APA Statement on Fentanyl and Naloxone

The Alberta Paramedic Association is aware of the very real threat to public health that has emerged with the drug, fentanyl. To date, 213 Albertans have died from fentanyl overdoses and the APA absolutely supports the Health Minister’s objective of making the antidote, Naloxone, more available to Albertans.

Naloxone is essential to the timely treatment of overdose of opiate drugs; however, is not without risks if not administered appropriately, by the right medical professional.

In accordance with the Health Disciplines Act, EMT Regulation, Paramedics are presently the only prehospital professional in Alberta that is able to administer Naloxone. The drug has been successfully and safely administered by EMT level practitioners (Primary Care Paramedics) in other provinces for many years. Currently, there are over 4200 Emergency Medical Technicians in Alberta whom already possess the knowledge and skills to administer drugs by intramuscular and intravenous injection and a sufficient knowledge of pharmacology and toxicology.

It is the position of the APA that with appropriate education, EMTs can safely, and should be able to administer Naloxone for patients presenting with opiate drug overdoses. This policy change would enable Albertans in rural and remote communities, urban centres, as well as industrial settings, to have better access to this lifesaving drug.

Moving forward, in conjunction with the Health Ministers multipronged approach, we wish to work with our colleagues at the Alberta College of Paramedics, our Physician partners, and the Minister of Health to educate EMTs. As well as assist in raising public awareness as part of the response to this leading public health problem.

This challenge in responding to emerging public health threats highlights the need for Paramedic practitioners to transition to the Health Professions Act as soon as possible. Without this transition, Paramedics will continue to face difficulties in adapting our scope of practice and education to the roles that we are asked to fulfill, Impairing our ability to provide world-class prehospital care to Albertans.

Statement and action relating to recent media reports related to mental health

Mental Health Committee update;

The APA has received numerous requests for statement and action relating to recent media reports related to mental health. We would like to respond to those requests from practitioners as best we can with this summary.

The APA has an active Mental Health Committee that is currently working on developing an online registry of therapists specific to meet the unique needs of Alberta’s Paramedics. This includes; (1) conducting a literature search to identify common diagnosis facing Paramedics; (2) identify minimum certification levels competent and authorized to diagnose those conditions; (3) conduct a literature search to identify supported treatment modalities for those diagnosis; (4) identify minimum certification levels authorized to use those treatment modalities. Once those certification levels are identified, the therapists meeting those credentials may apply to be added to our registry at which time their practice will be reviewed by the committee to ensure they meet the criteria. Concurrently the Mental Health Committee is creating an ‘EMS Awareness Program’ for therapists to complete prior to being placed on the registry, and is officially recognized by the APA as an approved resource for paramedics seeking help.

As you can imagine, this has been a monumental undertaking, however, we have been able to attract a registered Psychologist to the committee, as well as build a team of Psychologist peers to review the work they are doing. We also have a neuroscientist student in their final year, who is involving a Ph.D. Psychiatrist for quality control purposes, as well as follow-up research. These Alberta registered Psychologists are all working voluntarily, and are key in the development of a provincial strategy. The mental health committee has learned many things along the way, and we want to share some of those with you.

Currently, in Alberta, the term ‘therapist’ covers many certification levels. These levels may include Behavioral therapist, Pastoral counselor, addictions therapist, Registered Social Worker, Registered Nurse, Occupational therapist, Registered Psychologist, Provisional Psychologist, Psychiatrist, plus much more. Further to those, there are subsets within those specialties, an example may be a registered Psychologist specializing in PTSD vs a registered Psychologist specializing in child behavior therapy who has never assessed/treated a patient with PTSD. If a Paramedic presents to their local doctor with symptoms of mental stress, that Paramedic may be referred to any one of these certification levels (it should be noted that referral is not necessary). This has been noted in quite a few cases lately, as the APA is being contacted by practitioners who have been referred to inappropriate therapists, and are dissatisfied with the results.

The mental health committee has identified that there is a subset of therapists who are more proficient in diagnosing and treating Paramedics suffering from mental trauma. There are also indicators that some therapists are not adequately educated and/or experienced to treat Paramedics suffering from mental trauma.

If a diagnosis of PTSD is made there are recognized treatment regimens that therapists must be trained in beyond their basic education. This is an important component of building the resource database for practitioners.

Scenario loosely based on actual cases handled by APA;
Currently, a family physician may remove a Paramedic from the workplace citing mental health. That Paramedic may be referred to a mental health practitioner who is inadequately trained to treat the mental health issue. After an extended treatment regimen, the therapist may feel the Paramedic may return to work, and provide a letter of support to the physician. The physician may then advise the employer and/or WCB that this Paramedic may return to work, although this particular Paramedic has not had proper treatment as defined by the Canadian Mental Health Association. This Paramedic is now at risk of being further injured by sustaining the continued mental trauma we are all exposed to in our profession. The mental health committee has seen this scenario play out multiple times over the last few months.

With this scenario in mind, it is obvious and time sensitive that we work together as a profession to demand better for our practitioners. Once a Paramedic asks for help, there should be no barriers in receiving the kind of specialized therapy we deserve, to address the mental injuries we sustain from our unique workplace. Furthermore, once a Paramedic has completed treatment, we need to have a standardized return to work process that ensures the practitioner has indeed received the proper treatment and is fit to return to full duties. This kind of work is the mandate of an association.

Your mental health committee’s first goal is to complete the literature searches and build the provincial resource database for all practitioners seeking help. Once that database is completed, the committee can get to work on the next goals of creating an entry to practice pre-screening, formalizing a re-entry to practice strategy for those restricted from regular duties, as well as lobby the family physicians to ensure Paramedics get the right referral the first time.

The recent controversy regarding paramedicine and mental health highlights the need for a strong unified association. The work the mental health committee is doing is 100% voluntary outside our full-time jobs. We strive to expedite our work to reach our goals faster and respond to practitioners needs immediately, however, work such as literature searches, and limited volunteer hours by allied health professionals puts limits on how quickly we can reach our goals. With more support, and increased membership we can expedite this time-sensitive work by employing individuals on a short-term temporary basis to do complete some of these time-consuming tasks.

Please contact us with any questions or comments

info@albertaparamedics.ca
http://www.albertaparamedics.ca/

Together we are stronger.
Alberta Paramedic Association
Mental Health Committee