wow.

SPEAKER_00: 6:50

That's why we call it a practice. We never get it right. That's why docs always use the word practice. So it scares scares patients when you say practice. You wouldn't mean you're still practicing.

SPEAKER_04: 6:58

So the answer is beer. The answer is beer. Beer to medicine. Uh listen, uh I'm I I think they're one and the same. I think uh beer makes Guinness's uh Guinness's uh slogan for a long time is it's good for you. Beer, it's good. Guinness is good for you.

SPEAKER_00: 7:11

It's also a source of a lot of patience that we see in the emergency department.

SPEAKER_04: 7:14

So it's yeah, probably that too. Yeah, that's fair. Yeah, you know what that you know what Homer Simpson is? What's that? There's new studies that conflict that. No, no, no, no. The wise words of Homer Simpson. Alcohol, the cause of and solution to all life's problems. So yes. Um, but yeah, no, uh the we actually we had a quick little chat about this uh being on the o and over in the UK, about how the the pubs are attached to hospitals over there.

SPEAKER_00: 7:42

I don't know how they pull that off, but uh remember when I was uh a student in early residency, people will be doing electives overseas and they'd be doing the rotations in hospital and then in between rounds heading to the in-hospital pub. And I always thought that was really interesting that they had that type of thing, but also you could smoke a pipe in said pub, and I guess that only in the UK could you have something like that, pull it off the ground. But nevertheless, um there's no such uh similar kinds of things within the Canadian healthcare system.

SPEAKER_04: 8:10

No, too bad. That's too bad. I don't know. I I think I think the Nova Scotia is is due for like we have school house and things like that and everything for like you know, themed church brewing. So it's like, where's like the the the medical themed brewery? Oh my goodness. That like we can do like uh like uh blood donor Irish red or something like that.

SPEAKER_00: 8:35

I just think it's the color of the beer.

SPEAKER_04: 8:37

Triple bypass IPA.

SPEAKER_01: 8:39

Bypass IPA, yeah. Nice. Yeah, there you go.

SPEAKER_00: 8:42

It's but the colors too. You could it'd be maybe not the most appetizing uh beverage that's out there, but you can match the color of the beer to the bottle he flew with that uh there you go.

SPEAKER_02: 8:52

Yeah. He's gonna ruin beer for us here. Shoot.

SPEAKER_00: 8:55

We'll switch to martinis. There you go. Nice and clear.

SPEAKER_02: 8:58

So so I guess today you you are the director for EHS Emergency Healthcare Services, is that correct?

SPEAKER_00: 9:04

I'm part of a team. So think of it this way: anything to do with uh health or clinical care, when someone contacts 911, I get to have a hand in it. So whether it's the back of an ambulance, uh back of uh an airplane or a helicopter or uh our teams that are out there, anything to do with health when you call 911. Um I have the good fortune of working with teams that help uh help provide care.

SPEAKER_02: 9:29

Right on. And and do you find just high level, do you think the last few years have been challenging in certain ways or immensely do you feel the last few years have been I mean, I'm not gonna go back to COVID, but just within the last few years of after COVID, kind of getting getting back to a normalcy.

SPEAKER_00: 9:44

I think I'll be honest, every year that I've had uh with the system, I think has been better than the previous year.

SPEAKER_01: 9:49

Yeah.

SPEAKER_00: 9:49

Okay. I've I've been incredibly proud. I'm excited about what happens when you call 911 in Nova Scotia. The the at the end of the day, your care begins when you call 911. And I think that's important for Nova Scotians to understand. And that's the exciting part is that 30 years ago when EHS started, if you call it for 911, it always meant an ambulance transport to eMERGE. And if you call um 911 now, transport is ancillary, it's not mandatory. We can figure out things, do something different, but it doesn't necessarily mean uh uh transport to the emerge. So we're doing more and more of that this year than we did last year. And last year we're gonna be able to do that. It's everything.

SPEAKER_02: 10:32

Yeah?

SPEAKER_00: 10:32

Yeah, so it's not just the uh the IH is the integrated health programs, um, but that's just one piece, one of the tools. A lot of times that people call 911 is the worst day of their life and that type of thing. And we're able to kind of just ask more questions. And then sometimes that call then is answered by one of our nursing colleagues in the comp center, and we don't even dispatch an ambulance. And we plug them into a different pathway, or we do dispatch somebody, but as the ambulance is going there, they're speaking to one of the docs or the paramedics or both uh as the ambulance is responding. So, I mean, how it's just cool. It's so cool that that's now happening.

SPEAKER_02: 11:10

So technology's majorly helped thus far in kind of making those connections happen as well.

SPEAKER_00: 11:15

Yeah, technology, everyone's got a smartphone, so now we're using video. Uh, it's called text to video. So some of the patients we're having contact with, we're on the phone with them, and we say, you know what, you're describing things really well. We're gonna send you a text message right from the comm center. They click on it, don't have to download anything, and then we've got a video connection. And so they're like a Spielberg on scene, and they're kind of controlling the camera and showing their uh the cut and saying, Do I need to go to the hospital to manage this cut or this rash or whatever it turns out to be? But we've been doing that for almost two years.

SPEAKER_04: 11:47

And do you feel like that is gonna be like continuing to do that work is going to be the biggest thing in terms of like because I mean obviously the burning question is is ambulance wait times, right? Do you feel like that's gonna cut that down? Yeah, yeah. Yeah, I I think just have you seen that over the last couple of years since you started doing this?

SPEAKER_00: 12:04

I think uh absolutely. I think when the more important measure isn't is you don't measure success by how quick it did an ambulance get to someone. You measure how quickly someone got care.

SPEAKER_04: 12:15

Yeah.

SPEAKER_00: 12:15

So I think that's the change that we're looking at now. So we always ask people to say, okay, don't measure the response, but whether or not you saw an ambulance driving down the street or arriving on scene. Think about what was the interaction between the the caller, the family member, the next of kin, whoever's on the phone speaking with someone who's actually listening. And so your timed nurse is faster, your time to uh a physician assessment is faster. It's just different in how we're doing it.

SPEAKER_04: 12:43

Right. No, that makes sense. Yeah, I it's not differ really that different than how we have to revamp and how we think of healthcare in general at this point, like whether using pharmacists for things or using nurse practitioners and things like that, right? Right. Some of the recent changes that we've seen in the last two years.

SPEAKER_00: 12:58

Absolutely. And every bit of the province is slightly different. So some of the tricks are okay, you know what? Uh for you, you live in a rural part of the province and you don't may not have much access to resources. And so you have to think outside the box and pivot and say, okay, maybe we're gonna do some structured follow-up with your local pharmacist. Um, but again, the key thing is just that during that worst moment of someone's life when they've called 911, that you're able to just have more of a conversation, unpack things, and even sometimes it's like that's okay to wait, or you should go into the emergency department, but it's gonna have to be by an ambulance. Maybe uh you're good to go on your own, you're clear to go on your own, and tell you what, we're gonna be on overwatch from your home to hospital. And not to sound paternalistic, but just you know, send a text message and you get there and make sure you're I've safe. But if there's any problems from this point forwards, know that there's a someone in clinical overwatch watching to see if anything unfolds. So again, I think that's what people want. Um the provinces just they want some answers, they want to know if they're gonna be okay. And if they have a plan, it's like, oh, that plan's perfect, you're gonna get to care faster and in a safer way if you begin moving now, as opposed to say waiting for an ambulance, because even if you ride by ambulance, it doesn't always mean that you're fast tracked through the merge faster. It's quite often we'll actually just drop you off at the front door and you go into the waiting room.

SPEAKER_04: 14:20

I think that's a common like misunderstanding that people seem to think that if they go in by ambulance, they're gonna get seen first.

SPEAKER_00: 14:28

Yeah, it's it all depends on severity.

SPEAKER_02: 14:30

And so I don't people still think that you think?

SPEAKER_04: 14:32

Um pretty sure because I've yeah, I think I I think so. Yeah, I I've heard people say, like, well, I'll just go home and call an ambulance. And I heard it like someone at triage say, like, that that that we still triage you.

SPEAKER_02: 14:43

Wow. Yeah, that's terrible.

SPEAKER_00: 14:45

I mean, good.

SPEAKER_02: 14:46

Yeah.

SPEAKER_00: 14:47

But it's good though. So that's how the system's integrated. So that we as a system work with our health partners to make sure everyone's getting the right care at the right time for the right reason in the right place. Lots of rights there. Yeah type of thing. But it's one that uh it does work well. So just people should rest assured that if they're if they're sick, so EHS health or we're gonna get some care to you.

SPEAKER_02: 15:07

Going back a little bit, like what is IHF to someone that doesn't really understand it?

SPEAKER_00: 15:11

I I think the the word that we'd be using is IHP. Sorry, IHP. Yeah. Yeah. So you got me stuck in the IHF part. Um sounded like something like Mission Impossible movie and that type of that. The villain's IHF.

SPEAKER_02: 15:24

Oh, I I mean, anyone's listened to this show before as I struggle with acronyms to a fault. So no one will be surprised you uh coming back to listen.

SPEAKER_00: 15:31

He's he's gonna Andrew, he's gonna be calling you something else. It's all right, maybe No, so the I is integrated and the H is health. And then it's a program for integrated health programs, or and that's where it's a uh a cluster of people, a group of people, medics, nurses, and docs doing things differently. But also it's the IHP medic, integrated health paramedic. And that's uh like Rob Groom that I personally interviewed, was one of our first uh kind of IHPs, and they're woven through different areas there's uh these paramedic Jedi that are uh either in the calm center or they're in um non-transport capable ambulances called single response units. Oh, cool. But these paramedic Jedi's that are out there are are doing things a little bit differently. And I think uh whether it's an integrated health program or it's integrated health paramedic, that's the the that's the secret sauce, I think, going forward. So we're gonna be doing things differently.

SPEAKER_02: 16:30

Was that practice brought in from like other parts of the world or was that can't come in from here? Like did do was that innovative here?

SPEAKER_00: 16:36

It innovated here, but also learned from other places. And so it's a bit of a blended model. Um our very first integrated health paramedic would have been a paramedic that was in like the communication center, um, dedicated for providing clinical decision support. There's always been paramedics in the communication center, but one focused entirely on clinical help, and that began a long time ago. And then the next integrated health paramedic that came out was a paramedic who responded to long-term care facilities, and they kind of brought the emergency department to long-term care facilities to keep seniors uh safe at home, suturing, providing antibiotics, those types of things. So those were innovations kind of born in Nova Scotia that other provinces, other countries are saying, like, wow, that's really cool. We should be doing that here. And then we started learning from other places about that mobile integrated health paramedic. So these people that uh would be out as single providers, kind of roving, and there's a few places within North America and and elsewhere that's doing that. I'm always hopeful we can get EMS motorcycles and that type of stuff. But again, I people listening to say, oh geez, you said EMS motorcycles.

SPEAKER_02: 17:51

Why EMS motorcycle? I'm curious.

SPEAKER_00: 17:53

I come from a motorsport family, so I married into motorsports. I've been extremely lucky. My wife got her motorcycle license well before me. I know it's a conflict of interest being an eRGE physician, but being a motorcycle uh fan, but I can't help it. Yeah, we don't have motorcycles yet for our paramedic Jedi, but uh maybe someday.

SPEAKER_04: 18:09

That would be kind of badass. You just have like all your medical devices on like saddlebags. To put the star on the top of his helmet. I think like Inspector Gadget. You've been to the UK. Yeah.

SPEAKER_02: 18:22

Yeah.

SPEAKER_04: 18:23

So I I think I I think you know what? Listen. So if anyone's listening, you know, give it some investment here. Premier Houston, like let's let's get some investment in some motorcycle.

SPEAKER_00: 18:33

No, I've been that we've been incredibly lucky that all forms of government have been incredibly supportive of us moving the needle forwards. And I have to thank someone who isn't with us anymore, but Ron Stewart. Ron Stewart was the uh you're on my page.

SPEAKER_03: 18:45

You're reading it right off the page, you're beating me to my own notes. So Ron is still here.

SPEAKER_00: 18:49

He is the he is the S in EHS. Um Ed Kane is the E in EHS. These are the the kind of forefathers that that uh kind of created EHS. And so um we've been really fortunate. That's reason why when you ask about, you know, how are we now post-COVID? We're in a really good place. I think it's really exciting. I think there's lots of people.

SPEAKER_02: 19:11

I don't feel like that's the public perception. In fairness, if I talk to five people in a day, they'd like, oh man, I was in the ER for six hours because I when I broke my arm, and they'd be, you know. You'll be in the ER for longer than six hours if you just broke your arm. Yeah, yeah. Yeah.

SPEAKER_00: 19:23

But the uh you share with the vignette. I was on uh I was on one of the docs in the box, a doc in the comm center. And I was working there on Sunday, and there was a a patient that called in from Ron, Nova Scotia for her um her her mother. Yeah, and it was a 911 call. And it was for um it was for the person having some pain in their their mouth, some dental pain, and they were terrified. And they so they called 911. We do what's called secondary triage where we'll call patients back and stuff, and we spoke with this daughter and her mom and put it on a speakerphone, and we then unpack things and simply had a conversation about okay, what's going on, here's what we can do, and use that good sound video to kind of look and have an examination of kind of the tooth that was bothering her. And usually what happens when people call 911, they would say, Don't eat or drink anything until the paramedics get there. And we're like, okay, the paramedics we can get them there, but let's try these things and come up with a plan. 15 minutes we were on the phone call with this patient. And by the end of it, they were both happy, they were pleased, they had a plan. We de-escalated a whole bunch of things, and we came up with a safe care plan kind of going forwards. And it was all done in uh we weren't changing their wishes of of uh calling 911 and expecting to go to hospital. They were calling 911 saying, I need some help. Right, and I can't explain what's going on. And the daughter says, How long have we been doing this? And it's like, we've been doing this for four years. It was our four-year birthday of having like a doc in the calm center. And it's like, why haven't we heard about it? And it's like, well, it's it's one where we don't want people, you know, calling 911 when it's not an emergency. We still want people to pay attention to their instincts. But for me, that was that's a success. And I think I wish you could just bottle it up and then show that uh comfort that's provided to people in their homes when uh what began is the worst day, which prompted them to call 911, uh, ending in something which is really positive. And I'm really lucky every time I'm in the comm center, I have it's a story like that, story after story after story.

SPEAKER_03: 21:29

Amazing.

SPEAKER_04: 21:30

Yeah, it just goes to show you that like people are gonna go with their their feelings and kind of how they feel at the time or whether they're listening to good information or not, or whatever, right? Like I said, you know, if you're gonna go to the emergency, you're gonna sit there and wait for longer than six hours. But that being said, you probably should. I mean, you know, if you I I played football and I've had many broken things, and I've sat in the emergency for a decent amount of time, eight, ten hours sometimes, uh, for broken things. But it that's not an emergency. I need to be at the hospital because I need to get x-rays and I need to get cast. I can't go to my family doctor for that. But I'm also not having a heart attack and I'm not or I'm like whatever, right?

SPEAKER_00: 22:09

Like But the I it's a my it's a great point. I think everyone defines their own emergency and stuff like that. And I think yeah it's what we're there for. If people are in uh in uh a pain crisis, they're in a uh crisis, and so we never want to talk people out of paying attention to their instincts.

SPEAKER_03: 22:28

Yeah.

SPEAKER_00: 22:28

And it's that's one of the common things which you'd always tell people when I was in the emergency department as an eREG doc was we're gonna send you home and here's the instructions. Um, and pay attention to your instincts. If you can't explain what's going on, then that's what we're here for. And it may be frustrating, maybe long waits, and it may be doing something different and that stuff. But I'm really proud of both our eMERGE colleagues and the EHS system saying we can do things, we can maybe do things differently. And I think that's where we're in the change right now.

SPEAKER_02: 22:56

Cool. And I mean, how about Lake Avenues like 811? Are you finding those are being well utilized today?

SPEAKER_00: 23:01

It I absolutely and I think that's that connection of how do things flow from an 811 system into a 911 system, 911 into 811 back and forth, it's really just predicated on communication and using the right words and being there in the moment when someone's talking, letting them talk and and noticing the the signal that's uh in that what maybe noise to you or conversations as to what's going on, and then making connections and stuff. But I think it's not just between 811 and 911. We make referrals to 211 a lot.

SPEAKER_03: 23:40

211. What's 211? I don't even know. Well, this is uh this is a hidden gem. I the um there's three one one, there's two one one, one of those too many of them.

SPEAKER_00: 23:50

You call 511 for the weather.

SPEAKER_03: 23:51

Yeah, and then I didn't know that was a thing.

SPEAKER_00: 23:53

But this is uh for me, um when I was in the emergence department, I used to have a social worker who would be there to help with uh things on discharge from the eMERGE. As a comm center physician, two one one was our proxy for it. So you we may have medics that are seeing someone saying, I'm I'm I'm seeing a senior. It's the fifth time we've seen the senior this month for uh falls and uh stuff. But she's never wants to go to hospital. She has capacity, recover safe plans. In some areas of the province, we make a referral to a falls clinic right from the paramedics assessment. But part of the discharging plan we do with the medics is saying, Well, have her contact 211 because she needs to get some supports for some aids, some ambulation aids. Um if there's people that we see that have um needs for food or needs for navigating uh some systems, I don't know how to take steps towards getting power of attorney on my uh father who is showing some signs of uh uh Alzheimer's or has been diagnosed with Alzheimer's. I don't know how to navigate that. A number of these things, this is where that uh resource, like two in one, is really helpful.

SPEAKER_02: 25:03

So I think as patients call the system, we have all these agencies that can work together differently and collaboratively, all focused on the So you would call 811 and say, okay, my you know my father's showing kind of scary right now, he doesn't know where he is, you know, this type of scenario, and you'd call 811 and they might end up pulling into 211 depending on how they survey you. Is that how it would work?

SPEAKER_00: 25:26

I don't know from the 811 side specifically in terms of protocols, but the illustration, I wouldn't be surprised if someone called in and said, you know, my my family member's acting differently. That's appropriate for the kind of 911 side. Uh saying, okay, was it a Q change or not? So I wouldn't be surprised to come over. But that doesn't mean an emergency department visit. It means, okay, maybe what we're gonna do is we're gonna have one of our team reach out. And it could very well be the nurse in our comm center reaches out and says, tell me more. We have no, we have all the time in the roll, but let's unpack this and stuff. They get information and they may make the decision saying, you know what? I think this is a patient's gonna benefit from having a set of eyes on them. Maybe just make sure his sugars aren't low, make sure his vitals are okay. So we're gonna send out one of our paramedic Jedi, the single response units, head out to it and stuff. And now they're eyes on scene. And now they're actually evaluating the patient, and they then call back and speak with the doc in the calm center. And they say, okay, what are we gonna do? And then this is where the the team, the medics on scene, the nurse, the doc and the calm center, take this and say, All right, here's gonna be the plan. We're gonna um give the following information to the the the caller who started everything, saying, All right, here's the plan. We're gonna maybe have you contact 211 for kind of next steps with things. We're gonna get you to look at the EHS special patient program so we can get your father enrolled into it, so we can have a a case-specific tailored plan for your dad in the event of a 911 call, kind of focused on keeping him at home or keeping him managed.

SPEAKER_02: 26:56

That's brilliant.

SPEAKER_00: 26:57

But this is it's it's simple. It's just people talking without uh uh rushing through things or having a G-jerk response.

SPEAKER_02: 27:04

Communicating with each other on a on a and listening deeply to kind of get to the core of what our problem is.

SPEAKER_00: 27:10

The colleague of mine, Jeff Fraser, gave me his beautiful quote 20 years ago and he said, you know, Andrew, the 911 system of old used to be that there was uh we were looking through the peephole of a door, a keyhole of a door. It was short, it was constrained, it was limited, it was a 90 minute, 90 second or two-minute health assessment, but all you could see was what you could see through the uh um that little keyhole. Where we're at now today with the teams in place and all of it is we've opened the door. You're seeing an entire 360, you're seeing we've opened the door, and whether the patient's coming to us or we're going to the patient, the door's open and it's all built on communicating.

SPEAKER_02: 28:30

Wow. Pretty cool. It's awesome. Now that I understand like the mechanisms to work behind in the background.

SPEAKER_00: 28:36

Next step will just make a 9-1. It'd be faster to dial, just 9-1.

SPEAKER_04: 28:39

Please, please. Uh just out. I don't know. You know, uh you might have more uh more pocket missed dials. Yeah, more missed dials.

SPEAKER_00: 28:48

Yeah, I've been guilty of those.

SPEAKER_04: 28:49

Yeah, yeah, exactly.

SPEAKER_00: 28:50

So dear Trevor's just calling again.

SPEAKER_04: 28:54

So okay, so um I know there was a question you had there in the that you wanted to kind of ask about. Um you had a good one here where it says like uh you have a lens of emergency and pre-hospital care. So if you want to ask that. Oh, go ahead, ask that. Uh so how has the lens informed like uh informed what you think the system's strengths and liabilities are? So like I guess kind of give us an idea of like, you know, this is what it's really kind of made the improvements on, and this is what we kind of need to really work on because you know, this is where there may be some gaps.

SPEAKER_00: 29:28

I think the improvements is that we have empowered paramedics to practice to way beyond anything in many ways uh compared to other places. We've in Nova Scotia have faith in paramedics, that's why they're self-regulating.

unknown: 29:44

Yeah.

SPEAKER_00: 29:44

Whether it's the implementation of a college, I think they, as clinicians, are uh fantastic. And I'm honored to work with them. I think that is one of the successes. And everything we do in EHS is thanks to the paramedic professionals that are out there. I think the the liability, the risk part is sometimes we're victims of our own success. And we have to we can help things, but then we we have to be cautious on everyone then relying on the 911 system, on the each system to fill in the gaps.

SPEAKER_04: 30:16

Yeah, like not having a family doctor. Right.

SPEAKER_00: 30:19

And it's the the idea is saying, okay, uh we always be cautious on saying, oh, I'm gonna call 911 because I need a prescription refill for my blood pressure medication. Now it may be that they're terrified and really worried about it. It's like, okay, so maybe we're gonna do we're gonna take that 911 call and we're gonna plug you into the virtual care options that the health authority is. Or the it's called VUNS, which is a virtual urgent nursing, uh virtual urgent care novoscope. But these are the illustrations of kind of just asking more questions and having a rational conversation and plugging that in to a different pathway, even with that live. Ability of saying, okay, I don't know what else to do. I'm I'm lost. So I'm ending up calling 911. I just think it's uh that's where the area of risk are where they uh maybe filling in some gaps, which are not in the original kind of uh uh when the premise of that really wasn't a 9-1-1 call to begin with.

SPEAKER_05: 31:13

Right.

SPEAKER_00: 31:13

Again, we'd always tell anyoscotians rely on your instincts, you know your body and that stuff. So um we're never gonna talk to people a 9-1-1 call. We just want to provide different pathways.

SPEAKER_02: 31:21

I got a not so intelligible question, maybe. Are you charged if you call 9-1-1 you shouldn't have? Like, don't you get a charge? No, so the I thought that for some reason in my head. I thought if you like called it for like whatever in a week, is it by the police? No, no, but if you called it and didn't, like, you know, it wasn't for a good enough reason at the end of the chair. I don't know why, believe me. If you were prank calling them, maybe yes.

SPEAKER_00: 31:44

No, so that uh it's a great question. Yeah. So the there's only an ambulance fee if you're transported to hospital.

SPEAKER_03: 31:52

Okay.

SPEAKER_00: 31:53

And so the and the reason for that is multifactorial. It's one of the big things at a federal level, is that the Canada Health Act doesn't consider an ambulance transport a medical intervention. It doesn't make any sense. Wow. So so every province has ambulance fees tied into it. So it's federally though that needs to change at the Canada Health Act.

SPEAKER_02: 32:11

So 250 a trip, is it for a little bit?

SPEAKER_00: 32:15

750 a trip? No, it's a hundred uh and forty-ish dollars for an ambulance transport.

SPEAKER_04: 32:21

But from I'm pretty sure wasn't it like an event of a car accident? It's like 700 bucks or something.

SPEAKER_00: 32:26

Yep. And for a car accidents, I'd refer your listeners to the website because I want to make sure I'm not getting the numbers correct. But yes, uh, there when there's third-party billings like an insurance company, um, then there's a higher related cost. But relatively speaking, it's not like someplace in Canada where they charge both an upfront cost and a per kilometer cost. It's very expensive.

SPEAKER_04: 32:45

It's like Uber. The US cost. No, oh, I bet I I learned about that one day. This is where I'm gonna insert a quick little plug about buying travel insurance. Yeah. There you go.

SPEAKER_00: 32:57

But the the important part though is if you're not transported, there's no cost. And so one of the questions was how often does a non-transport happen? So of all 911 calls, um at least a third, more than 33% of calls we don't transport.

SPEAKER_05: 33:16

Wow.

SPEAKER_00: 33:16

We treat and release, we follow up on these patients, we're doing things safely, we're applying different pathways. So one in three ambulance calls we don't transport. And that's the regular paramedic teams. The paramedic single response units, when we send them out, they have a a 60 to 95% non-transport rate.

SPEAKER_02: 33:35

60 to 95? Correct. But that's only five percent then, as low as wow.

SPEAKER_00: 33:39

So it means that most cases they're not transporting, meaning there's no cost borne by the person. Yet they're getting treatment at home, a palliative care patient, so on and so forth. And so um it's one um it it surprises everyone when we tell them those numbers. We thought every call went to the emergency department. It's like, no, actually, yeah, only the again, 33%. And it's been like that for a very long time. And the idea is we want to we wanna make those numbers even more efficient, uh, so that we can still do more treat and release, more treat and refer, I should say.

SPEAKER_04: 34:12

It's in it it's it's interesting because I mean, like because EHS is a private company.

SPEAKER_00: 34:17

No, no, so the uh the that's a a common misconception.

SPEAKER_04: 34:20

Okay, I thought it was, yeah.

SPEAKER_00: 34:21

No, so EHS is a public utility model, and we're one of the only public utility models in North America, which means Nova Scotians own it. Oh, okay. So EHS is a section of government, it's the that's the regulator. Yeah, and that's where I'm in point. I'm uh have a contract with uh Minister of Health or with uh within DHW. And EHS is that arm of government that oversees the clinical care protocols, the assets, the uh device, all those equipment and stuff which are out there. And in a high performance contract, our co-lead is EMC. And EMC is the the the company that you're referring to, which is part of Medivh. And so there's the best way of thinking about it is that EHS is the what, and that's government, and then EMC is the how.

SPEAKER_04: 35:10

So it I guess for anyone to understand it, it's almost like kind of like Halifax water.

SPEAKER_00: 35:15

It's the many way to describe it. That's why we use the term public utility model. And for us, as a public utility model, we've got a responsibility for um healthcare.

SPEAKER_03: 35:24

Right.

SPEAKER_00: 35:25

But that's only one part of it, and that's the like what happens during the 911 call. We have a responsibility though for public safety. That's the next 911 call. And we also have responsibility for public health and community health, and that's the all the previous 911 calls that we can then use to inform things and work with our partners differently so we can keep communities healthy and safe. So those three things as a public utility model healthcare, public safety, and uh public health are the main drivers. But EHS, yeah, is uh he has a wing of government. And that's where my uh my office is located. I'm in the good fortune of working in the Department of Health here downtown in Halifax.

SPEAKER_02: 36:04

Wait, pretty cool. I'm learning tons of stuff, by the way. So thank you so much for being awesome. This is very informative. Yeah. I have another thing here. So uh that friend of mine, Rob, when I you know texted him early this morning and said, Hey man, what should I ask this guy? You know? He gave me a couple suggestions. And this one I thought was quite interesting because I didn't know anything about it. Um, but I guess the goal here, help me understand the quintuple aim in Nova Scotia. First off, what is the Quintuple? How could that be described? I'm gonna murder Rob.

SPEAKER_04: 36:42

Rob, you were gonna have to call 911.

SPEAKER_00: 36:45

If you can ask Rob what the square root of 72 is, there's gonna be a big long pause.

SPEAKER_04: 36:51

We can shorten this up, don't worry about that.

SPEAKER_02: 36:53

No, no, I I'm I'm I'm I'm thinking um with regards to precisely for what the quintuple aim is and for those that are uh I guess first a high level for for you know a lot of us are like me, we we might not even I I didn't know 211 existed in this in this in this episode. I mean, what does that even mean, the quintuple?

SPEAKER_04: 37:11

Well you have graphs and charts.

SPEAKER_00: 37:14

Well, no, it just means it kind of depends in terms of which group you're talking about, the quintuple aim.

SPEAKER_03: 37:19

Yep.

SPEAKER_00: 37:20

There used to be that there was uh frameworks around um if you're providing healthcare, you could have it fast and good and cheap.

SPEAKER_04: 37:31

Oh, this thing. Okay.

SPEAKER_00: 37:33

And then you have to choose two of those three things. You could have a fast, good, it wouldn't be cheap. And then it kind of migrated, and people started using this quintuple aim of saying, all right, there's a few things there with regards to there's a patient experience, uh population health, provider experience, equity, and the associated cost around things. I think whatever definition we're using for it, that has to be in the DNA of the EHS system. We need to be everything we're doing needs to go back and kind of be uh tested against it.

SPEAKER_02: 38:01

How it kind of measures against those five pillars. Right. Right? Yeah, yeah.

SPEAKER_00: 38:04

But there's one thing if I can, just um there's one uh I'm a geek. You said at the beginning, like say Andrew, you did a master's in epidemiology and stuff. What does that mean? There's for me the quintuple things that we can do to improve lives in Nova Scotians is there's five things we can do in healthcare. Everything that we do uh uh routinely is what we call secondary health prevention. What that means is people are already sick and we're preventing the disease from getting worse. They have a heart attack, we open up the blockage. They have a knife sticking in their chest, we take the knife out and fix things up. But they have the disease and we're preventing it from getting worse by giving them life-saving therapies. That's the mainstay of what secondary health prevention is. But then there's these four of the things we could be doing as an EHS system. Oh no, this is really boring, but it's one of those things. But the first thing is primordial health prevention, reducing the presence of risk factors.

SPEAKER_01: 38:59

Okay.

SPEAKER_00: 38:59

Yeah. Primary health prevention, reducing people's access to those risk factors.

SPEAKER_02: 39:04

Good example. I left a rake standing up one time in the garage, and then Andrea walked into it and gave a really big egg on her forehead right before she had to get her picture taken for something. That's right. What I could have done is not have that rake there, right? You know. Preventively.

SPEAKER_00: 39:19

The primordial prevention would have been put that rake away. Yeah. The primary health prevention would have been, hey, uh, Mike, watch out for that rake. The tertiary health prevention is getting people back to baseline.

SPEAKER_02: 39:30

Right.

SPEAKER_00: 39:30

Quaternary health prevention is spread in medical air. So the one of the questions is saying, all right, as an EHS system, we've got the quintuple aim that we can look at and make sure we're doing things. But in my world, the clinical world, are we doing everything we can for the communities that are out there? How we can use our data and that type of stuff to make communities safer.

SPEAKER_02: 39:48

How would you implement like a guy like me that leaves a rake? Well, that's a silly example, I know, but like how would you implement something?

SPEAKER_00: 39:56

Well, we we pre-filled the Darwin Awards uh form put that in place for the self-inflicted rake injury.

SPEAKER_04: 40:02

I always took a drink there.

SPEAKER_00: 40:06

But I'll give you an illustration about trauma. So one of the illustrations is that data from EHS helped inform legislation about ATV usage.

SPEAKER_03: 40:14

Right.

SPEAKER_00: 40:15

It helped then actually uh put legislation in delimiting the use of ATVs by minors. Uh primordial prevention was teaching youth on making sure or putting mandates in saying you have to wear a helmet if you're operating ATV.

SPEAKER_02: 40:28

You're seeing all these kids or whatever coming in the ER, and you're just like, my gosh, this could be preventing with just some pretty simple measures.

SPEAKER_04: 40:34

You know, I'm gonna I'm gonna go I'm gonna go there. Get your damn kids vaccinated. How about that one? Whoa, whoa, cool off there. No, it's because like I saw a report recently that it was like 25% of all the Scotians don't vaccinate their kids for measles. 25%? Ew. I didn't know that. I was like, yeah.

SPEAKER_02: 40:54

That's that's a scary thing.

SPEAKER_04: 40:56

Yeah, you're right, I agree.

SPEAKER_00: 40:56

Your templar artery is throbbing there. I can see that pulsating.

SPEAKER_04: 41:00

Oh yeah. Like parents who don't get their kids vaccinated, it's just like they're like, oh, but like before they can edit up. The day before kids died at the age of two. I don't disagree, but we're gonna move on.

SPEAKER_00: 41:12

Uh so just we're the guys that couldn't temple, I'm a fan of it, but I'm a bigger fan for the five things we can do to every single community to make things safer for us.

SPEAKER_02: 41:22

So one is kind of look and see what's happening. What are the biggest problems in the community? Is that bringing the most people to the ER or causing the most deaths or injuries?

SPEAKER_00: 41:28

Or well, let me give you one other quick example opioid use disorder.

SPEAKER_03: 41:32

Yeah.

SPEAKER_00: 41:32

So that's uh rampant right across Canada. What has EHS done been doing to try to help out to minimize the risk of opioid bad outcomes? Primordial prevention. We use a program within our system here to identify when synthetic opioids first arrived within Nova Scotia. And we use that's called first watch. But data in the communication center that could help inform where some of these uh hot spots were. Primordial health prevention. Anytime a paramedic is in the back of the end of the year.

SPEAKER_02: 41:58

You're basically saying, sorry, like so people come in the air, you're getting the postcode or whatever, and now you're seeing geographically all these folks that are overdosing. Nope, nope upstream. Sorry.

SPEAKER_00: 42:07

During the 911 call, there we have uh programs that sit in that pay attention to certain words that can be found. It's like Shazam on your phone. And it's called first watch. We use it for syndromic surveillance. But a simple idea of if we put some things in, we want to know when carfentanyl entered the Nova Scotia system. So we put in the term carfentinyl. Or during COVID, if there was ever any diseases that were happening where there was uh clusters of things during the 911 call, it would help identify these hot spots. That intel can then be used with our agencies to help identify hot spots, reducing the presence of risk factors uh in the community. But the primary health prevention is when a medic is with somebody and teaching them about an overdose, advocating for them, saying it's okay to go to the eMERGE or whatever. Secondary health prevention, yeah, these naloxone kits and how to manage opioid emergencies. Tertiary health prevention is helping that overdose rehabilitate back. Maybe they're not transferred the eMERGE, but giving them an alloxone kit again, plugging them back in, advocating for them. And quaternary health prevention, the last one, the fifth one, is the whole idea of looking at errors. A senior citizen who is misdosing her medications, taking too much of a narcotic, our medics are picking that up. And so being able to identify that, flag it with the pharmacist or flag it with the patient or the family member. So the illustration is we're measuring success of our e-age system by adding to all five of those domains of kind of health prevention, primordial through to quaternary. Now I know all the epidemiologists that are there are going like, rock on Travers, I'm so excited because you're talking about epidemiology, health prevention. But that's the uh epidemiology geek in me, more so than the quintopolame.

SPEAKER_02: 43:54

100%, yeah. And I mean and there must be health factors you see in in in in in your field as well, where you know preventative health measures, like just on a high level from what you're eating, what you're doing, you're are you exercising. I know these things sound contrived, but they probably make a tremendous difference.

SPEAKER_00: 44:08

It does. Uh they the the question which I use quite often in merge was what were you thinking?

SPEAKER_02: 44:14

Oh, gee guy.

SPEAKER_00: 44:15

That caused this thing, oh you're right. I shouldn't have walked into the rake as I was walking into the house in the middle of the night, having left the rake out there.

SPEAKER_04: 44:23

Yeah, no, get it. Yeah, 100%. So we have some questions on these pillars.

SPEAKER_02: 44:28

Well, yeah, I mean something we kind of really go through. I mean, you know, you're really touching a lot of this back kind of going back to this Quinn Temple aim thing. So some of the uh pillars that they talked about were things such as patient experience, where we which we really touched on a lot already today, I think, especially the fact of how you're relating it through different uh different parts of the healthcare system and stuff. I think that's great, right?

SPEAKER_00: 44:51

I hope the patient experience is positive.

SPEAKER_02: 44:53

Yeah.

SPEAKER_00: 44:53

And that the their their experience isn't defined by an ambulance rolling up, but their experience is being defined by what they uh what's happening after the conversation when there's colonymal one.

SPEAKER_02: 45:03

Okay, and then I guess the next one here, like one on population health. So we kind of just talked about that very briefly, with you know, being healthy uh obviously will have a tremendous impact on how many people go to the ER. Um however, you know, we also have an aging population in Nova Scotia. Um so that will eventually at some point probably put more of a strain on the industry. I mean, are there issues like that that kind of keep you up at night right now that you think, oh, gee, we have to be prepared for what's coming in terms of this or that?

SPEAKER_00: 45:31

Yeah, they the absolutely that that population is a very exciting one to work with. Keeping seniors um fit, keeping them at home is one of the whole mainstays that we've been doing with an illustration of uh a senior who has a fall, referring them into a falls clinic. Again, right from the scene by the paramedic without having to transport the hospital. Through to the other end of uh we used to have a we have programs which was adopt a senior, uh, where paramedics, the integrated health paramedics, would follow up in seniors um out uh in the community.

unknown: 46:05

Dr.

SPEAKER_00: 46:06

Judah Goldstein, who's a primary care paramedic PhD, who's uh one of our research leads in the province, his specialty is pre-hospital geriatrics. He is a world-leading paramedic researcher on how we can improve the lives of seniors in the province. So it's not gonna be a challenge. We welcome it. And this is gonna be very exciting for people to have generations of uh good health in Nova Scotia.

SPEAKER_02: 46:31

That's a great answer. Yeah, yeah. I mean, and I I guess another one I'm throwing these out pretty quick, and I do.

SPEAKER_00: 46:36

You're being kind of listening to have a sip of your beer, man.

SPEAKER_02: 46:39

Have a sip of your beer.

SPEAKER_00: 46:40

I feel bad you got the most beer here out of all of us, so we uh I'm just thankful that you're giving me the uh the resolution of the the five items of the quintuple aim. So I'm gonna track down right after this.

SPEAKER_02: 46:52

Well, only part of this.

SPEAKER_04: 47:00

Well, in particular, this next question I think is actually or next topic I should have. This next topic is really.

SPEAKER_02: 47:05

Yeah, so I mean, and and like again, uh uh one thing I know, I mean, again, I have a few close friends that are in the healthcare world, right? Uh burnout. COVID. Oh my dear God. Like, I mean, there was never a sadder time to see, you know, how much this the system was strained when people were being forced to work beyond 12 hours and beyond 24 hours, I think, in some crazy circumstances. It was insane. And as a result, I think we lost people. We lost people from that industry forever, right? And some people, you know, ended up having you know uh mental health uh uh crises and everything else you could think of, right? And that's really unfortunate. Um what do you what do you think is the way out on that? How do we get better in those areas for yeah, fix morale and burnout for for burnout morale in this in this industry that's so demanding?

SPEAKER_00: 47:57

I think the for me, first responders have the uh have this uh the solution. Um for transparency, um I was in New York uh during 9-11 on uh at ground zero for the first 16 hours.

unknown: 48:13

Yeah.

SPEAKER_00: 48:14

And uh one of the questions was, oh, you must have had some significant injury from it. No. And the reason being is that uh people that I was traveling with, one was a paramedic, a primary care paramedic, her name was Stephanie, and she was my research coordinator that I was working with when I was in New York City. And I learned from her this whole idea of diffusing, debriefing, and normalizing okay, that wasn't right. And doing that while things were really fresh kind of set things in motion for me. Again, that was 2001. Twenty-four years later, I'm still learning from uh our first responders. And there's a simple thing which when they talk about operational stress injury that can then over time lead to burnout and injury and that type of stuff, permanent injury, but normalizing that whole conversation and the whole program road to mental readiness is using some simple words uh like are you green? Uh you kind of normalize this language. And I remember there'd be times What does are you green mean? Like new? So green, no, green means that things are okay. You're having some, you're you're functioning normalizing.

SPEAKER_03: 49:16

Okay.

SPEAKER_00: 49:16

Then there's there's yellow, orange, and red. It's a way of kind of normalizing the conversation, saying, okay, we just had we're you the three of us are managing a case in the eMERGE or in the back of the ambulance or whatever. It's bad. And I'm asking you, say, Matt, are you okay? And you can come back and say, I'll get back to green. It's a way of kind of we're in an unspoken way saying, Okay, I'm a little yellow.

SPEAKER_04: 49:40

Right.

SPEAKER_00: 49:41

You're not having to unpack things, personal items are there, but it's in the lexicon, it's in the vernacular.

SPEAKER_02: 49:47

And I think that Yeah, you're just kind of checking the temperature of the room, I guess, or the person. Yeah, so is the culture remissive of that, you think, though, at this point? Like everyone's kind of doing that? Because sometimes it's like if you know someone asks, You're good, you're like, Yeah, I'm good, even if you're going through hell.

SPEAKER_00: 50:00

Personally, I think so. I think paramedics and other first responders, this is in their DNA of helping each other.

SPEAKER_03: 50:08

Cool.

SPEAKER_00: 50:08

Personally, I think it all falls apart when you get to hospital. That I think there's a lot of things that we can learn in hospital that we're not doing that could be learned from that theater, which is uh the out of hospital environment. So at the end of the day, uh uh defusing, debriefing, speaking about it, I think is healthier. And uh I'm really proud of my paramedic colleagues for showing me a way to keep me healthy. Again, being the youngest of six, uh, husband of one, a father of two, uh, in a way which I was able to protect my family. And my I I think the the next steps is still coming from um more lessons to be learned from our paramedic colleagues.

SPEAKER_04: 50:48

Yeah. So next is how do we afford it all? But I mean, like it's seriously, like uh, you know, we have obviously a finite amount of funds and and uh in the last couple of years we've seen uh uh at least provincially, we've seen a government that has invested heavily in the Well, none of us want to be paying more taxes right now.

SPEAKER_02: 51:08

I mean we're all stressed. I mean, we all see the financial pinch probably more than ever.

SPEAKER_04: 51:12

Yeah. But we've seen some major investments in in healthcare in the last two years. And uh I mean, how where where are you seeing that we could um see some efficiencies where we can change some things?

SPEAKER_00: 51:24

Great question. Uh EMS motorcycles. I'm kidding.

SPEAKER_04: 51:29

Best I can do is mopes.

SPEAKER_02: 51:31

That's right. EMS scooters. Yeah.

SPEAKER_00: 51:35

So I'll give you an illustration that it probably best drives this. Uh someone has a heart attack, they have a blockage in their artery. We can give a medication to them, which is really expensive. It's called tenectoplase or TNK. It's a clotbuster. And it used to be only given by uh academic cardiologists and academic centers, but not TNK. It was a previous version called TPA and streptokinase, but these clotbusters. It was time sensitive, time is muscle when someone has a heart attack. It then went from cardiologists to um uh emergency departments, but only academic emergency departments, not all emergency departments. And then went from all emergency departments to saying, well, how could we actually reduce the time to treatment? If time is muscle, uh, maybe that same medication could give them the back of the ambulance. And that's why I started doing research on down in Edmonton when I was doing an epidemiologist eMERGE, and what drew me to Nova Scotia was the notion is maybe we can give them the back of the ambulance. Now, when you give these clockbusters, it doesn't mean that they're then getting them again in the emergency department, but you're shifting that uh medication and the cost with it upstream to when there's that first medical contact, the back of the ambulance. And if you do that earlier, you save more lives, patients do better, there's cost savings with it.

SPEAKER_05: 52:46

Right.

SPEAKER_00: 52:47

So I think there's a number of things that we can do. Without putting new dollars in, it's just okay, now we need to start doing that same thing for other diseases. Pre-hospital antibiotics, recepsis. Oh, doesn't mean they can. 100%, but that's the beauty of the EHS EMC partnership, of EHS being a public utility model. It's one of the most efficient methods of EMS system design. And again, it goes thanks to Ron Stewart and Mike Murphy and Ed Cain, the kind of help create this. Because if you create healthcare in a high performance system like this, that introduces as one of the main pillars of it is economic efficiency. Uh that it's an efficient way of doing things because of the the improved mortality morbidity of patients. So, yeah, I don't think it means new dollars. It just means uh investing existing dollars into these new pathways. And a lot of it is shifting uh things. So in Nova Scotia, uh our formulary, our drug box has almost 50 medications in it. Five oh. Whereas most EMS agencies have maybe a dozen.

SPEAKER_04: 53:59

Wow.

SPEAKER_00: 54:00

So for me, and I think that's good. That's really good. Yeah. And then there's things there, but again, this doesn't mean cost duplication. It means we're just shifting some of those treatments to the back of uh uh the that first point of care that it isn't uh that you again, your care beginning when you arrive in the emergency department. The emergency department care begins kind of when you're calling 911.

SPEAKER_02: 54:20

Even the integration of stuff in drug stores, like now you can go there for strep throat and last time. Last time I had strep throat, I think last year I I called uh on my phone, showed my throat, and he gave me the medication, picked it up. Brilliant. I'm like, thank goodness I didn't have to see anybody for this, right? Because you know, I knew what it was, my partner knew what it was.

SPEAKER_00: 54:39

He had a man called, those things are terrible.

SPEAKER_02: 54:43

100%. Yeah, so I mean, thank you for surviving through that. I appreciate it. So that was the hard part's over. Um we had a fun kind of bonus prompt here. If you were asked to pick of a a pillar uh in Nova Scotia, um which is behind, or or if you didn't want to do that, or a pillar that you say, we're not even looking here, we should be looking there also. Either or what would you say, what would you pick? What would you say that is something that we should be doing better? Or we're not looking at. Well, however you want to answer that.

SPEAKER_00: 55:22

That's a fat great question. Uh a pillar for me is the the whole community health and population health of a community. I think that is the direction that EMS is heading towards. People think uh um EMS is the word that people use. I think it's less emergency, more medicine, and definitely services.

SPEAKER_01: 55:49

Okay.

SPEAKER_00: 55:49

So this whole idea is that uh we're we're not just taking care of a patient.

SPEAKER_02: 55:56

Sorry, yeah.

SPEAKER_00: 55:57

We're taking uh care of uh communities. And I think that is the the direction we're heading. Okay. I think that's where EMS, the challenge, is being given to us more broadly. But I think that is uh that ongoing new pillar that we're kind of creating. But we need the Nova Scotians' help to consider that. Yeah, it's one that uh again begins with people understanding if you call 911, it doesn't mean an ambulance transport to an emerge. It can be something different, and how we get there, we do that shoulder to shoulder with them.

SPEAKER_02: 56:29

You know, I mean you answered a lot of I mean, I'm looking through some of my other stuff here, and we actually, Matt went through a lot of this stuff, I mean, right up until about the 50-minute mark that I had here scheduled. So, I mean, and and plus I want to get into our fun, dumb questions, because that's the best part of this show is when we ask you questions that really don't mean anything.

SPEAKER_04: 56:47

And then just before we get into that, I think I did the tech stuff.

SPEAKER_02: 56:50

Yeah, sure. Let's let's yeah, I think we should cover up some of the tech. So the last bit, I mean, okay, well, there's there's there's two things. I have compliment a compliment in I'm gonna go way back up to that here. Uh a lot of stuff here on you, man, because I was nervous for this one. I didn't want to mess this up, you know. My buddy Rob and Andrea, I would have got in trouble if I didn't do a good job here at Uh.

SPEAKER_04: 57:09

On top of that, it's a topic that we, you know, as dummies don't know anything about.

SPEAKER_02: 57:13

It's something we don't know almost we knew embarrassing little about, so I kind of overprepared.

SPEAKER_00: 57:18

You guys have great insight into that.

SPEAKER_02: 57:20

So thank you. Yeah. Uh uh, but uh any of the nurses this is a compliment to you. Uh any of the nurses working in the IHP program have nothing but great things to say about him and truly love working with him. He is the best, and he's awesome. Direct quotes, lol. There you go.

SPEAKER_04: 57:36

I'm I'm less card tricks now.

SPEAKER_02: 57:40

And his characters are corny. Oh, I didn't read that one. I thought it was kind of rude. But uh, but yeah, so I guess the last bit that Matt and I we we were talking about this this morning, it's something that excites us because it's I know it's it's a theme of 2020 uh five. Unfortunately, what like it or not, AI is here. And and seeing how this is going to play into healthcare. I mean, obviously, I I think I don't know if you know this, but like just recently, ChatGTP took a step back and basically stopped diagnosing people because too many people were calling in with their ChatGTP diagnosis thinking that they had issues. Going in and seeing it, and it's like, I think there's you're going on about vaccines. I mean, there was um, you know, uh, if you look deeply enough into Chat GTP, there'd be things like, well, there's cyanide in the vaccines, but when you look at it, that type of cyanide might be different from the type of cyanide that you'd be extremely concerned about or a different chemical element. So anyway, so I uh it's obviously having its challenges now because it's you know uh well as it provides us a generous amount of good great information, there's a lot of misinterpreted information and misinformation. Like, how do you see this playing a role in the next few years to come? Are you looking at it closely?

SPEAKER_00: 58:52

Yeah, and it's already already here. So I'm I'm proud that the um that our system is incorporating AI into the communication center so that we're able to uh move patients more efficiently and recognizing patterns and that type of stuff. So as opposed to relying upon uh uh uh just a person kind of listening and saying, okay, we're gonna match this resource to that patient's need, having someone's AI tools in the background can make it a bit more efficient. There's other items there too where AI can be helpful right at the the coal face during the 911 call, where the person's answering questions, but there's something uh noise, a signal in the noise as the person's speaking that AI can be used saying, the person said they weren't short of breath, but we picked up on the person you're hearing it. You can hear it exactly. Right. And it's not to replace that human judgment, but just to kind of put alert on it. They said no to the key directed questions, these close-ended questions that the dispatcher or the call taker is using, but AI is being uh uh is kind of picking that up in the background and saying, okay, it's a a discordant finding, a bit of an alert that comes up. Right again, not to override the decision, but as an aid to it. And you guys and the cool thing too, just to show you where the technology is, the phones have a thing, the way they sample from top to bottom, it can pick up subtle variations in perceptible human eye. So the tool that I was talking about with Good Sam video, right? When we do that with patients, we can click a feature. When I'm talking to them, their heart rate appears next to their image. I'm not even touching them.

SPEAKER_03: 1:00:26

Well, wow.

SPEAKER_00: 1:00:27

Because it's recognizing the oscillations and the person's color.

SPEAKER_04: 1:00:30

When do we get robot doctors? Is that asked? Drones. Yeah, yeah, there you go. Yeah.

SPEAKER_00: 1:00:36

But that technology is there. And we were just getting back from Denmark, and in Denmark, they were using that technology during the 9 1 call taking process uh for people that were in cardiac arrest and saying, look, I think you should start chest compressions to the collar. Based on what you're saying, I think the person doesn't have a pulse, and the person's like, Well, I think they're breathing. No, those are what we call agonal respirations. We want you to start chest compression. And the person's like, no, no, I can't. In Copenhagen, they were doing research on it where they took, I could send a link to your phone, hold your phone over top of the patient. And that is able to determine if there's any kind of pulsatile blood flow.

SPEAKER_05: 1:01:08

Wow.

SPEAKER_00: 1:01:08

And with that, we can say, okay, no, I can tell you there's no blood flow there, start chest compressions, and they would. It improved the accuracy. So the technology side of things, uh, whether AI or it's the software or the apps, I think we've got an obligation of matching that tech to the patient's needs in a positive way.

SPEAKER_02: 1:01:27

I'm gonna ask you a weird more philosophical question on this. So so here's here's the challenge. So we use this technology, and it we we've all medically got to this point where we're at here now in life and society. I mean, are you we have any fear that the research was stopped? Like we want to keep going? Like so if we start relying on AI heavily enough that you know we we uh No we not uh I think I I think you can't beat human conversation. Yep.

SPEAKER_00: 1:01:50

There's tones there. You can tell that there's a soul on the other end of the phone on both ends. And uh people help people. And I don't think AI can do that. And I think that whether it's by phone or video or on site, uh humans are still gonna be here.

SPEAKER_02: 1:02:04

So that deeper human level and intuition still kind of gonna override certain things, certain feelings, no matter what.

SPEAKER_00: 1:02:10

Yeah, humans will have a gut impression, and that gut impression speaks volumes.

SPEAKER_02: 1:02:14

No, I believe that. 100%.

SPEAKER_00: 1:02:16

Like that rake outside in the hallway that you walked into saying, you shouldn't have gone that route.

SPEAKER_02: 1:02:22

Anyways, do we want to move to 10 questions? I think it's time we move on to our 10 questions.

SPEAKER_04: 1:02:28

So this is a fun little game we kind of throw some semi-rapid fire, right? Okay here, I'll kick it off with number one. So welcome to 10 questions. Here we go. Question number one: if an ambulance call had a theme song, what do you think it would be?

SPEAKER_00: 1:02:43

Theme song. Uh the James Bond uh intro theme. Oh, okay. Like Goldeneye kind of thing. No, like the ding-ding-ding ding ding ding ding ding ding ding ding ding ding ding ding ding ding.

SPEAKER_02: 1:02:56

I like it. I thought it'd be a little more punk rock personally, but but I I still like it.

SPEAKER_04: 1:03:01

Yeah, like, you know, dun dun dun dun dun kind of like I personally, if you want people's attention, I think it should be like immigrant song.

SPEAKER_02: 1:03:07

Oh that was just playing as the signs are going, you're pretty cool. Ah that'd be pretty cool. Okay. If you could add one fun or okay, if you could add one fun or ridiculous feature to every emergency room in Nova Scotia, what would it be?

SPEAKER_00: 1:03:26

Doodle boards.

SPEAKER_02: 1:03:27

Doodle boards.

SPEAKER_00: 1:03:28

Yeah, every every patient server should have a doodle thing so you can doodle on it, and that stuff, uh, I think it should have that.

SPEAKER_02: 1:03:34

That's great. Medical etch a sketch. I was hoping for like soft serve ice cream, where you just be like, oh, I'm gonna do a little sundae while you're there.

SPEAKER_04: 1:03:41

You know, uh while you're waiting. I certainly would take that. All right, question number three. In an alternate reality where you were a musician instead of a physician, what would your instrument of choice be? Drums. Oh, that was quick.

SPEAKER_00: 1:03:55

You like playing drums now? I air drums, which I sock at.

SPEAKER_04: 1:03:59

Right.

SPEAKER_00: 1:04:00

Yeah, it'd be drums. I just I I love uh percussion, the precussion drums.

SPEAKER_02: 1:04:05

All right, cool. Question number four of you. What's one thing that you think all people should have in their home to help them in a medical emergency that most people do not have? That they don't have. So think of something that you know you should have in your home in case of a medical emergency that you may not have.

SPEAKER_04: 1:04:30

Or if it's no, maybe it's like a metal straw for a tracheotomy or something.

SPEAKER_00: 1:04:34

Jeez.

SPEAKER_02: 1:04:37

Um or or or we we could solve that up. Maybe something that's that that's advisable to have to avoid a trip to the air, like uh to check blood pressure or uh uh anything like that. Is anything of those things really great to have in the home? Like a blood pressure cuff or uh a good a good tweezer. Good set of tweezers?

SPEAKER_00: 1:04:56

Yeah, you know what good tweezers is a good everyday carry item, have it in the kit available. One the Lee Valley one that actually is like on the keychain, that is a uh guaranteed win.

SPEAKER_04: 1:05:09

Can't sleep on a good set of tweezers, I agree. We have like four or five tweezers, and there's only one I'll use. Oh, yeah? Yeah. I got we have quite a few tweezers too. I live with two girls.

SPEAKER_00: 1:05:18

Really good tweezers. I'm sorry that took so long. No, no, no. It's a great question. No, you were reaching for the defibrillator because I took so long to answer.

SPEAKER_04: 1:05:25

All right, question number five. What's one of the most bizarre things that you have seen in the ER that you can legally tell us?

SPEAKER_00: 1:05:37

A moose foot in someone's abdomen brought in as a major trauma.

SPEAKER_01: 1:05:43

Whoa.

SPEAKER_04: 1:05:43

Like the foot. I'm thinking car accident. I'm thinking, I'm thinking car accident. Yeah. So yeah. Yep.

SPEAKER_02: 1:05:52

Wow. So what'd they do? They saw it off the the moose football.

SPEAKER_00: 1:05:55

No, no, no. The patient was uh was uh did well in that type of stuff, but yeah, a moose foot in someone's abdomen.

SPEAKER_04: 1:06:02

Wow, okay. Gotta get my moose by. Number six over to you, man. All right. Holy.

SPEAKER_02: 1:06:08

If if you could watch one last movie from all the shows you've seen in your lifetime, which one would you pick? I guess we're asking for an all-time favorite film. Uh Aliens. Great movie, dude. Yeah. Cheers to that.

SPEAKER_00: 1:06:21

I can do Aliens Karaoke. I can turn the volume off. I got all the lines memorized. I love that movie. Fantastic, it's Aliens. Yeah, number two.

SPEAKER_02: 1:06:29

Are you watching the new show?

SPEAKER_00: 1:06:30

Yes, Alien Earth.

SPEAKER_02: 1:06:31

Enjoying it? I did. Okay.

SPEAKER_00: 1:06:32

I love the pink pan reference.

SPEAKER_02: 1:06:34

I gotta finish it, but uh most of the way through.

SPEAKER_00: 1:06:36

Okay, no spoiler. I loved it. Yeah, aliens. Fantastic.

SPEAKER_04: 1:06:40

Question number seven. So what we saw one tonight, but what is your favorite card trick that you've ever performed?

SPEAKER_00: 1:06:47

Um, my favorite card trick is the next one that I do for my wife. Oh. I love her reaction when I do a card trick. She's been married for 30, over 30 years, and she is my uh I love doing a card trick with her, and that is my next favorite.

SPEAKER_04: 1:07:04

I love it. That's a great answer. Great answer. Yeah, yeah.

SPEAKER_02: 1:07:07

All right, number eight over to you. Okay. What is the bad habit? And please don't say beer, um, that could likely result in the most ER visit. You jumped a nine. What? Did I where we at? Oh, sorry. Okay. I'll just get I'll finish this one and then we go to U reading. Um, what's the bad habit that likely results in the most ER visits?

SPEAKER_00: 1:07:28

Uh the river disease. What's the river disease? Yeah, denial.

SPEAKER_04: 1:07:32

Oh, what a bad joke, bad pun.

SPEAKER_00: 1:07:35

Uh, it's it the most common thing is people um they don't pay attention. And it kind of goes back to the conversation before. Uh, it's pay attention to your instincts. Yeah. Uh I can't say enough. You know your body, your family around you knows you, and if something's not quite right, seek help.

SPEAKER_04: 1:07:50

All right. Question number nine. Your likeness has been casted in the ER-based soap opera. Who plays you as the actor?

SPEAKER_00: 1:07:59

Um, the fellow who is in uh Knight's Tale, he's British, he played Chaucer. Um the voice he was in the Marvel universe, he played uh computer guy. Um, oh yeah, okay.

SPEAKER_02: 1:08:14

Uh uh Vision, the guy that played Vision? Uh what's his name? Gosh.

SPEAKER_04: 1:08:18

Yeah, he all he was also in the the the what's it called, the Tom Hanks movie there. Great actor. Paul? Paul Biemini. BMini? Biemen Biemini. We'll just call him our friend Paul. Yeah. Yeah.

SPEAKER_00: 1:08:30

He's a fellow albino. Um are you albino?

SPEAKER_04: 1:08:34

No, I just like it's and the last question. All right.

SPEAKER_02: 1:08:39

Um, you wrote this in. I did. Can you can you take a look at the mole on my back?

SPEAKER_04: 1:08:51

There's too much hair there. I can't make it through the hair. Okay, so this is really funny today. Uh he sent me over these 10 questions, and all he had for question 10 was when.

SPEAKER_02: 1:09:01

Oh, did I not finish it?

SPEAKER_04: 1:09:02

No, it was just when.

SPEAKER_02: 1:09:04

Oh, geez, I probably just sent it.

SPEAKER_04: 1:09:05

So I'm gonna finish that. I was like, you know what? I'm gonna start this. I'm gonna make him ask that question. You did a perfect job. Yeah, good job. That was a great question. 10th question. But last call. Yes. So we have a last call, which is where we ask you for advice that you were given in your lifetime that you would like to share with us and our listeners.

SPEAKER_00: 1:09:27

Just stay connected with family.

unknown: 1:09:30

Okay.

SPEAKER_00: 1:09:31

That's the uh that's the my advice to my kids, uh to my family, to my friends, my colleagues, people that are important to me is just uh stay connected with your family. You can't beat it.

SPEAKER_02: 1:09:42

Great answer. That's awesome. Thank you so much for your time. We really enjoyed this. We learned a ton. You're welcome to come back anytime you want to talk about any issue. We would definitely welcome the second round of the new year. Thanks again. Awesome.

SPEAKER_03: 1:09:53

Thank you, folks. Stay well.